From education to employment

How medicine can heal FE quality and income problems

Reith lecturer and surgeon Dr Atul Gawande held me spellbound recently when he spoke about The Century of the System. As I listened I realised that this man was singlehandedly solving the majority of ills afflicting FE with one prescription.

In his lecture, Dr Gawande argued that better systems can transform global healthcare. The methodology was that by radically reducing the chance of mistakes it is possible to significantly increase the chance of successful outcomes.

As I listened to an intriguing story of a girl that drowned, I thought of every FE provider I’ve ever visited. Before I explain this, let me tell you about the little girl that drowned.

Dr Gawande held his audience mesmerised as he told the story of a young girl that fell through the ice in Austria. It was 90 minutes before her body was recovered and, despite the fact she had been underwater for so long, CPR was immediately initiated.

On getting her to hospital A&E was bypassed and she went straight into intensive care where she was put onto a heart/lung bypass machine. Slowly, over days, they warmed her severely chilled body.

Her heart started to beat again. But she didn’t breathe.

So they opened her chest and moved her onto a lung bypass machine. Then they gradually worked on her vital organs. Slowly each organ regained its functionality. But still she did not breathe…

Finally she breathed. But her brain was still non-responsive, effectively she was dead.
On examination her brain was found to be swollen. An emergency operation was needed.


One morning the little girl, who had stopped breathing for 90 minutes, woke up.

We’ve all heard of bodies that are plunged in to freezing water making miraculous recoveries. But Dr Gawande knew the reality is that this very rarely happens and it normally only happened when medical intervention of the highest order was available. What intrigued him most was how a small hospital in Austria had achieved this.

So he investigated and discovered another miracle.

The miracle of checklists

Dr Gawande knew that with so many complicated steps in the medical intervention the little girl had received there were thousands of things that could go wrong and kill her. Simple things like not scrupulously washing hands or being a few minutes late in performing a basic medical function could spell death.

So how had they managed to achieve so much? How had they managed not to make basic mistakes?

What Atul Gawande discovered was that for even the most basic function the hospital team used checklists. Nothing was left to memory to chance.

Later Dr Gawande was to introduce this system into major hospitals worldwide and see success rates soar. But first he wanted to investigate the practicalities. For example, who manages this complex process?

The answer was another surprise. The process management was given to the most junior member of staff: a telephonist.

Why? Simple. When a telephonist phones you at home and says you are needed to give an anaesthetic in 30 minutes, you don’t ask questions because you know the telephonist doesn’t know the answers. You go in to the hospital immediately.

This way no one is ever late for a procedure. And when you learn to follow the checklist you don’t forget any detail – however small.

Lessons for FE

In FE if we forget a detail no one normally dies. In hospital they do.

But that isn’t to say the FE details aren’t important to the future of our students. If students miss lectures it isn’t good enough to think we must call them and check why they missed a class. FE needs a system that will ensure that the student and/or employer is called every time they miss a lecture.

Getting the details right means the student’s future can be assured. It means the quality of education doesn’t suffer and that income keeps flowing into the establishment. It also means Ofsted doesn’t downgrade us at our next inspection.

To achieve this takes insight. We need to learn from medicine where mistakes cost lives. We need to create checklists that scrupulously detail every event and then ensure they are adhered to.

For those that say it wouldn’t work here, that I don’t need lists, that it will stifle initiatives, there is something to remember. Of all the doctors that made these claims, 96% of them said they would prefer a team that follows lists to look after them and their relatives.

You might also remember the little girl.

Marketing consultant Stefan Drew was previously director of marketing at two FHE colleges and now works with providers throughout the UK, Europe and the US – visit: and

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