Better – A Surgeon’s Notes on Performance

A couple of years ago I heard an interview with Atul Gawande, a US surgeon/professor/writer about his book “Better – A Surgeon’s Notes on Performance” as part of a Scientific American podcast. Several aspects of this interview stayed with me and I made a mental note that I should read his book. Then a few weeks ago this interview was repeated and it spurred me on to finally get a copy which I have now finished reading. “Better” sets out to discuss how it is possible to improve the success rate of medical care in a number of settings from hospital hygiene, to battlefield injuries to “routine” treatment of medical conditions. It is a brilliant book, even for someone who, like me, has no particular interest in medicine (and who struggled somewhat to read a detailed description of the process of completing a Caesarean Section…). Gawande, tries to identify the factors that turn “good” into “better”. One simple example, which was used in the original interview I heard, is of improving hygiene in hospitals to limit spread of infectious diseases – the answer is not to search for some fancy new procedure; it’s something much more basic, namely to ensure that everyone properly washes their hands every single time that they should do. Simple.

There are two particular quotations that I liked. The first is this:

“When you make an effort, you find sometimes you are not the only one willing to do so.”

and the second comes towards the end of the book and is a kind of summary of the whole book:

“Arriving at meaningful solutions is an inevitably slow and difficult process. Nonetheless, what I saw is: better is possible. It does not take genius. It takes diligence. It takes Moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”
[this one is SO good I’m going to add it to the bottom of my work email signature I think]

The final chapter of the book looks at what it takes to become what Gawande calls a “positive deviant”. This is someone who stands out from the crowd and makes a difference, who naturally makes things better and who continually raises the bar. He comes up with five suggestions for how one might make a “worthy difference” and become a positive deviant. Whether he is right or not, I think they make a great list and what particularly pleased me as I read them each in turn is that it turns out that I already do most of them…

1. Ask an unscripted question: i.e. talk to people; find things out about them; make human connections
2. Don’t complain: “it’s boring, it doesn’t solve anything, and will get you down”
3. Count something: gather data on something, anything; look for the patterns; learn something interesting about something that interests you
4. Write something: “by offering your reflections to an audience, even a small one, you make yourself part of a larger world”
5. Change: “it often seems safest to do what everyone else is doing – to be just another … cog in the machine”

What a great list – I’m going to work harder on number 2 and, to a lesser extent, number 5, and with a bit of luck, I’ll get better.