9. Power of Habit Chapter 6

 - Rhode Island hospital had a gap between physicians and nurses, with the nurses feeling unappreciated and undervalued. The nurses had habits to avoid physician arrogance. They color coded doctors based on their personalities, and developed habits to make sure patients underwent procedures properly. 

- An 86 year old man had a hematoma and was taken to Rhode Island Hospital. A neurosurgeon in the middle of a routine spinal surgeon was paged and he told his assistant (a nurse practitioner) to get the man's wife to sign a consent form approving surgery. When the man was wheeled in, they found that the consent form didn't say which side of the man's head the hematoma was on, or which side to operate on. 

- The surgeon said it was the right side of the brain, ignored the nurse's protests or suggestions to recheck, and began operating, only to find out that they were operating on the wrong side of the brain. The surgery took twice as long, and the man died without ever regaining consciousness after two weeks in the ICU. The hospital paid a settlement and the surgeon was barred from ever working at Rhode Island Hospital again. 

- Richard Nelson and Sidney Winter wrote a book examining how companies work and the habits that go into it. They said that organizational habits or routines are incredibly important because without them nothing would get done. Routines reduce uncertainty and create truces between groups or individuals that could potentially fight. 

- Rhode Island Hospital had an uneasy peace where only the nurses were compromising and were in a truce. They were the ones doing all the work, and their habits showed that. 

- Philip Brickell, an employee of London Underground was on shift at King's Cross when he was told there was a burning tissue at the bottom of an escalator. He immediately went to find it, put it out, and returned to his position. He didn't do anything else, like notify a supervisor or try to find out why it happened in the first place. 

- The Underground had a tenuous peace where everyone did their specific job without stepping in anyone else's "territory". After many passengers reported seeing smoke, safety inspector Christopher Hayes was put on the investigation. However, even as flames began to come up the stairs, Hayes didn't call the fire department because that was another one of the unwritten rules of the Underground. Instead, a policeman who had noticed the flames, went to contact his headquarters. Twenty two minutes after Brickell found the burning tissue, the fire department received a note that said "small fire at King's Cross." 

-Hayes went to find the sprinkler system, but didn't know how to use them because it was someone else's department and he instead went to the machine room. The fire spread across the escalator and was trapped with the ceiling which was covered in twenty layers of paint (which someone had suggested to remove years earlier but had rescinded his recommendation when told to stay in his own department). 

-Another train arrived and people got out, saw the fire and tried to get back in, but the train driver closed the doors and left due to the policy rules. There was eventually an explosion and thirty one people died and dozens were injured. 

- Rhode Island Hospital's mistakes were made public and people began to hate them publicly. They shut down their surgery units for a day and made some serious changes. After problems, companies begin to make changes. 

-Desmond Fennell was charged with investigating the King's Cross fire. When he interviewed the Underground's leadership, he found that while everyone was aware fire safety was a serious issue and had ideas on how to fix it, no one had done anything. When Fennell began suggesting ideas of his own, he was also roadblocked in the same way as before. So he called for public hearings and talked to newspaper reporters until commuters began picketing the offices. A slew of new laws was passed and the culture of the Underground and it's habits was fundamentally changed. 

- The Rhode Island Hospital's culture is completely different now too. The nurses and doctors treat each other with kindness and suggestions are welcomed.