Growing up in Great Neck, a Long Island suburb about twenty miles east of Manhattan, kids my age played baseball, basketball and, when our mothers allowed, tackle football. The thought of playing a game only with our feet and heads made no more sense than walking home on our hands.
Little did we know, our disinterest in soccer put us firmly in the global minority. Today, “association football” claims 4 billion fans, more than half the world’s population. Like many Americans today, I become one of those 4 billion fans every four years, when the World Cup graces TV stations. There’s just something about the combination of national pride, obsessed fan bases and the universal superstar appeal that makes this event unique.
As we look ahead to the FIFA World Cup final Sunday, July 15, it occurred to me that U.S. healthcare could stand to learn a lot from international soccer. So, here are five lessons for American medicine courtesy of “the beautiful game”:
1. Winning takes teamwork, not just superstars. Talking heads love to pick their pre-tournament favorites, but too often they go with whatever rosters have the biggest superstars. This year, two of the greatest players in history, Portugal’s Christiano Ronaldo and Argentina’s Lionel Messi, both went home disappointed. Neither player (or their teammates) made it out of the round of 16.
This misguided obsession with superstars carries over into healthcare, as well. Case in point: The most common question I get asked by patients is “Who’s the best doctor for…?” Regardless of what injury or ailment fills in the blank, this is the wrong question. Effective medical practice today is a team sport.
Publicly reported data can help you figure out which organizations and departments achieve the best outcomes. For instance, check out Leapfrog’s Hospital Survey to see which surgical “teams” give you the highest probability of winning.
2. Great talent doesn’t always beat a good strategy. In 2014, Germany took home the FIFA World Cup and entered this year’s competition as one of the odds-on favorites. However, the Germans were shut out twice in the pre-qualifying rounds and failed to make it even to the “knockout” round. Germany’s final opponent, South Korea, was considered one of the weakest in the field but managed but beat a much more talented team with a strategy that focused on a rigid defense that held firm until the very end. By keeping things close, the South Koreans knew they could afford to take the risks later in the match, when both teams needed to score. It was a great strategy—one that outlasted a good team.
In healthcare, no matter how talented a physician may be, health-system success requires a great strategy. The kind of nation-leading quality you find inside Kaiser Permanente or the Mayo Clinic doesn’t happen by accident. It reflects a specific operational plan and a commitment to implement it every day. If you want to find out which system best at achieving overall success, consult the National Committee for Quality Assurance (NCQA) report cards online.
3. Incentives drive behavior. One thing that drives American viewers crazy about soccer is all the flopping and flailing that occurs throughout a match. Players, hoping to get a favorable call from the referee, often fall down at the slightest hint of contact. Neymar, the megastar from Brazil, does this so regularly and flagrantly that he became an international meme and even the inspiration for a KFC commercial. But what’s important to Neymar and his teammates is that he’s effective. Meaning, if the refs reward it, why not do it?
Photo by Buda Mendes (Getty Images)
Little do we realize the same mentality applies in U.S. medicine. Here, doctors and hospitals are rewarded not for the quality of care they provide but for the quantity of it. The prevailing “fee for service” model encourages physicians to provide more care, not better care. Only by modifying the reward system will behaviors change, in both futbol and healthcare. Until then, expect more flopping and unnecessary procedures.
4. Practice makes perfect. When a defender sends the ball out-of-bounds and behind the goal, the opposing team is awarded a corner kick. From within the arc, a player must loft the ball 35-40 yards toward the goal, out of the reach of the goalie but close enough so that a teammate can drive the ball into the net. These “set pieces” require hours and hours of practice and preparation. Without practice, there’s no payoff like the kind we saw in the semifinal match between France and Belgium. There, in the 51st minute, with the game still knotted at zero, France’s Antoine Griezmann lofted a corner kick to teammate Samuel Umtiti who outjumped a tall Belgian defender and headed the ball into the back of the net. Though they made it look easy, I suspect the French players practiced that same series thousands of times. That practice kept the dream of a World Cup trophy alive.
In healthcare, patient safety requires practice, too. Lots and lots of it. Simulations and trainings help physicians and nurses understand what to do should a patient experience a cardiac arrest or suffer severe hemorrhage after childbirth. Checklists help doctors follow every necessary step, whether in the operating room or the ER. The Institute for Healthcare Improvement (IHI) has done a superb job of defining these steps and helping hospitals across the country reduce complications and deaths. But we still have so much farther to go. In the USA, hospital acquired infections remain the third-leading cause of death. Doctors still fail to wash their hands one-third of the time they meet with a new patient. Clearly, U.S. healthcare needs a lot more practice.
5. No, team USA is not the best in the world. When it comes to soccer, this is an understatement. In a nation with more than 300 million citizens and, according to the most recent data, 24 million soccer players, it’s mind-blowing that the U.S. national team couldn’t even qualify for the 2018 World Cup. By contrast, Croatia, a nation with 4.2 million citizens, will play France for the title this Sunday.
Some of the global data on healthcare quality is equally lopsided and stunning. Take the Commonwealth Fund’s signature report on systemwide performance. Although the United States spends considerably more on its healthcare than any other nation, it ranks last among the world’s 11 most-industrialized countries. We can’t keep beating our chests and claiming we’re the best in the world when it’s simply not true. In soccer, there’s a televised match and a score that proves USA isn’t No. 1. In healthcare there are also rankings that prove we’re not much better. They just don’t seem to get much attention.
The next World Cup will take place in Qatar in 2022. Perhaps by then, American healthcare will have incorporated some of these important lessons. If so, life expectancy in the U.S. should rise, reversing the downward trend of the past two years. Perhaps we will flatten the rising cost of healthcare coverage, making medical treatment more affordable. Perhaps even team USA will make it to the final day of the tournament.
Of course, if any of this is to happen, the time to prepare is now. And if we can be successful in healthcare, hundreds of thousands of lives will be saved.
Did I miss a lesson? Leave me a comment and tell me what American doctors or patients can learn from soccer.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.
Sometimes it is best to pass the ball back to your own goalie and start over from the beginning which also applies to some medical problems.