Dr. Gawande is an excellent author. Anytime he can learn from a Harvard grad, I’ll dedicate the time to it. “Better” speaks of certain simplistic conclusions from complex problems. Being a positive deviant is how Dr. Gawande characterizes success and progress in medicine or in any endeavor.
Why is this important to me? You will inevitably run into complex problems in your life. Taking a diligent approach to solving these problems will usually result in simple solutions. Better talk about how to do that. What does it take to be good at something where failure is so easy, so easy? Dr. Gawande tells the story of one of his patients who was admitted under his care when he was in medical school. The patient was stable and needed to be observed. He complained of insomnia and sweating the night before. The older resident told her to keep a close eye on her and agreed to see her at noon. That simple assumption nearly cost the patient his life. The main resident checked her first and she had a fever and needed to be admitted to the ICU. She lived and was sent home just fine a few days later. The point of this story is that the simple assumption of controlling the patient in a couple of hours could have cost her her life. A simple thing to do separates life and death.
Better is divided into three main parts that I’ll touch on briefly, and then we’ll 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 about as complex as you can get. Where do they come from? How did it happen? When did it start? What type is it? All these questions are valid and are part of the complex puzzle. After much study, the proper solution is to WASH your hands. Now there is a strict procedure that doctors have to follow, the key word here is “should” and most don’t.
There are small improvements that make HUGE differences that are described in the book. Here is a simple example. The nurses in the operating room usually ran out of supplies and had to go get more. So they leave the room and re-enter. Simple solution, make sure supplies are fully stocked so you don’t have to leave. This simple, just-in-time delivery system solution eliminated infections by 90% in the operating rooms of the hospitals that used it.
2. Measure – Another part of due diligence is measurement. In the Vietnam War, when a soldier was injured, the average time from the field to the US was 45 days. Today is 4 days. Gunshot mortality dropped from 16% in Vietnam to less than 5% today. The reason is not technology. It is in process. Today there are FSUs (Advanced Surgical Units). They follow the battalions of troops. Now, when a soldier is wounded, they perform sketchy mini-surgeries to make sure he lives, and then the rest of the surgery is completed. This seems counter-intuitive, but it works.
The key to understanding why Forward Surgical Units work is to measure things. It was learned that the time from injury to care is directly correlated with life and death. Minimize Time – Maximize Life. Knowing this allows them to minimize time in various areas.
3. Simplistic Relentlessness – Wit is the bread of measure and diligence. Once you open your eyes, the solution appears. This is a daily slight edge behavior that creates big results. Using simplistic relentlessness on identified problems generates explosive returns. This is the 80/20 rule of steroids. Most people wouldn’t look at the little things, but a simple checklist can save lives.
A great quote from the book is: “What the best can have, above all, is the ability to learn and change, and to do it faster than others.” To that end, I want to talk about the five recommendations for becoming a positive deviant. This is the term for using your wits to solve complex problems.
1. Ask spontaneous questions 2. Don’t complain 3. Tell something 4. Write something down 5. Change: These 5 things are designed to tap into “collective knowledge.”
I hope you found this short summary useful. The key to any new idea is to work it into your daily routine until it becomes a habit. Habits are formed in as little as 21 days.
One thing you can take away from this book is to tell something. If you don’t measure it, then you can’t manage it. This is a big problem. Spend time and measure the things that are important, especially if you need to solve a complex problem.