Let’s improvise the diagnosis. How knowing when to wing it by sticking to the rules can help in the emergency room
January 24, 2017
For Dr. Gregory House, the popular protagonist of the successful hit TV series, one look on the fly is enough to make a complex diagnosis. It’s fiction, of course, but maybe one that’s not so detached from reality – and, even more surprisingly, from practices that can enhance what’s offered from medical and health services.
If medical practice has, year after year and worldwide, increasingly taken the form of a highly specialized and highly standardized profession, the art of improvisation – also understood as being receptive to a particular case, reactive in the face of unexpected, attentive to detail – remains an important aspect of the job in emergency units.
The fact that standardization and improvisation, especially in such a delicate area, can work together in a fruitful way seems to be a contradiction: and yet these two attitudes are far from being incompatible, though there is still a lot to be done – by researchers and professionals – to find out how much knowing how to decide and when to act can have an effect in highly structured and institutionally complex environments such as hospitals and specialized clinics.
In a study conducted with an international research team, Luca Giustiniano, professor of Corporate Organization at LUISS University, shows how improvisation operates as a productive element in a strictly controlled work environment like an emergency room. Close on site observation showed how, maybe in a counterintuitive way, the simultaneous absence and presence of improvisation – absent as it is banned by the strict rules and rigid protocol compliance by doctors and nurses; Present as it’s natural brought about by the unpredictable urgencies of patients – has worked as a useful tool for the overall improvement in organizing rescue units.
Providing an example, a positive improvisation ended up being the basis for new, more standardized procedures and work processes. It may sound like a paradox, but it’s also an example of unexpected organizational effectiveness, which can be used as a virtuous example by everyone. Unless you work with Dr. House.