Book Summary: Better - A Surgeon's Notes on Performance - Written by Atul Gawande

Dr. Gawande is an excellent author. Anytime I can learn from a Harvard graduate then I will spend the time on it. "Better" talks about certain simplistic conclusions from complex problems. Being a positive deviant is how Dr. Gawande characterizes being successful and making progress in medicine or any endeavor.

Why is this important to me? Inevitably you will come across complex issues in your life. Taking a diligent approach to solving these issues will usually result in simple solutions. Better talks about how to do that. What does it take to be good at something in which failure is so easy, so effortless? Dr. Gawande tells a story of one of his patients that was admitted under his care when he was in medical school. The patient was stable and needed to be put under observation. She complained of insomnia and sweats the night before. The senior resident told him to keep a close eye on her and he agreed to see her mid-day. That one simple assumption almost cost the patient her life. The senior resident checked on her first and she had a fever and needed to be put into the ICU. She lived and was sent home fine a few days later. The point of this story is that a simple assumption to check on the patient in a couple hours could have cost her - her life. One simple thing to do separates life and death.

Better is broken down in three main parts which I will touch on briefly and then we will talk about Dr. Gawande's recommendations for becoming a positive deviant.

1. Diligence - Each year 2 million Americans acquire an infection in the hospital and 90,000 die from that infection. Infections are complex as you can get. Where did they come from? How did it happen? When did it start? What type is it? All of these questions are valid and are part of the complex puzzle. After much study, the proper solution is WASHING YOUR hands. Now there is a strict procedure that doctors should follow, key word here is "should" and most don't.

There are little improvements that make HUGE differences that are profiled in the book. Here is a simple example. The nurses in the operating room would routinely run out of supplies and have to go get more. Thus they leave the room and come back in. Simple solution, make sure the supplies are fully stocked so you do not have to leave. This simple solution of just-in-time supply system eliminated infections by 90% in hospital surgical rooms that employed it.

2. Measure - Another part of diligence is measurement. In the Vietnam War, when a soldier was wounded, their average time from field to the U.S was 45 days. Today it is 4 days. Gunshot mortality dropped from 16% in Vietnam to less than 5% today. The reason is not technology. It is in the process. Today there is FSU's (Forward Surgical Units). They follow the troop battalions. Now when a soldier is hurt they perform mini-incomplete surgeries to make sure they live and then the rest of the surgery is completed after. This seems counter intuitive but it works.

The key to understanding why Forward Surgical Units work is to measure things. It became known that the time from wound to care is in direct correlation to life and death. Minimize the time - Maximize Life. Knowing this allows them to minimize the time in several areas.

3. Simplistic Relentlessness - Ingenuity is bread from measurement and diligence. Once your eyes are opened then the solution appears. This is slight edge daily behavior that creates huge results. Using simplistic relentlessness on identified problems creates explosive returns. This is the 80/20 rule on steroids. Most people would not look at the little things but a simple check list can save lives.

A great quote from the book is: "What the best may have, above all, is a capacity to learn and change-and to do so faster than everyone else." To that end I want to talk about the five recommendations to becoming a positive deviant. This is the term for using your ingenuity to solve complex problems.

1. Ask unscripted questions 2. Don't complain 3. Count Something 4. Write something 5. Change - These 5 things are designed to leverage the "collective know how!"

I hope you have found this short summary useful. The key to any new idea is to work it into your daily routine until it becomes habit. Habits form in as little as 21 days.

One thing you can take away from this book is count something. If you don't measure it then you can't manage it. This is a big deal. Spend time and measure things that are important especially if you need to solve a complex problem.


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