You're Either Drafting or Pulling: What Health Care Can Learn From Cycling

Submitted by Alan Cassels on November 1, 2011 - 13:43
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Alan Cassels, Drug Policy Researcher and Adjunct Professor, Human and Social Development, University of Victoria, cassels@uvic.ca

Most people think cycling, and by that I specifically mean road racing, is an individual sport. They look at the superstars, people like 7-time Tour de France winner Lance Armstrong and think: "that guy is awesome!" Which is true, but only partly.

Lance is no doubt one of the world's greatest cyclists, but he also happened to be a member of the world's greatest cycling teams, who helped put him on the podium seven times.

I know this because I'm a cyclist, an occasional road racer who particularly enjoys the long distances. Big slogs where you carry all the food and water you need for three hour-long lung bursting, leg thrashing rides. Last year I rode in a race with 5,000 other cyclists from Vancouver to Whistler, over 122 kilometers of mostly uphill. I guess I did ok, averaging almost 34 km per hour, and finishing 26th in my age class of 1,100 men aged 40-49.

People will look at that stat and say, "Alan, you rock." Which, like the praise we heap on Lance, is only partly true. You see, when I'm alone, riding the 160 km from Victoria to Parksville, just north of Nanaimo on Vancouver Island, which I do several times every summer, I can only manage about 30 km per hour. Why the difference? The answer is in the draft.

You see, the biggest enemy of riding a bike is wind resistance. Get up over 30 km per hour and about 40% of your energy is going into breaking the wind. When you've got a guy in front of you doing that for you, as I followed along the fast guys going to Whistler and as Lance had as he raced to the Arc de Triomphe, you're getting an easier ride. You're in the leader's draft and life is a lot easier. You take your turn at the front, doing a "pull" as they say, and your teammates can rest. When you're in the draft, life
looks good. When you're pulling, or on your own with the devil wind, life is tough.

What does this have to do with healthcare? In the most simplistic way, it is about the way we innovate and change, to improve things. Most of us are trying to reinvent things that others have already done. Most of us want to be seen as the one out there doing the pulling. Most of us find it too hard and we don't achieve what we could because, we don't sit in the draft as much as we should. And sometimes we sit behind and just pedal along, as others do the serious work up front.

Let's take any issue, whether it's pharmaceutical benefits policies, hospital wait times, or health care teams. You only need to look around and see who are doing those things well, and get in behind them. You don't need to invent, you can ride the draft. There's lots of good play in this analogy.

The next time I write about this issue, I'll give you some examples where health professionals are out there pulling when they should be drafting, and they're getting winded and worn down. And then there are others who are drafting when they need to do their time at the front.

Either way, baseball is not the only analogy that is useful in looking at health systems and health system changes. What will it take to put us on the podium in health care? An understanding of drafting and pulling. And going there together is vital; because after all, cycling, like health care, is best done as a team who knows how to work together.

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