Biomimetics applied to the Operating Theatre (Part 2)


So now it gets to the point where my ant farm is ticking over, and I get to make some discoveries.

Biomimetics is a dangerous science.


It offers many useful solutions to particular problems, such as how a desert chameleon wicks

moisture from its tail to its mouth.

And it offers many compelling pitfalls, such as thinking we need to flap wings in order to fly.


So the path I go down here is a thought experiment, which may be right, or it may be wrong.

It is only wholly wrong, however, if it fails to make us think.


So in terms of 20 signals which get everything done, I move from the dot-point singularity of

the individual to elegantly engineered systems architecture to the future-proofing vision. 

11: Feedback and performance management

I wasn't sure how to word this one.

So I went to my Teams Consultant.

Haz, aged 19.


I asked: "What works best? Reward or Fear?"


His answer was simple.


"Too much reward and people don't reflect on their performance.

Too much fear and people hide their failings.

What you want is accountability, so that people will be accountable for their good performance as well as their not-so good performance."


So I got together with a colleague, and we did each others appraisal.


We spent time on Her goals for Her, her goals for the team, and then MY goals for her to potentiate the team.


Simple. It took half an hour. 


Ten minutes for her, ten minutes for me (pretending to be the boss), and ten minutes for both of us to share our visions.


Then vice-versa for me.


Before we even started we ripped up the Organisational Performance Appraisal Form and made our own.


We can do that, because neither of us are managers.


But the thirty minutes we spent communicating was priceless.


By the end of our appraisals, we both felt empowered.


We were more aware of our reward points.


We were already well aware of our fears, and yet had trust enough in each other to voluntarily compare meaningful narratives;


And we both held and hold OURSELVES accountable for our workplace performance, irrespective of whether our bosses do or not.


Now THAT'S performance management!


Thanks, Haz!

12: Celebrate effectiveness

So, you've done good.




What now?


What use doing good if you don't celebrate your wins?




If my dog sits, I treat him well.


It reinforces good behaviour. 


It seems to work for humans, too.


At work, when we finished the ENIGMA Trial, we could have let the milestone achievement slide by.


And we nearly did.


But then, we decided it would be a good idea to celebrate.


So we had a cake cooking competition, a competition to see who could cook the best 'Enigma' themed cake.


We got a Beetroot and Chocolate cake, a cake that looked like a BBQ grill, a Devil Food Cake made in an Angel Food Cake tin, that sort of stuff.


Each one an enigma of some sort.


It cost us nothing, gave us heaps (we STILL talk about it!) and we got to celebrate our hard-won win.


Now we are on to our next trial: The PANACEA Trial.


The one thing we are looking forward to?


What cakes we are going to cook THIS time!


Celebrating effectiveness works.


It is a low cost high impact way of saying "Well Done!!!"


And we ALL like to be told "Well Done!"


Especially when we have done things well!



13: Learn and Share Freely

People spend a lot of time worrying about intellectual property, as if it is going to make them their fortune.


But we are in the business of caring, not in the business of making fortunes.


Otherwise, we would have sought out a potentially more lucrative occupation.


Protecting intellectual property is as easy as copyright.

But it won't stop people copying it.


So instead of letting it get in our road, and dominating our thinking at the expense of quality outcomes, we thought:

"Why not give up early and let our idea roam free?"


An idea is no good if it resides only in MY head.

But let loose, it may just (eventually) have global impact.


So instead of worrying excessively about business models, we did what we could to promote 'Below Ten Thousand' with low-cost high-impact marketing methodologies.


We shared freely.

We wanted to see how far we could go, and this is as far as we got.


Fortune? No.

Fun? The BEST fun of our careers.

Memorable? Yes.

But it is just ONE of the moments that define us as people.




We DO NOT pretend that this is good business or financial advice.

Yet... if we want to build a fortune?


We just make sure we have good habits and do the best we can with our after-tax dollars. That way, even if the idea fails, we have sufficiently good skills and grounding to ensure that we are back on our feet in no time!


Our good habits will provide for our needs well enough.


Business models? Sure, we have one.

But it is not the only thing in our arsenal!

15: Contingency and redundancy planning

The only constant is change.


The Chinese wrote a book about it.


A few thousand years ago.


64 different states of change, with stability only one of them, and the one state that is MOST inherently unstable.




So planning for evolving potentialities is what we do.


It is an algorithm of logic.


Plan A

Plan B

Plan C

Plan D.


No-one can contingency plan like an operating theatre nurse.


Our only constant is the ever-present likelihood that things will change.


And when they do, unexpectedly and dramatically, we have to be prepared to go from giving 100%.....


to giving an entirely new quantum level of 100%


And sometimes even more.


Guttoral challenge?


We eat it for breakfast.


How we flux and flow depends on the resources at hand.


That in itself is a protean standard.


(That's a Dan Coffeen joke, by the way! If you want an education, Berkley University's Dan Coffeen 'Rhetoric 10' course is where you get one!)


Contingency is the plan.

Redundancy is the elasticity in the resource.


No slack in the resouce?

Then how the hell are we  going to stretch when we have to put our foot to the floor because something BIG has come through the door?


Poetry? It's my specialty!  

14: Succession Management

Identification of talent and growing potential:


I was once asked:


"Do you have ambition?"


The answer was a flat "no".


But other people do.


And they have talents which need to be nurtured and skills which need to be grown, and directions that need to be made visible to them.


It is not the best clinician that makes the best manager or the best educator.


The skill-sets are different.


Identifying people who have the right underlying aptitudes, skills and attributes takes a keen eye.


And growing their potential takes not just a person, but a community.


And a vision.


Who cares if I spend a lot of time training them only to have them pack up their skills and leave?


The biggest compliment anyone can pay me is to stretch their wings and fly.


Each person I motivate and see grow beyond my wildest dreams is a testiment to the environment that encouraged them to reach for the sky.


Succession management takes a lot of understanding and effort and time.


But the end result is worth it when the future becomes bright.

16: Recruit, retain and retrain (collateral investment)

I have no idea about recruitment.


All I know is that people turn up when vacancies are advertised.


Is there a best person for the job?


Is there a best person for the team?


One team of management consultants described the warm body problem, and described recruitment in terms of investment and dynamic interaction.

If you want good advice, hear it from them. Not from me!


Retaining I know more about.

It's not that difficult.

The rules are simple. All you have to do is GET them (the rules).

And if you've got this far, I'm guessing you know a bit about them already.


The difficult thing is the half life of knowledge.

Five to seven years?.


In seven years. half of what I thought I knew has changed or has been proved obsolete.


In thirty years of nursing, that's a lot of undoing and re-doing of neural memory circuits!


Professional development and comunication suddenly become VERY important, and in a profession where production pressure is king and queen, and where a 24/7 roster scatters people across the time-space continuum, this very concept becomes exceedingly difficult.


I guess this is why anaesthetists have sabbaticals every seven years, and non-clinical time every week.


Because catching up is like the tortoise and the hare in Zeno's Paradox.


No matter how fast you run, the ever-persistant slow and steady rate of change will beat you every time.


One solution has been the use of social media for clinical education.

Similar too, and often much better done than what the 'Below Ten Thousand' model has evolved to be, I'm sure;


But things left to chance are not very good at getting themselves done, and chance is no model for effectiveness. 

It requires a mindset and culture of 'investment' in human capital to achieve currency and safety and quality in everything we do. 


Trouble is, our patients expect it of us, and being too busy to learn is no excuse, and no defense, when the diarrhoea hits the turbo-prop.

17: Plan for the future

20/20 Hindsight is a wonderful thing.

It is so tempting to be wise after the event that we tend to only look backwards, not forwards.


If you can't see ahead of you, and can only see behind you, the Pete Smith logic is that you are walking backwards through life.


The future is there, even if your view only extends to the event horizon.

So what tools are available to help you get it right?


I start with mind maps.

They are magnificent for expanding your thinking.


Then there are probabilities:

Should I aim to get the future 51% right?

75% right?

99% right?


My new concept is the standard deviation towards rationality.

In other words, how many standard deviations are you and your current solution from the best possible and most rational solution?


It is a powerful mind tool.


Then there's Ockham's Razor.

Given two alternatives of equal value, the solution which has the most elegant simplicity has the highest probability of being the right one.


Finally, there is the Pete Coin Test.

Given a tough choice between two equally valid solutions, I get the person who has consulted me on the problem to get me a coin.


We then make a contractual decision which is fully binding. 

No wriggle room.

If it comes down heads, that is the option they HAVE to choose.


I toss the coin, catch it in my hand and invert it, still covered, upon the back of my free hand.


Then I cheekily glance at the coin, look up and smile, and say.....

"Now, how would you feel if it were.....heads!"


I'm looking for their immediate, often transient, 'feeling' response.

If the immediate reaction is "You Beaut!!!", it is the right choice.

If there is even a twinge of regret, then the other choice is the right one.

If there was nothing.....then you weren't paying attention.

Problem solved.


18: Innovate, mentor, cultivate outliers

Innovation is SO inconvenient!


It makes us stand up and move out of our comfort zone!


What do I know about comfort zones?


Not much.


But a little bit.


I think.


I spent a month in Bangladesh after my nursing training was finished.


I was but one member of the first (1986) contingent of the 'Bangladesh Australia Child Health Project', a Rover Scout initiative in collaboration with UNICEF.


I must admit, the culture shock was incredibly confronting.


Not in Bangladesh, nor in India nor in Nepal.


In Australia.


Stepping off the plane back into a western nation full of opportunity, but full of people who failed comprehensively to appreciate their SUBLIME GOOD FORTUNE was mind-fucking!


I could be more polite, but unfortunately, sometimes succumbing to sensibilities doesn't get the point across!


If you want to learn about the power of innovation and disruptive technologies, go and see these amazing people.


They don't let fear get in the way of a practical solution.


They just get in and do it.


Overcoming fear means you can identify the innovators.


Then you can nurture them.


Nothing may come of it, but, hey;

maybe the time will come.


For example:

In the lead-up to the great potato famine, who was growing cabbages?


19: Constant maintenance and updating
20: Grow as demand and resources allow

Things wear out and break.


It is simply a function of use and time.


The need for constant maintenance is obvious to anyone with a weatherboard house or a lawn.


Programmed maintenance seems expensive.


But it gives you the best results.


It seems a bit obsolete in these times of programmed obsolescence and single use items, but I'm guessing the foundations of the idea remain true:


"If you look after something,

It will look after you."


I'm guessing ants understand this.


After all, an ant colony has the potential to be immortal.


And immortality is a serious business when you think about it.


Entropy over time defeats immortality, and so energy has to be expended to make immortality livable, worthwhile.


My operating theatre (each and every one of them) was there before I arrived.


They will (mostly) be there long after I leave.


Whether they thrive or not depends upon how well they maintain themselves.




I've painted the house.


Now it's time to mow the bloody lawn!


"Please excuse our progress."


This sign has been at our front door for a few years now.


The Supply and Demand Curve is a concept that has been around for a long time.


I learned it first in Agricultural Studies in High School.


Mr Timmins was very passionate about it, and used the concept to teach us about the dynamic, ever-changing value of cattle at the saleyards.


I know.


That is a tautology. 


But if I say something twice, I know for certain that I've said it!


The other thing Mr Timmins taught us was that overburdening rural land leads to desert.


A Scorched Earth, deplenished of nutrients neccessary for continued sustainability. 


In other words, pushing things too hard leads to trouble. A bubble. Collapse.


He seemed to think that the best sustained productivity occured when utilisation was at 90% of capacity, and when you actively nurtured your resource.


So if you want more cattle, ultimately you will need to buy more land, which you will also need to tend and nurture.


Funnily enough, the 'IHI White Paper on Patient Flow in Acute Care Settings' seems to agree.


So I learned the concept first on the land in 1979.

And again in Health in 2003.

In 1991 I first understood Starlings Law, which describes exactly the same concept, but in terms of cardiovascular physiology


So where are we in 2015?


Whilst the half life of knowledge may be seven years, it seems the half life of transitional understanding may well be 50 years!


Beauty! Only another fifteen years to go!

Below Ten Thousand

An international collaboration

Empowering clinicians in safety culture