The secret of great learners: Focus on the process, not the outcome

The history of orthopaedic surgery offers some surprising lessons for self-improvement.

by Bradley Staats
Last Updated: 04 Jun 2018

Learning is so vital today that we can think of ourselves as living in a learning economy. We can’t just be knowledge workers; we must also be learning workers. In the words of Jeffrey Immelt, the former chairman and CEO of General Electric, ‘You never hire somebody, no matter what job you’re hiring for, for what they know. You’re hiring them for how fast you think they can learn.’

But we’re bad at learning. Supremely bad. In fact, we’re our own worst enemies. Instead of doing the things that will help us learn, we often do just the opposite. One of the most common mistakes is obsessing about outcomes while neglecting to examine carefully the process through which we achieve them.

I have three sons who, at least for the moment, all love baseball (as does their father). I have the good fortune to help coach each of their baseball teams, although soon their skills and knowledge will surpass mine. Recently my eldest son came to the plate with the bases loaded against a hard-throwing but wild pitcher. Most of the team was either striking out or walking. He ripped a pitch, but unfortunately it went straight to the shortstop, who fielded it on one hop and, given how hard it was hit, easily turned a double play from second base to first base.

My son’s response was not one of grudging acceptance that he had done everything right but got unlucky. Rather, it was ‘Dad, even a weakly hit ground ball would have avoided the double play.’* Of course, no coach would send a player up for bat and tell him to mishit the ball in an attempt to get lucky. But after seeing what happened, that is exactly what my son was wishing for. All my sons, when evaluating their performance in a game, react this way. They tend to view how well they hit the ball as a function of whether they got on base (the outcome), not of how hard and where they hit it (more accurate measures of the process).

Unfortunately, their tendency is not uncommon. Most of the time, even though we know that learning requires evaluating the process we used to get to an outcome, we focus on the outcome instead.

That’s not the approach Robert Booth takes, however, and we can learn from him how a process focus leads to master learning.

Process focus in orthopaedic surgery

When Robert Booth began his career as an orthopaedic surgeon, in the 1970s, he looked much the same as others like him. He performed procedures, such as hip and knee replacements and arthroscopy, and provided nonsurgical care for orthopaedic conditions. As time passed, though, Booth began to appreciate that if he wanted to improve the quality of outcomes for his patients, he needed a full understanding of the entire process of care— from initial meetings to surgery and through recovery.

He decided to focus first on knee and hip replacements and eventually on total knee replacements only, thus increasing the number of surgeries he performed of that type. As he grew more familiar with that procedure, he was able to identify new areas for improvement.

Booth’s model centered on completing the work quickly in order to achieve the best possible results for his patients. He wrote, ‘I once heard it said that there are three kinds of surgeons— fast/good, fast/bad, and slow/ bad— but there are no slow/good surgeons. Clearly, the ability to operate quickly and efficiently is a priority. At some centres, the average operative time for a primary total knee arthroplasty (TKA) is less than 30 minutes. If you observe such a procedure, what you should focus on is the process, not the prosthesis… The more efficient we become, the more we study that process, the more skill we develop, and the better results we get.’ 

To build an efficient and effective model, Booth created and continually improved a process that managed care as a system.

Booth and his team paid attention to aspects of the process that other surgeons often did not, and made a number of changes. Each year they would analyse the surgical tool sets they used and remove infrequently used tools. This saved money and time on sterilisation and created space in the operating theatre. The removed tools were kept in a sterile backup set in the operating room in case they were unexpectedly needed.

Booth even focused attention on the staff members in charge of sterilising equipment, who were often among the lowest-paid people in the hospital. He brought them into the OR to show them the importance of their work and created competitions in which the people who did their work best got tickets to local sporting events.

To improve efficiency during a procedure, Booth always worked with the same team of surgical nurses; they knew what he wanted when he wanted it. He also used only one prosthesis supplier for his replacement joints. Although that meant that a device might not be perfectly tailored for an individual, differences in device-patient fit were typically quite small. This focus helped him gain additional attention from the supplier and learn the intricacies of the device.

He was also able to suggest novel innovations within the prosthetics that resulted in improved quality for patients. Booth did not try to be on the cutting edge of technology. He recognised that learning within the process was most important for delivering efficient and effective care, so it was better to stick with a tried and true, improved approach than to jump from one new idea to the next.

Booth’s focus on the process served him and his patients well. Over 15 years he conducted more total knee replacements than any other surgeon in the United States. He was recognised four times by the Knee Society with its research award and served as its president.

The case of Robert Booth illustrates the difficulty of and the opportunity from taking a process focus to learning. Each part of a system is given careful study in order to build deeper understanding. With practice, the parts improve, but so do the connections between them.

In this approach, the focus isn’t on the outcome— although that, too, improves, at least eventually.  Process-focused learners recognise that they aren’t fixed in their ability to learn. With effort and study, they can achieve significant change.

This article was excerpted from Never Stop Learning: Stay Relevant, Reinvent Yourself, and Thrive, by Bradley Staats, associate professor at North Carolina Kenan-Flagler Business School. Reprinted by permission of Harvard Business Review Press. Copyright 2018 Bradley R. Staats. All rights reserved.

*If this were cricket, MT notes, the anecdote would rather lose its impact. For a quick guide to baseball, see here.

Image credit: Gita Kulinitch Studio/Shutterstock


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