介绍： 2 want to get great something,get a coach
要擅长某个领域，那就请个教练吧

speaker:Atul Gawande，医生，公共卫生教授，作家。

00:00：
and I had to think,you know,there was something fundamentally profound about this.he was describing what great coaches do,and what they do is they are your external eyes and ears...

介绍： 2 want to get great something,get a coach
要擅长某个领域，那就请个教练吧

speaker:Atul Gawande，医生，公共卫生教授，作家。

00:00：
and I had to think,you know,there was something fundamentally profound about this.he was describing what great coaches do,and what they do is they are your external eyes and ears,providing a more accurate picture of your reality.they’re recognizing the fundamentals.they’re breaking your actions down and then helping you build them back up again.after two months of coaching,I felt myself getting better again.
我不得不思考，这背后一定有着更深的意义。他不愧为一个出色的教练，因为出色的教练就是充当你的第三只眼睛和耳朵，为你的状态给一个更真实的描述。他们更注重细节。他们会细致地剖析你的行为， 并帮你建立正确的习惯。经历两个月的训练后，我犹如重获新生。

00:30:
and after a year,I saw my complications drop down even further.it was painful.I didn’t like being observed,and at times I didn’t want to have to work on things.I also felt there were periods where I would get worse before I got better.but it made me realize that the coaches were onto something profoundly important.
一年之后，我发现术后的并发症进一步减少了。这一过程是非常煎熬的。我不喜欢被监督，有时候也厌倦工作。在达到最佳状态之前，我也经历过低谷。但这使我意识到教练扮演着极其重要的角色。

00:58:
in my other work,I lead a health systems innovation center called Ariadne Labs,where we work on problems in the delivery of health care,including global childbirth.as part of it,we had worked with the World Heath Organization to devise a safe childbirth checklist.it lays out the fundamentals.it breaks down the fundamentals--the critical actions a team needs to go through when a woman comes in in labor,when she’s ready to push,when the baby is out,and when the mom and baby are ready to go home.
除了本职工作，我还领导着一个叫阿里阿德涅实验室（Ariadne Labs）的医疗系统创新中心，致力于给医疗保健服务，包括全球生育。同世界卫生组织合作，我们共同设计出了一个安全可行的生育检查表， 这也是该项目的内容之一。这张表列出了基本要求，并细化了这些要求——强调了一个团队必须遵守的行为规范，比如一个孕妇进入产房时，她准备用力时，婴儿出来之后，母亲跟孩子准备回家时，他们应该分别采取怎样的行动。

01:30:
and we knew that just handing out a checklist wasn’t going to change very much,and even just teaching it in the classroom wasn’t necessarily going to be enough to get people to make the changes that you needed to bring it a-l-i-v-e.and I thought on my experience and said,”what if we tried coaching?what if we tried coaching at a massive scale?”
我们知道仅仅制定出检查表，效果并不会有太大的改观，甚至在学校里着重强调这些内容，也不一定能有多少效果。于是，我又想到了自己的经历，“我们尝试一下教练模式如何？在大规模范围内进行试验怎么样？”

01:52:
we found some incredible partners,including the government of India,and we ran a trial there in 120 birth centers.in Attar Pradesh,in India’s largest state.half of the centers basically we just observed,but the other half got visits from coaches.we trained an army of doctors and nurses like this one who learned to observe the care and also the managers and then help them build on their strengths and address their weaknesses.one of the skills for example they had to work on with people--turned out to be fundamentally important--was communication.
我们找了一些出色的合作伙伴，比如印度政府，并在印度最大的邦，北方邦的120个生育中心进行了试验。我们观察了半数的生育中心， 但另一半即使没有被监督，也有教练进行指点。我们训练了一组医疗人员充当教练队伍，学着观察护理过程还有管理人员，然后帮助他们发挥长处，弥补不足的地方。 比如，他们要学着与他人打交道——为日后能进行高效的交流打下坚定的基础。

02:32:
getting the nurses to practice speaking up when the baby mask is broken or the gloves are not in stock or someone is not washing their hands.and then getting others,including the managers,to practice listening.this small army of coaches ended up coaching 400 nurses and other birth attendants,and 100 physicians and managers.we tracked the results across 160,000 births.the results...in the control group you had--and these are the ones who did not get coaching--they delivered on only one-third of 18 basic practices that we were measuring.and most important was over the course of the years of study,we saw no improvement over time.
当婴儿面罩坏掉，手套没有库存，或者有人没有洗手，护士们应学着去指出这些问题。而其他人，包括管理人员，应该学会倾听。这支教练队伍已经培训了400个产护人员和一些助理，还有100个医生和管理人员。我们追踪了16万个出生案例。至于结果—— 在对照组，也就是没有接受培训的结果——我们要考察的18个基本要求中，他们只做到了1/3。最重要的是，经过数年的跟踪，对照组的表现没有任何改善。

03:18:
the other folks got four months of coaching and then it tapered off over eight months,and we saw them increase to greater than two-thirds of the practices being delivered.it works.we could see the improvement in quality,and you could see it happen across a whole range of centers that suggested that coaching could be a whole line of way that we bring value to what we do.you can imagine the whole job category that could reach out in the world and that millions of people could fulfill.we were clearly at the beginning of it,though,because there was still a distance to go.you have to put all of the checklist together to achieve the substantial reductions in mortality.
而实验组的人经过4个月的训练，死亡率连续八个月都有所下降，我们看到了他们的进步，成功分娩的婴儿数量比以前足足多了2/3。教练模式起作用了。我们发现很多生育中心都发生了质的改善，这意味着整个过程有教练的参与，可以为我们的工作带来更多价值。想象一下，如果世界上所有的工作都有教练的加入，无数的人就可以从中获益。尽管在起初，我们成效显著，但我们还有很长的路要走。我们需要整合所有的检查表，以在降低死亡率方面实现实质性的进展。

04:02:
but we began seeing the first places that were getting there,and this center was one of them because coaching helped them learn to execute on the fundamentals.and you could see it here.this is a 23-year-old woman who had come in by ambulance,in labor with her third child.she broken her water in the triage area,so they brought her directly to the labor and delivery room,and then they ran through their checks.I put the time stamp on here so you could see how quickly all of this happens and how much more complicated that makes things.
最早实施这一项目的地方已取得了一些进展，这个生育中心就是其中之一，因为教练模式帮助他们学会了解决根本问题。你们可以看到这一过程。这个23岁的产妇是被救护车送来的，她即将迎来第三个孩子。她的羊水在分流区破裂，因此医护人员直接给她安排了产房接生， 并且着手检查。我为这些照片加了时间标记，大家可以看到，这一切都发生得如此迅速，大大增加了整个过程的复杂程度。

04:42:
within four minutes,they had taken the blood pressure,measured her pulse and also measured the heart rate of the baby.that meant that the blood pressure cuff and the fetal Doppler monitor,they were there,and the nurse knew how to use them.the team was skilled and coordinated.the mom was doing great,the baby’s heart was 143,which is normal.eight minutes later,the intensity of the contractions picked up,so the nurse washed her hands,put on clean gloves,examined her and found that her cervix was fully dilated.the baby was ready to come.
在四分钟以内，她们测量了产妇的血压，脉搏，还有婴儿的心率。这意味着血压袖带和胎儿多普勒监视器都在现场，并且产护人员知道怎么操作。团队技术娴熟，配合默契。这位妈妈状态良好，婴儿的心率是143，属正常范围。八分钟后，子宫收缩的强度开始增加，产护人员将手清洗后，带上干净的手套给她做检查，发现她的子宫颈完全张开。婴儿即将出生。

05:17:
she then went straight over to do her next set of checks.all of the equipment she worked her way through and made sure she had everything she needed at the beside.the baby mask was there,the sterile towel,the sterile equipment that you needed.and then three minutes later,one push and that baby was out.
产护人员立即进行剩余的检查项目。她对各项逐一进行检查，确保需要的所有设备都已就绪。婴儿面罩，无菌毛巾和需要的无菌设备，全部就位。三分钟后，产妇开始用力，婴儿出来了。

05:40:
I was watching this delivery,and suddenly I realized that the mood in that room had changed.the nurse was looking at the community health worker who had come in with the woman because that baby did not seem to be a-l-i-v-e.she was blue and floppy and not breathing.she would be one of that one-in-20.but the nurse kept going with her checkpoints.she tried that baby with a clean towel.and after a minute when that didn’t stimulate that baby,she ran to get the baby mask and the other one went to get the suction.she didn’t have a mechanical suction because you could count on electricity,so she used a mouth suction,and within 20 seconds,she was clearing out that little girl’s airways.
当时我正在注视着产房，突然发现产房里的气氛变了。产护人员正看着护送产妇进来的社区保健人员，因为那个婴儿似乎状态不妙。她全身发紫，皮肤松弛并且没有呼吸。她似乎就是被死神选中的那一个。 但是产护人员按部就班地行动了起来。她用一个干净的毛巾擦拭婴儿。 但一分钟后，婴儿还是毫无反应，她立刻跑去拿婴儿面罩，另一个产护人员拿来了吸管。因为没有可靠的电力供给，她没有用电动吸管，而是用口用吸管清理小女孩的呼吸道，在20秒内，异物被一点点吸了出来。

06:28:
and she got back a green,thick liquid,and within a minute of being able to do that and suctioning out over and over,that baby started to breathe.another minute and that baby was crying.and five minutes after that,she was pink and warming on her mother’s chest,and that mother reached out to grab that nurses’s hand,and they could all breathe.
在一分钟内，她不间断地重复着，最终吸出了粘稠的异物，婴儿开始了呼吸。孩子的哭声紧随而至。5分钟后，她的肤色变得正常，被母亲抱在了怀里，那位母亲激动地握住的产护人员的手，那一刻，大家都松了一口气。

06:57:
I saw a team transformed because of coaching.and I saw at least one life saved because of it.we followed up with that mother a few months later.mom and baby were doing great.the baby’s name is Ansshika.it means”beautiful.”and she is what’s possible when we really understand how people get better at what they do.

Thank you.