A Clean Bill of Health Can Be Deadly: The Power of S.M.A.R.T. Thinking

High reliability organizations take action every day towards achieving the benchmark goal of zero preventable harmful events. They constantly weigh the cumulative impact of daily choices and actions.
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David is a 53-year-old attorney on the executive leadership team of a firm based in New York. While he does his best to maintain a healthy lifestyle, he knows that his family has a history of heart disease. Excluding a year when he was chided for gaining a few extra pounds, David has consistently received a clean bill of health from his physician. A few weeks ago, he completed a mandatory executive physical, which included a cardiac stress test and several lab tests. He passed the physical, as usual, with flying colors.

Today, David is running late for work. He's been working all night with his Dubai team, resolving a critical regulatory issue. He has a brief meeting in the city, prior to a 14-hour flight. As he's getting into his sedan, he feels a tingling sensation stretching from his jaw to the fingers of his left hand. He feels nauseated and dizzy, and notices a tightness in his chest that won't go away. Dismissing it as exhaustion, he continues on his journey to the office.

A century ago, tuberculosis, pneumonia and dysentery were the leading causes of death in the United States. Over time, disease patterns have changed radically. Instead of dying from an infectious disease we contract from others, we get sick and die from diseases we give ourselves through lifestyle choices.

While many leaders, entrepreneurs and executives put extensive work into the companies they lead, they often neglect their most valuable asset: Personal health. David's work ethic helped him achieve success with his work, but he didn't apply the same level of intuition and determination to managing his own wellness.

There is a solution. I invite you to step up and
become the CEO of the business of your wellness.

In many ways, the physiological processes inside the human body work like the most efficient, most complex businesses in the world. Every enzyme, every protein structure, every DNA strand and every metabolic pathway play an important role in our physiology, working together with an unrivaled level of efficiency. These systems are not immune to failure, however. Threats, both internal and external, are a continual source of concern. And many of the causes systems failures in the body which lead to disease can be prevented through the emerging specialty of lifestyle medicine. The operational efficiency of the business of your body is in your hands. Like David, you can feel fine for years on the way to a preventable health crisis. High Reliability Science, a technique used in many industries, can help you prevent these crises from ever occurring. Here is how it works.

Your Wellness, High Reliability Science and S.M.A.R.T. Thinking

Air traffic control systems, nuclear power facilities, and disaster response networks all are complex industries which operate in different ways. However, one construct links all these organizations: High Reliability Science. Businesses that use this strategy make a commitment to safety at the highest level. Since the risk of failure in high-risk industries can be catastrophic, High Reliability Science aims for a benchmark of zero preventable harmful events.

High Reliability Science is used in many hospitals to improve patient outcomes. This field isn't limited to institutional use, however. S.M.A.R.T. Thinking is a personalized adaptation of the five key principles of High Reliability Science. While a heart attack or a stroke may not carry the same consequences as a nuclear accident on a societal level, it carries personal consequences that are just as dire. In the human body, health crises are often caused by chronic, untreated health issues that are ignored or overlooked. While these issues may not be severe in the short-term, they can lead to long-term consequences in the future.

As the CEO of the business of your body, S.M.A.R.T. Thinking allows you to apply High Reliability Science to the business of achieving, maintaining and sustaining your wellness with a goal of zero preventable harmful events. Below is a description of the five principles (*) followed by a discussion of the principle applied to personal wellness.


*Preoccupation with Failure

High-reliability organizations are preoccupied with failure. Never satisfied with an accident-free safety record, they are always alert to the smallest signal of a new threat. Any lapse, however small, is a symptom that something is potentially wrong with a system. Instead of trying to hide failures, they are treated as opportunities to understand the overall health of a system. These small failures, errors and close calls are turned into learning opportunities that help prevent the development of more serious problems in the future.

Awareness of the potential for failure is critical for detecting warning signs of threats to personal health. Being vigilant and 'preoccupied with failure' is not the same as neuroticism. David made the assumption that a clean bill of health meant he wasn't at risk of developing a chronic disease. Since his annual physicals had never shown any issues in the past, he developed a false sense of security. Many of us don't like to think about our mortality, or the fact that our entire existence is reliant on the health of the body and organ systems that make us who we are. If we ignore our inherent mortality, we put ourselves at higher levels of risk.

*Sensitivity to Operations and Avoiding Oversimplification

High reliability organizations prepare for the unexpected by staying sensitive to all aspects of an operation and by refusing to simplify situations that require complex, nuanced responses. High reliability organizations avoid a myopic view of internal and external processes; instead of focusing on one perspective of a system, they view how all parts work together. This helps them predict and proactively respond to unexpected events. High-reliability organizations are sensitive to small changes, which may indicate a potential threat. When small changes are noted, they resist the temptation to simply their observations or experiences.

Only you are in a position to stay 'in tune' with your body. While knowing your numbers is critical for wellness, your personal intuition may serve as a harbinger that something is wrong, long before a diagnosis indicates the presence of disease. While hypochondria on its own is not healthy or productive, a rational, educated awareness of your body and what you experience on a daily basis can play a valuable role in diagnosing a health issue. Health is more than just a blood pressure reading or a fasting lab result. It's how you feel on a daily basis: Your ability to recognize and respond to changes in your body is critical for S.M.A.R.T. Thinking.

David recognized but ignored subtle signs that warned of the development of coronary heart disease. David did many things right to maintain good cardiovascular health, but he didn't remain adequately sensitive to operations. He deluded himself with a simple explanation for how quickly he became exhausted when exercised, and he ignored the intermittent chest pain when he engaged in sexual activity with his spouse. He dismissed his shortness of breath, fatigue and prolonged recovery following a workout as a normal part of aging. When he did have abnormal blood pressure readings, he did not take action; he did not proactively call his physician to ask what could be done.

Oprah Winfrey once said, "Learning to trust your instincts, using your intuitive sense of what's best for you, is paramount for any lasting success. I've trusted the still, small voice of intuition my entire life. And the only time I've made mistakes is when I didn't listen."

*Deference to Expertise

High reliability organizations have a mechanism in place to identify individuals with the greatest relevant expertise, and defer to their judgement for critical decisions. These organizations embrace and defer to vetted expertise, regardless of where that expertise is in a company. High reliability organizations recognize experience is not the same as expertise. While experience can be a step towards building personal expertise in a field, experience can also cause someone to fall into a pattern of similar solutions, where they act based on their "muscle memory" of a past situation. Unfortunately, this may limit their ability to truly search for the best solution.

David was an expert at his job, but he didn't realize that his expertise extended beyond that. No physician is an expert in what it's like to be you or how you define wellbeing. As an advocate for your wellness, you must recognize your innate expertise--and its limitations. As an expert in you, you have the ability to bring relevant, timely information to your provider, which allows them to provide the best possible care. Doctors utilize clinical practice and preventive care guidelines, developed by expert panels based on analysis of research findings A health advocate is an expert in navigation, access and translation of medical language and healthcare culture, which helps bridge gaps in understanding between patients and their providers.

*Commitment to Resilience

High reliability organizations develop capabilities to detect, contain, and bounce back from inevitable errors. These organizations aren't error free; instead, they embrace processes to ensure that an error isn't disabling. These groups often improvise workarounds that allow a system to keep functioning. High reliability organizations imagine worst-case conditions and practice their own equivalent of fire drills.

David's resilience had allowed him to guide his company through a nasty near takeover of his firm. He led the fight, and his firm thrived. Yet when it came to applying these skills to his personal health and wellness, he dropped the ball.

Many people demonstrate resolve and resilience in their work lives. Applying these skills to personal health and wellness can be a challenge. Resilience gives you the ability to acknowledge and act on a potential health risk or threat, instead of ignoring it. Avoidance behaviors are often grounded in a mindset that acknowledging a health issue will rob you of the comforting normalcy of everyday life. True resilience comprises managing all aspects of the business of your wellness. It includes acceptance and self-education regarding diagnoses and treatment options available to you. With resilience, you'll be better prepared to comply with regimens for chronic disease and acute disease, reducing your risk of harmful complications.

*Achieving Zero Preventable Harmful Events

High reliability organizations take action every day towards achieving the benchmark goal of zero preventable harmful events. They constantly weigh the cumulative impact of daily choices and actions.

When David arrived at his office building the pressure in his chest was unbearable. He asked the driver to head to Mt. Sinai emergency room. Within an hour of arriving in the ER, an EKG showed Wellens' Syndrome, a particular lesion that obstructed the left main coronary artery, limiting blood supply to the heart. Often leading to death, this condition is known among physicians as the "widow maker". Luckily, David reached the ER in time for an emergent intervention to unobstruct the artery. After he was discharged with a cardiac stent, David had a moment of truth. He wondered how he could have a 'clean bill of health', yet have a heart attack.

Statistically, David's scenario is likely for many of us. Heart disease, second only to cancer, is the leading cause of death for both men and women. Approximately 610,000 Americans die from heart disease each year. This represents one of every four deaths in the United States. In the U.S. alone, someone experiences a heart attack every 43 seconds. Coronary heart disease kills more than 370,000 people annually.

Some researchers attribute these trends in death and disability to shifting pressures in modern life. In particular, people who live in advanced societies face continual, relentless low-level stress. Ongoing stress, like that which David experienced every day at work, can cause lasting, negative changes in human physiology, ranging from metabolic disorders to immune system dysfunction.

There are many determinants of the occurrence of a cardiac event, such as a heart attack. Your annual physical exam and the complex science of risk assessment are only tools that allow healthcare providers to take a brief snapshot of a person's health. Diagnostics that assess a person's risk of coronary artery disease and 'heart attacks' include EKGs, MRIs, PET scans, CAT scans, blood tests and stress tests. Stress tests include treadmill ECG studies, treadmill echocardiograms, treadmill nuclear studies, pharmacologic echocardiograms and pharmacologic nuclear studies. It is likely that someone you know had a 'negative' diagnostic test, yet succumb to a significant cardiac event shortly after.

Despite a clean bill of health, David ignored signals of harm from a stressful lifestyle and the onset of heart disease. Ultimately, he was fortunate and only experienced a near-miss for a potentially fatal event. A perceived healthy past doesn't ensure a system free from failure.

By accepting your body and its health as a business, your first action step is to become CEO of your wellness and establish a vision and goals for your business. With S.M.A.R.T. Thinking, you can leverage your COO's skills to support you in achieving your wellness goals, and you can improve your family's health legacy for generations to come.