Yesterday, I wrote about an absolute must-read book: The Checklist Manifesto: How to Get Things Right

It has been shown in an extensive world-wide study that a simple checklist used in surgery cuts infection rates, cuts death rates, and saves costs. It does all of these by substantial margins, everywhere they’ve been implemented. But so far only a minority of hospitals (Dr. Gawande mentioned 10 percent) have started using the safe surgery checklist, or any others, for that matter.

Yet today, the New York Times has an article titled “Results Unproven, Robotic Surgery Wins Converts.” Here are the most important quotes:

But robot-assisted prostate surgery costs more — about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same.

[...]

Last year, 73,000 American men — 86 percent of the 85,000 who had prostate cancer surgery — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical, the only official source of such data. Eight years ago there were fewer than 5,000, Intuitive says.

[...]

[O]nce a hospital invests in a robot — $1.39 million for the machine and $140,000 a year for the service contract, according to Intuitive — it has an incentive to use it. Doctors and patients become passionate advocates, assuming that newer means better.

[...]

And the robot is slow; it typically takes three and a half hours for a prostate operation, according to Intuitive, twice as long as traditional surgery.

So in this particular kind of surgery, a majority of surgeons quickly take up a new technology that has yet to show it can provide any sort of benefit! The same procedure is now slower and much more expensive. And the same doctors are resisting adopting a simple checklist (for little to no cost) that conclusively show improved results.

Not to make too much of a political situation here, but our health care system is clearly a mess. Doctors clearly don’t always know what’s truly important for their patients. I’m not saying surgeons shouldn’t use robots, but exhaust the easy, cheap, and conclusively better tools first! Use a damn checklist!

Back in 2007 I read a fascinating article called “The Checklist” written by Dr. Atul Gawande in the New Yorker. Atul Gawande is a practicing surgeon, MacArthur Fellow, Rhodes Scholar and professor at Harvard Medical School and Harvard School of Public Health. The article described how a doctor convinced a group of hospitals in Michigan to do a wide-spread trial of a simple experiment: a checklist. The checklist aimed simply at making sure staff completed five key steps to limit central line infections, an unfortunately common source of infections in hospitals.

The result?

In one hospital:

• 10-day infection rate went from 11% to ZERO
• Prevented 8 deaths
• Saved $2million in costs

Across ICU’s in Michigan:

• In three months cut infections by 66%!
• Typical ICU cut infection rate to ZERO
• In 18 months, prevented 1500+ deaths
• In 18 months, saved $175,000,000

These are amazing results, and his book on checklists, “The Checklist Manifesto,” was recently published. Click below to order it from Amazon.

This book is inspiring, educational, engaging, riveting and fascinating. It’s extremely well-written, and is a fairly easy read. I’ve never written a blog post immediately after finishing a book, but I am now because not only is it GOOD, but this book is IMPORTANT.

Dr. Gawande led a huge study of a “safe surgery” checklist, a simple set of steps to be checked in each surgery. It was used and studied in eight hospitals: four in the developed world (US, UK, etc.) and four in the developing world (Tanzania, New Delhi, Jordan, Manila). Thousands of patients were studied for months before and after checklists were implemented. The results?

• Rate of complications fell by 36%
• Deaths fell by 47%
• Infections fell by nearly half
• Even in advanced hospitals in developed world, complications were decreased by one-third

I mean…. WOW! Cutting infection rates and death rates in surgery by half (with marginal differences between developed and developing countries) is simply incredible.

But here’s a choice quote from the book:

Take the safe surgery checklist. If someone discovered a new drug that could cut down surgical complications with anything remotely like the effectiveness of the checklist, we would have television ads with minor celebrities extolling its virtues. Detail men would offer free lunches to doctors to make it part of their practice. Government programs would research it. Competitors would jump in to make newer and better versions. If the checklist were a medical device, we would have surgeons clamoring for it, lining up at display booths at surgical conferences to give it a try, hounding their hospital administrators to get one for them – because, damn it, doesn’t providing good care matter to those pencil pushers?

Checklists are powerful, and not just for surgery. Gawande writes about data from investment managers and venture capitalists that shows that those that use checklists are much more successful than those that don’t. They’ve been used in aviation for 70+ years, ever since airplanes became so complicated as to be dangerous without checklists. The modern construction industry uses checklists to ensure their projects are safe and properly constructed.

I’m very familiar with checklists; operating a nuclear reactor in a US Navy submarine means you live with checklists in everything you do. But I accepted it without too much thought since we had no idea there was any other way of running such a complicated machine. It’s amazing to me that other complex professions don’t also use the same procedures.

Checklists are threatening to many people and professions. Using them implies that professionals don’t know what they’re doing, that they don’t have the ability to do their jobs. Even with the results described in surgery above, many surgeons still don’t use them. (Despite the fact that they continually prove to save patients’ lives, everywhere.) As Dr. Gawande describes above, if the same results were achieved through a pill or machine, doctors and hospitals would be racing to adopt them!

Dr. Gawande goes into real detail not only in what makes a good checklist and how to develop them, but also why they work. They work by simply making sure that key simple steps are accomplished, and by freeing your brain from concerning itself about the easy stuff (since the checklist will catch anything you miss). This frees the brain to think about the hard stuff, and able to deal with complications more directly. Good checklists also make communications easier, so that when things do go wrong, the experts involved can address them more directly.

Fundamentally, time after time, in study after study… checklists WORK.

Summary

This is a hugely important book, and I honestly can’t recommend it more highly, It doesn’t matter what industry you’re in, if you deal with or manage complexity, you NEED to read it.

If you want to efficiently improve your performance or your teams’ performance quickly and substantially, a checklist is your way to do it.

The week of 25-29 January 2010 is going to be absolutely awesome in Cambridge. There are three great events that you need to attend.

Of these, it’s most important that you come to the Cambridge Tech Meetup. We’ll be kicking the year off with a bang and six “wicked awesome” technology demos, from people/companies based in Cambridge.

Tuesday – January 26th – Enterprise Tuesday

Time: 6:30-7:30pm lecture (registration from 6pm, networking afterward)
Location: Lecture Theatre 0, Engineering Department, Trumpington Street
Speakers: Neil Davidson, Co-Founder and joint CEO, Red Gate Software; Steve Barlow, Co-Founder, Alphamosaic; Alex Mehta, Communications Director, Judicium

Enterprise Tuesday is a great event, and the topic for next week is “Building a Dream Team.” I recommend this specifically because I think incredibly highly of Neil Davidson, who co-founded Red Gate software and continues to serve as co-CEO. (In addition to founding the Business of Software conference, serving as Chairman of the Cambridge Network, and starting the Springboard programme at Red Gate.)

Link: http://www.cfel.jbs.cam.ac.uk/programmes/enterprise/timetable.html

*** Wednesday – January 27th – Cambridge Tech Meetup ***

Time: 6:30pm doors for 7pm start of demos (additional Q&A and discussion afterward)
Location: Lecture Theatre 1, Judge Business School, Trumpington Street

If you have to pick one event, come to the Cambridge Tech Meetup! (Yes, I started it with the help of many, many others.)

Six products will have has seven minutes to demo their technology/product; all of them developed in Cambridge! Everything from new display technology to cool video search technology to audio analysis and 3d model building via webcam will be demo’ed.

Demo companies/technologies are:

• Light Blue Optics – http://lightblueoptics.com
• Taptu – http://taptu.com/
• Cambridge IPTV – http://www.cambridge-iptv.com/
• AudioAnalytic – http://audioanalytic.com/
• ProFORMA – http://mi.eng.cam.ac.uk/~qp202/my_papers/BMVC09/
• Prismastar – http://www.prismastar.com/

Link for info and to RSVP: http://www.meetup.com/Cambridge-Tech-Meetup/calendar/12221063/

(The sharp-eyed among you will notice that this takes place shortly after the big Apple announcement on the 27th. I’ll be sure to have the screen tuned to a live-blog or tweet-stream until the demo’s kick off.)

Thursday – January 28th – Cambridge Business Lecture: Dan Pink

Time: 6pm start (networking afterward)
Location: Robinson College, Grange Road
Speaker: Dan Pink, best-selling author, writer, speaker

This event is a Cambridge Business Lecture, hosted by the Cambridge Network. Dan Pink is a great author/writer, and I think it’s just fantastic he’ll be speaking in Cambridge. If you’re in town, go.

Link: http://www.cambridgenetwork.co.uk/events/article/default.aspx?objid=65628

A lot of people have been talking about and playing with location-based applications these days. I wanted to put my two cents into the debate, specifically on Flook, Gowalla, and Foursquare.

Flook

Flook is the least-known of these three apps, but potentially the most interesting. Users take photos (which are automatically geo-tagged) and then add captions and information about the photo. What’s cool is that if you go somewhere new, you can quickly pull up the interesting places nearest to you. That might be a pub, a cool shop, or virtually anything else. And of course there’s a comments section around each card, too.

For me, the current downfall of Flook is that it’s iPhone-only, and I’ve recently moved to an Android phone. It’s also difficult to find and follow people you know, unless they’re in the same area and you see their cards normally.

Fundamentally, Flook is a hugely rich source of interesting information, with a *fantastic* user interface. I highly recommend that you download it for your iPhone and try it out. (Disclosure: I know the founders/investors of Flook, and think highly of them.)

PS- They’re currently running a competition to win a MacBook Air by just making cool Flook cards… check it out by clicking here.

Gowalla

Gowalla competes directly with Foursquare, and I have to definitely give the edge to Gowalla. It’s a beautifully made application, and what I love about it is the metaphor that Gowalla uses: a passport. Users are encouraged to get “stamps” in their “passport” for visiting new places. You earn and collect cool items from commissioning/founding new places, and can drop them off and pick up other cool items anywhere you visit. It’s definitely helped me think about new and interesting pubs, restaurants, etc. near me. (And of course see where your friends are checking in, too.)

While Gowalla has an iPhone app, their Android interface is through a web application. (http://m.gowalla.com) It has 80% of the functionality; the only major thing it’s missing is the ability to see and drop off your “items”.

[UPDATE]: I forgot this in my original post, but Gowalla lets you add locations anywhere in the world, and not just in particular cities like Foursquare. For example, I was at a conference at a huge convention center in southwest Ireland recently and added that to Gowalla, no problem. (Unlike Foursquare.) Foursquare may be rolling out to new cities all the time, but Gowalla can be used anywhere in the world right now.

Foursquare

Foursquare is bigger (in number of users) than Gowalla and has top-flight investors (Union Square Ventures), but I just don’t care for it. Its design is good, but not beautiful like Gowalla’s. But the biggest thing is the metaphor of points & mayorships that Foursquare uses. Each week a user’s points gets reset, and you have to keep checking into places to get and keep your “mayorship.”

To me, the metaphor of “mayorship” is a recipe for stagnation. It encourages users to go back to the same places over and over, and the mayorship will likely only rotate amongst a small number of regulars. For me, I quickly became the mayor of places where few other people checked in, and was out of the running for mayor-ships where I went regularly but where others checked in far more frequently. In both cases, my incentives were to stop using it.

Now, Foursquare does have a native application for both iPhone and Android, and it has excellent advisors. The founders previously started Dodgeball, a similar application which was bought by Google (where it stagnated) a couple years ago. It will need some better execution to get over its current problems. While Foursquare might be popular now with early adopters, I think it will have serious problems if/when it goes mainstream.

Summary

So I’m a Flook user when I have my iPhone handy, and I’m definitely a Gowalla user. Gowalla is great to track cool places I’ve been and where my friends go, and Flook is great to find interesting stuff that I might otherwise miss. Definitely give both a try.

So the reason I haven’t posted here in a while is because I got a new job!

As of about six weeks ago I started working full time with Google as a Strategic Partner Manager, in the EMEA Reseller team. It’s been fun, exciting, and a lot of work and material to learn and (hopefully) master in quite a short amount of time.

If you’re curious what “Reseller” means at Google, here are a couple of links:

• The Reseller program description
• A YouTube video pitched at potential new Resellers

Finally, a disclaimer: The views and opinions I post here on my blog are mine, mine alone, and not those of my employer. I don’t (and wouldn’t presume to) speak for Google. (And no, I can’t talk about any cool new stuff that hasn’t been released. Most of the time I only find out about it when it’s released, anyway.)

It’s going to take a while before I get back to posting regularly, but I’ll eventually find the time.

Note 1 – A VERY local Failblog

If you haven’t ever heard of Failblog, it’s simply hilarious. Every day there are a ton of photos and videos that can only be described as “FAIL.”

But Thursday there was a post called “Bus Driver Fail“. What’s great about this is that the video was taken at my local bus stop! It’s literally just a couple hundred meters from home.

Just check out the video here:

[If you can't see the video, just click here.]

Note 2 – A Wikipedia entry for a 500-person town

When I was very young, I grew up in the rural Minnesota town of Danube, Minnesota. The other day I just happened to look it up on Wikipedia, and found the entry hilarious. Clearly some local has turned it into a bit of a brochure for small-town America. Examples include:

Danube Pride

While the people of Danube may appear to be normal small-town dwellers, they in fact have a very rare and highly regarded sense of pride for their quaint city in Minnesota. Many residents have been noted as saying proudly, “Danube is the heart of God’s Country.” or a blunt reply, “This is Danube, of course it’s awesome.” This is most evident in the people who were born and raised in or near Danube. This sense of pride typically continues into adulthood and in many cases it continues even after they have moved away from their hometown.

and

Activities

The youth of Danube enjoy some unique activities that help to keep Danube special. The youth ride bicycles as their way of getting around, and typically have ridden their bikes through the streets and sidewalks of Danube enough to accumulate 5,000 miles (unofficially). Skinned knees are an epidemic with these youth. [...]
In their teenage years, residents will typically discover that the Danube water tower can be climbed (much to the chagrin of the city maintenance workers and the lone police officer) for a great view of the city and the surrounding area. [...]
Adult activities include “going up town” for lunch at the cafe, catching up with the gossip at “The 1-Stop”, “going up town” to get the mail, or attending the high school’s various sporting events. Nightlife is monopolized by Miller’s on Main – the residents’ only choice for a place to sing some karaoke.

On a side note, my mother used to own the cafe mentioned above…

As a former resident of Danube, I suppose I have to have that “Danube Pride” described above. And to be fair, I do have fond memories of the town, though generally through visits with family friends after we moved away…

Note 3 – Google Waving

If you haven’t heard of Google Wave, it’s a new tool for collaborating that Google announced earlier this year. I recently got an invite and have been playing around with it. (If you’d like an invite yourself, just let me know.)

But here’s a video of Google Wave, um… “simulating” the movie Pulp Fiction. It’s pretty funny. Check it out here: (Not safe for work)

I noticed a few weeks ago that Marc Andreessen had deleted virtually everything off his blog. The only thing that’s left is the post announcing the formation of his VC firm, Andreessen Horowitz.

I’ve been such a huge fan of Marc’s writing, and hated to see so many brilliant and incredibly helpful posts lost. So I went to the Internet Wayback Machine and copy/pasted all the posts they had (through March 2008). I had also subscribed to Marc’s blog via Feedburner e-mail, so grabbed all of the e-mails I had saved to fill in the gaps.

To be clear, I have no ulterior motives other than making sure that Marc’s posts can be found and useful to entrepreneurs everywhere. (And if Marc wants me to take it down, I would reluctantly do so… hopefully he won’t!)

blog.pmarca.com was like a meteor from June 2007 through the spring of 2008. Here are a bunch of my favorite posts:

• The Pmarca Guide to Startups, part 1: Why not to do a startup
• The Pmarca Guide to Startups, part 2: When the VCs say “no”
• The Pmarca Guide to Startups, part 3: “But I don’t know any VCs!”
• The Pmarca Guide to Startups, part 4: The only thing that matters
• The Pmarca Guide to Startups, part 5: The Moby Dick theory of big companies
• The Pmarca Guide to Startups, part 6: How much funding is too little? Too much?
• The Pmarca Guide to Startups, part 7: Why a startup’s initial business plan doesn’t matter that much
• The Pmarca Guide to Startups, part 8: Hiring, managing, promoting, and firing executives
• The Pmarca Guide to Startups, part 9: How to hire a professional CEO
• The truth about venture capitalists, Part 1
• The truth about venture capitalists, Part 2
• The truth about venture capitalists, Part 3
• The Pmarca Guide to Career Planning, part 0: Introduction
• The Pmarca Guide to Career Planning, part 1: Opportunity
• The Pmarca Guide to Career Planning, part 2: Skills and education
• The Pmarca Guide to Career Planning, part 3: Where to go and why
• The Pmarca Guide to Big Companies, part 1: Turnaround!
• The Pmarca Guide to Big Companies, part 2: Retaining great people
• Luck and the entrepreneur, part 1: The four kinds of luck
• Counterpoint: Ben Horowitz on micromanagement
• CEO Crime & Punishment
• The three kinds of platforms you meet on the Internet
• Age and the entrepreneur, part 1: Some data
• The Pmarca Guide to Personal Productivity
• How to hire the best people you’ve ever worked with

Click here for the full archive on pmarca-archive.posterous.com

Some quick cautions and warnings!

• The link addresses aren’t changed, which mean they’re prefaced by the Internet Wayback Machine archive link. If you look at the link you’ll figure out which part to delete to go to the right address.
• Some videos have been taken down, or I couldn’t find the embed code.
• I tried to include every post he made and not filter anything. However, I may have missed a few. Please let me know (via comment below) if you have any that aren’t in the archive.

I hope this is useful to some of you out there. And Marc, if you read this, I’m a big fan and only mean for this to help the millions of entrepreneurs you’ve inspired.

So my undergraduate degree is in aerospace engineering, from the University of Michigan. (Go BLUE!) As I wrote yesterday, I am and always will be an aero geek.

But perhaps I also chose it for long-term earning potential? A blog post in the New York Times showed this graph of the “Top 10 College Majors That Lead to High Salaries”:

Of course, I didn’t choose it for the salaries; I just love aerospace technology.