If you said to any top athlete that the secret to winning gold was to learn how to properly wash your hands, you’d probably receive a fairly fiery response. But when British track cyclists won 7 out of 10 track cycling gold medals in the 2008 Beijing Olympics and then again in the London 2012 Olympics, British Cycling’s performance director Dave Brailsford was asked what the secret to success was and believe it or not – that was part of his answer.

Team GB used to be the ‘also-rans’ in world cycling. One pundit even described the operation as “a laughing stock”, but in the last two Olympics – Team GB has captured 16 gold medals and British riders have won the Tour De France three times in the last four years. So just how did they transform themselves from ‘also-rans’ in to world-beaters?

A brief introduction to marginal gains

Marginal gains is a concept used by some of the top athletes in the world to take their performance from extraordinary to world-beating. It comes from the idea that if you break down everything that you can think of that goes into your performance, and then improve it by 1%, you will get a significant increase when you put them all together… and no detail is too small to be considered for improvement.

By experimenting in a wind tunnel, Dave (British Cycling’s performance director) noted that the bike was not sufficiently aerodynamic. By analysing the mechanics area in the team truck, he discovered that dust was accumulating on the floor, undermining bike maintenance. So he had the floor painted pristine white, in order to spot any impurities. It wasn’t just technique and technology that went under the microscope – the rider’s health and wellbeing was also of paramount concern. To ensure a better night’s sleep regardless of location – all riders were given pillows that matched the ones they used at home and these went with them wherever they went. They were also taught how to thoroughly wash their hands and in particular, their nails – why? To minimise the risk of infection which might result in days away from the training track.

Once the ball was in motion, Dave started to probe deeper into untested assumptions, such as the dynamic relationship between the intensity of the warm-down and speed of recovery. The more they analysed the day-to-day lives of the riders, both inside and outside of training – the more they learnt and the more marginal gains they were able to make.

So how can this be transferred into Healthcare?

A great example of where this can be applied is in preventable medical errors. Hospital Errors are the third leading cause of death in U.S contributing to a staggering 440,000 deaths per year. That’s greater than the entire population of Miami… and these are preventable deaths.

One of the reasons why preventable medical deaths occur is that some doctors struggle to admit to their mistakes and weaknesses, because they worry about the effect on reputation and possible litigation. But imagine a different approach, where doctors were up-front, open and constantly on the look-out for marginal gains.
In fact, this kind of system has already been adopted in one Seattle hospital. Staff are encouraged to file reports if anything goes wrong, like accidentally prescribing the wrong medicine for example. That gave the hospital an opportunity to make small changes, such as altering the labelling on drugs so that they could be easily identified under pressure of time.

This commitment to continuous improvement also led to the discovery that a newly admitted patient had received a colour-coded wristband signifying “Do Not Resuscitate” instead of one indicating drug allergies (as a result of a nurse being colour blind). So, text was added to the wristbands. It was another marginal gain.

But this was just the start. By using checklists in the operating room, to alter the ergonomic design of surgical equipment and to systematically improve clinical hygiene. Each improvement seemed small, but they rapidly accumulated. The result has been that since the new approach has been taken, the hospital has overseen an astonishing 74% reduction in liability insurance premiums and is now regarded as one of the safest hospitals in the world.

And this concept can be taken one step further still, to monitor and improve the patient experience. Real-time digital surveys, completed by patients at the point of receiving care provide unlimited opportunities for more marginal gains. Simple changes to lighting, bedding and even how a patient is greeted are all it takes to make a big difference… and that’s not just good news for patients, but also for the hospital bottom-line.

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