Effectiveness: Degree to which an action is capable of producing an intended result
BASKETBALL: Abdul-Jabbar’s skyhook was indefensible due to his superlative technique, height, and athleticism, among other positive attributes. It was undoubtedly effective in overcoming opposing players and teams.
HEALTHCARE: Many interventions have been proven to work, i.e. they are evidence-based. By employing evidence-based practice, hospital teams improve their odds of achieving the clinical outcomes they desire.
Reliability: Dependability; Freedom from failure over time
BASKETBALL: It’s one thing to have an effective shot in your repertoire, it’s another to shoot it as consistently as Abdul-Jabbar. He not only scored more points than anyone else in the history of professional basketball (38,387), but also boasts a remarkable career field-goal percentage of 55.95%. That’s making nearly 56 out of every 100 shots, ranked all-time tenth in arguably the toughest league in the world!
HEALTHCARE: Effective interventions need to be delivered with high reliability, i.e. consistency, to maximize their potential. Conversely, failing to execute evidence-based interventions reliably, say more than 85% of the time, might have significant negative consequences. For example, studies have demonstrated that smoking cessation counseling in patients with coronary heart disease (heart attack or angina) reduces the death rate by 36%. Reliability of 29% – the rate at which this intervention is provided in the USA – reduces the overall effect to only 10% (0.29 × 0.36) reduction in the death rate. Also, consider the patient’s perspective: If you just suffered a heart attack and were a smoker, wouldn’t you like your risk of dying over the next five years reduced from 20% (with no smoking cessation counseling) to 13% (with counseling)? Abdul-Jabbar increased his probability of scoring by releasing the ball closer to the basket. Similarly, improvement teams can improve the consistency in which they deliver care processes by applying reliability principles.
Teamwork: Collaboration to achieve a common goal
BASKETBALL: To accrue as many points as he did, Abdul-Jabbar needed opportunity. Team maneuvers were devised, and executed with precision, to create opportunities for him to shoot his skyhook. His teammates played their part so that he – and they – could capitalize on the former’s unique offensive weapon. Abdul-Jabbar, and the teams for whom he played, won a total of six NBA (professional league) and three NCAA (college) championships.
HEALTHCARE: In healthcare, the main goal is to do good by the individual patient. The system needs to develop and support high-performing teams, and the key individuals who lead them, so that they can reliably deliver high-quality care. Unfortunately, this happens less often than it should. For example, overstretched staff working in flawed hospital systems cannot be expected to reach peak performance and deliver the best care possible.
Basketball and healthcare differ in at least one way: In basketball, when one team wins, the other loses. In healthcare, when hospital teams achieve their goal of delivering great care, everyone wins – patients, staff, hospitals, payers. With quality, there are no losers.
Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA [Internet] 2003;290(1):86–97. Available from: http://dx.doi.org/10.1001/jama.290.1.86
Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med [Internet] 2000;160(7):939–44. Available from: http://dx.doi.org/10.1001/archinte.160.7.939