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!

The definitive proof? This song: There’s no one as Irish as Barack O’Bama

(Lyrics here) And a better video can be seen if you click on this link. The band disabled embedding videos…

I’m incredibly happy and proud for the United States to have the new leadership that we will soon have. It’s going to be an incredibly challenging time, and the next four years will not be easy for Obama or the country. But I feel that we have a wise, capable and visionary leader.

But I wanted to take some time to reflect on some themes around Barack Obama and his campaign. Fred Wilson posted his list of what he believes the country can expect from an Obama administration:

1. A world class management team
2. Honesty
3. A steady hand
4. Diplomacy
5. Fairness
6. Leadership

There’s a reason that “A world class management team” is at the top of the list, and it’s closely tied to “Leadership.” It’s clear from articles like “Near-Flawless Run is Credited in Victory” that Obama built a solid team. Not only that, but he had the confidence to push out a tremendous amount of responsibility to his organization. From a military outlook, it was an excellent example of what is called “maneuver warfare.” But there’s a great example of his management and leadership styles colliding in this video of his talk to his Chicago campaign headquarters just after securing the Democratic nomination. I encourage you to take 10-15 minutes to observe what Barack Obama is like as a leader:

Obama is clearly a charismatic leader. Just take a look at this incredible collection of photographs from the Boston Globe. And because I think they’re both still so meaningful, check out his New Hampshire concession speech and the video that was made from it. Even in defeat he lifted people up and inspired them.

Finally, I’d like to remind everyone that elections matter. I recently created a prediction market on Hubdub for something that I think will become very critical quite soon: Supreme Court nominations. I encourage you to register on Hubdub and predict for yourself!

How many US Supreme Court Justices will retire by the end of 2009?

• Top Gear! - Top Gear is back on television! One of the best shows on TV anywhere, it started its new season last night. Really funny, and just lots of fun to watch.

  This also allows me to bring up a HUGE pet peeve of mine with British TV. They do a HORRIBLE job of promoting new seasons of shows. With American TV, new shows debut around the same times of year (September, January, etc.) and the channels promote that the shows will be starting soon. On the BBC, I have NEVER heard that the new Top Gear season will be starting, even though I was checking their website every few weeks!

  For a show that makes a tremendous profit for the BBC, you’d think they would try to make sure that people are actually… you know… WATCHING IT?

• Lewis Hamilton - Well done to Lewis Hamilton and the rest of the McLaren team. (Though I doubt he’s reading, congrats Oli!)

  If you don’t follow Formula 1 (far too many Americans, unfortunately), Lewis Hamilton just won the Drivers Championship yesterday in one of the most thrilling and nail-biting races I’ve ever seen or heard of! Coming into the last race (Brazilian Grand Prix), Lewis Hamilton was leading in number of points, but his only competition (Felippe Massa) has always dominated in Brazil, his home country. Even if Massa won, as long as Hamilton placed fifth or better he would become Formula 1 champion.

  The race was crazy. Rain at the start delayed the race and forced teams to upend their strategy as they changed tires to Wets. Hamilton stayed in fourth or fifth for the majority of the race and seemed to be playing it safe in order to win the championship. But on the final ten laps of the race, rain came out again, forcing teams to choose to either leave “slick” tires on and hope it didn’t rain hard or go into the pits and get their “wet” tires.

  On the second to last lap, Hamilton was in fifth place but passed! He drove like crazy trying to catch up, but didn’t, and the championship slipped out of his grasp… Massa crossed the finish line in first place. But out of nowhere, Lewis Hamilton passed the car that had been in third place! It hadn’t pitted to get new tires, and was slow on the wet track. Hamilton caught up and passed him just seconds before crossing the finish line… in fifth place!

  It was an amazing race. Lewis Hamilton became the youngest person to win the Formula 1 World Championship, and the first black man to win the Formula 1 World Championship. Britain hasn’t had a driver win the championship in twelve years, so the country is deservedly celebrating!

• Barack Obama - Is Lewis Hamilton’s victory a portent of things to come in tomorrow’s election? I certainly hope so. According to fivethirtyeight.com, he’s heavily favored… winning >95% of the simulations.
• Prototype - The prototype for my new venture is nearing completion. While it is FAR from perfect, I will be launching it within my MBA class here at Judge Business School soon to start getting feedback from real users. The U/I in particular is rather crude (my fault), but I’ve been talking to a really talented guy (a fellow Jesus College grad student) who’s going to be helping me out on the coding/design end of things.

  I do promise to write more about this soon, but that post will take longer to write than I have today!

For people that are interested in Obama, his grassroots/volunteer movement, or politics in general, I would encourage you to watch this short (2.5 minute) video. It’s a very touching story about an elderly volunteer in one of his Colorado offices.

• Stephen Hawking will be retiring from the Lucasian Chair of Mathematics at the University of Cambridge. Apparently it’s traditional for the person in the post to retire at 67, which he’ll be next year. I didn’t realize he was so old! But he’s certainly still active at the University… a friend of mine has seen him a couple of mornings as he heads to work. For the history buffs out there, this is the same professorship that Isaac Newton held from 1669, as he did most of his pioneering work.
• Speaking of Stephen Hawking, he dedicated a new clock at Corpus Christi College (the Chronophage, or the Corpus Clock) just a couple of days before I arrived at Cambridge. It’s really amazing; it’s a huge pendulum clock, has a big grasshopper at the top, and doesn’t have any hands. (It uses LED’s instead.)
  

  Here’s a video:
  

  What’s perhaps most amazing is that virtually every time I walk or bicycle past it between 2 and 10 times a day people are standing by it, watching it, and taking photos. No matter the time of day or night! I think there’s only been four times in five weeks that I’ve gone by it without someone there! It’s really that captivating.

• I recently saw an interesting article on Gordon Ramsey. Yes, he’s making tons of money from TV, books, restaurants, etc. But what’s most amazing to me is that he owns:

  1 – Three-star Michelin restaurant
  2 – Two-star Michelin restaurants
  2 – One-star Michelin restaurants

  For my birthday dinner a year ago, LondonAnnie and I went to Maze, his one-star restaurant on Grosvenor Square in London. It was absolutely amazing; the food was incredible, the service was brilliant and we had such a great time. The article mentioned this is his highest-earning restaurant, with revenue in excess of £10million a year!

• This is a great quote from Evan Williams:
  

  Starting a company is like landing on the shore of a deserted island

  You have a certain amount of provisions, which you have to make last until you find a way to make the island sustain life—or convince someone to send you more.

  You don’t know how big the island is at first or what predators lie in wait.

  There’s always a chance someone else will raid your island if it looks fruitful, so you need to shore up your defenses.

  Eventually, if you’re successful, you’ll be king of your own prosperous world. If not, you’ll die—or, at least, have to go home.

  Either way, it’s a fun adventure (until you get eaten by a tiger).

• I really feel for Barack Obama. Just as he’s about to achieve the triumph of a lifetime, his last family member is in her final days. I simply hope that his grandmother will live to see him elected.
• If you’re fascinated by the current US election, and haven’t gone to fivethirtyeight.com, GO THERE RIGHT NOW. It’s a site run by a legendary baseball statistician, Nate Silver, who has turned his attention this year to the election. In the primaries he made some calls that were well outside the conventional mainstream (in particular Hillary barely winning Indiana and Obama winning North Carolina huge) that were spot on. As of right now, it looks like McCain has about a 5% chance of winning the Presidential election.

HOLY ****!

Why do I say this?

In less than two years the Space Shuttles are scheduled to be retired, leaving the United States without the capability to get manned missions into orbit. Meanwhile, we’ll be paying the Russians to get to the International Space Station and the Chinese will be progressing toward their stated goal of putting a Chinese astronaut on the moon.

Here’s a quick reminder: the United States went from the first spacewalk to landing men on the moon in 4 years and 1 month. I don’t think there’s anything standing in China’s way from doing the exact same thing. (Though according to Wikipedia their plans aren’t nearly that ambitious time-wise.)

I bring this up because I’m quite concerned about the United States’ competitive capacity and ability to innovate on the governmental level. While smaller firms have seen good success (Scaled Composites with the X Prize/Virgin Galactic, SpaceX with modern launch vehicles) I feel we’re falling behind on major government-level initiatives. That it’s feasible in five years’ time that the United States has to pay Russia just to get into space while China is landing missions on the moon at will is unacceptable. It’s a competitiveness issue and a national security issue, and it needs to be better understood by Americans.

But before we go, here are a couple of cool links/stories I wanted to pass on:

• Checklists for Doctors (from the New Yorker): A simple four-step checklist managed to reduce infection rates in intensive care units by 66%! In eighteen months, the group of hospitals saved 1500 lives and $175million.

  No matter how good someone thinks they are, and how much study they’ve done of complex procedures, checklists are absolutely necessary. After three years running a nuclear reactor, I can say this with certainty. While we were trained to be able to do everything without instructions, we failed any procedure where we didn’t use them.

  I really hope this is something that actually catches on in the medical community. It’s long overdue

• Looking for a quick laugh? I keep forgetting to check McSweeney’s. This feature is great: “Corrections to last month’s letters to Penthouse Forum.” (via kottke)
• If you like politics, and don’t mind a little math, you have to check out FiveThirtyEight.com. Developed by Nate Silver, who’s a pioneer in sabermetrics (aka baseball statistics), it’s a really deep look into the state of the Presidential and Senate races for this election. Very light punditry, very heavy math.

And to end this post, photos of Elise and Sarah’s bronze in Athens 2004, as well as Elise and Anna’s World Cup gold in June of this year.

http://www.clubforgrowth.org/2008/04/what_is_a_prediction_market.php

I somehow doubt they know that they are currently featuring on their front page a video created by someone who’s a strong supporter of Barack Obama.

Like I said… I’m not sure what to think…

(If you’d like to watch the video, click here to get to it on YouTube.)

One of the supposed questions about Barack Obama is based on the fact that he doesn’t have the executive experience that many recent Presidents have had, as a Governor or leading a major agency of some sort. Marc asked Obama about it, and here’s what he wrote:

We asked him directly, how concerned should we be that you haven’t had meaningful experience as an executive — as a manager and leader of people?

He said, watch how I run my campaign — you’ll see my leadership skills in action.

At the time, I wasn’t sure what to make of his answer — political campaigns are often very messy and chaotic, with a lot of turnover and flux; what conclusions could we possibly draw from one of those?

Well, as Marc wrote, the answer is pretty clear:

Well, as any political expert will tell you, it turns out that the Obama campaign has been one of the best organized and executed presidential campaigns in memory. Even Obama’s opponents concede that his campaign has been disciplined, methodical, and effective across the full spectrum of activities required to win — and with a minimum of the negative campaigning and attack ads that normally characterize a race like this, and with almost no staff turnover. By almost any measure, the Obama campaign has simply out-executed both the Clinton and McCain campaigns.

This speaks well to the Senator’s ability to run a campaign, but speaks even more to his ability to recruit and manage a top-notch group of campaign professionals and volunteers — another key leadership characteristic. When you compare this to the awe-inspiring discord, infighting, and staff turnover within both the Clinton and McCain campaigns up to this point — well, let’s just say it’s a very interesting data point.

Compare that to the NYTimes article on Hillary Clinton:

But even as Mrs. Clinton revived her fortunes last week with victories in Ohio, Rhode Island and Texas, the questions lingered about how she managed her campaign, with the internal sniping and second-guessing undermining her well-cultivated image as a steady-at-the-wheel chief executive surrounded by a phalanx of loyal and efficient aides.

“She hasn’t managed anything as complex as this before; that’s the problem with senators,” said James A. Thurber, a professor of government at American University who is an expert on presidential management. “She wasn’t as decisive as she should have been. And it’s a legitimate question to ask: Under great pressure from two different factions, can she make some hard decisions and move ahead? It seems to just fester. She doesn’t seem to know how to stop it or want to stop it.”

and

Still, interviews with campaign aides, associates and friends suggest that Mrs. Clinton, at least until February, was a detached manager. Juggling the demands of being a candidate, she paid little attention to detail, delegated decisions large and small and deferred to advisers on critical questions. Mrs. Clinton accepted or seemed unaware of the intense factionalism and feuding that often paralyzed her campaign and that prevented her aides from reaching consensus on basic questions like what states to fight in and how to go after Mr. Obama, of Illinois.

Mrs. Clinton showed a tendency toward an insular management style, relying on a coterie of aides who have worked for her for years, her aides and associates said. Her choice of lieutenants, and her insistence on staying with them even when friends urged her to shake things up, was blamed by some associates for the campaign’s woes. Again and again, the senator was portrayed as a manager who valued loyalty and familiarity over experience and expertise.

As I’ve written a couple of times before, he’s got my vote!