What can the legal world learn from healthcare?

Written by Ana de Liz for Crafty Counsel

“We’ve got a small number of people in charge of a lot of people’s lives and you can have a big impact on those lives,” Dr Imogen Staveley says of the similarities between the aviation and the healthcare industries, which brought the medical industry to adopt one or two strategies from its high-skies counterpart (more on that later).

The legal industry, in some ways, harbours similar power in the sense that a select group of people in society (lawyers and barristers) can sometimes hold the fate of a number of its citizens — in the case of lawyers working in business, the success or failure of their critical projects and aspirations.

So, what can lawyers learn from doctors? In a conversation with Dr Imogen Staveley, GP and Deputy Chair of the Warwickshire North Clinical Commissioning Group, Crafty Counsel sought to find some answers.

Treating one’s career as a career-long learning experience

After medical school, doctors are on continuous training until they become consultants, after which they qualify either as a hospital specialist or as a GP (are you thinking back to your trainee years yet?).

Whichever path they chose, doctors have yearly appraisals and every five years, they are re-validated to show that their skills have been kept up to date: no longer is it accepted that more years under your belt mean that you’re a better or safer doctor, Dr Staveley says.

Even with experience, skills can wear-and-tear. Dr Staveley mentions an example where a doctor might be having a face-to-face consultation with a patient, someone might call her on the phone to ask a prescribing query, and then a trainee could come in to ask a question. In a legal context, an analogous situation might be dealing with more than one deal at a time, or juggling client work alongside managing team-members.

“It wouldn’t be beyond the realms of possibility that you might make a mistake in one of those interactions that are happening at the same time. However experienced you are, this can happen because your brain is not able to process that much information,” she mentions. Therefore, it is very important (both in medicine and in law) to have systems in place as fail-safes.

Dr Staveley explains that CPR practice training is compulsory on a yearly basis, focused on the actual resuscitation as well as the procedures and system around it. Everybody, no matter their seniority in the clinical team, has to come to the training every year, regardless of where they are in the team.

The shift in attitude came from a recognition of similarities with the aviation industry: where a small number of people are in charge of a lot of people’s lives in each job, and the aviation industry learned first that the “captain isn’t always right”: mistakes can be made and it’s important to learn from and prevent them from the most junior pilot to the most experienced doctor. The medical industry followed suit.

What can legal learn from this approach — in particular, regular simulation training of common situations (e.g. deal closings), and the involvement of all team members who would take part in that matter? Should partners, associates, trainees, paralegals and secretaries all train together?

One of the instruments which the medical industry has introduced to prevent mistakes has been more and more time doing better care checklists. What started out in 2007–8 as a WHO experiment to make surgeries safer for patients was quickly adopted into surgeries around the world and at the NHS. It didn’t take away any of the immense experience needed from the main surgeon (read: partner) to execute the surgery (read: deal), but it made it easier for them and the team around them (read: associates, trainees, paralegals) to minimise the chances of making mistakes.

Their introduction, however, was not without resistance. Dr Staveley explains that some surgeons will sometimes feel reluctant to go through checklists (even skipping chunks of some procedures all together) because of their many, many years of experience.

Nevertheless, she hopes that the culture is changing since junior doctors see the value in checklists, given that evidence shows that using them reduces harm significantly, and doctors lead by evidence. “It would be foolhardy for any junior doctor now to ignore it or not respect it. What’s really, really important is that it’s often a lead nurse in charge of calling it out and it’s so important that we support those people, do it, and take part in it ourselves,” she says.

What is it like, though, when the most senior person in the room undermines the clinical process in that way and what can a junior doctor or lawyer do about it?

Challenging the most senior doctor in any situation “take a lot,” Dr Staveley admits since they are often needed by the junior to sign off a placement form or fill in reports.

The problem lies where juniors fall into line and just do as expected in order to have the easy life. “We need to not have the easy life, we need to say something. And it doesn’t have to be dramatic, it’s just questioning: where were you when we were doing the checklist; or highlighting that they weren’t there. This is a small step to us all changing and improving things for the future and improving this for our patients.” She says that in whatever industry you find yourself in — whether legal or healthcare -, questioning our seniors is a must in order to change things.

An organisation can only learn from its errors if it knows about them. Dr Staveley observes that it is important for organisations to develop a culture that allows open and systematic discussion about mistakes without immediately seeking to apportion blame. This encourages those in the system to share mistakes they have made so that everyone can learn. (And — where serious mistakes have indeed been made — ensuring that doctors are provided with sufficient support as the necessary investigations and regulatory processes are completed.)

What can legal learn from this approach? How many partners or General Counsel are able to point to a culture that encourages more junior lawyers to step forward and discuss mistakes in an open and transparent way?

Law can be very introspective, and Crafty Counsel is hoping that shining a light on professionals in other disciplines will help lawyers to improve and innovate. If you have other suggestions of angles to take and people to interview — let them know!