dr Gawande is an excellent writer. Whenever I can learn from a Harvard grad, I’ll spend the time doing it. “Better” speaks of certain simplifying conclusions from complex problems. Being a positive deviant, as Dr. Gawande characterizes being successful and making advances in medicine or other endeavors.
Why is this important to me? Inevitably, you will encounter complex problems in your life. A careful approach to solving these problems usually leads to simple solutions. Better conversations about how to do it. What does it take to be good at something where failure is so easy and effortless? dr Gawande tells the story of one of his patients who was taken into his care while he was studying medicine. The patient was stable and required observation. She complained of insomnia and sweating the night before. The elderly woman told him to keep a close eye on her and he agreed to see her at noon. This simple assumption nearly cost the patient her life. The senior checked her first and she had a fever and had to be taken to the intensive care unit. She survived and was sent home safely a few days later. The point of this story is that a simple assumption to check the patient in a few hours could have cost her – her life. A simple thing separates life and death.
Better is divided into three main parts which I will briefly discuss and then we will talk about Dr. Gawande’s recommendations speak to becoming a positive deviator.
1. Diligence – Each year, 2 million Americans are hospitalized and 90,000 die from the infection. Infections are as complex as you can get. Where are you from? How did it happen? when did it start What kind is it? All of these questions are valid and part of the complex puzzle. After a long study, the right solution is to WASH YOUR HANDS. Now there is a strict procedure that doctors should follow, the key word here is “should” and most don’t.
There are small improvements that make HUGE differences that are detailed in the book. Here’s a simple example. Operating room nurses routinely ran out of supplies and had to fetch new ones. So they leave the room and come back in. Simple fix: make sure supplies are fully stocked so you don’t have to leave. This simple just-in-time supply system solution eliminated infections by 90% in the operating rooms of hospitals where it was used.
2. Measuring – Another part of due diligence is measuring. When a soldier was wounded in the Vietnam War, it took him an average of 45 days to get from the scene to the United States. Today is 4 days. Gun mortality fell from 16% in Vietnam to less than 5% today. The reason is not in the technology. It’s in process. Today there are FSU’s (Forward Surgical Units). They follow the troop battalions. Now when a soldier gets injured they will perform small incomplete operations to ensure they are alive and then the rest of the operation will complete. This seems counterintuitive, but it works.
The key to understanding how Forward Surgical Units work is to measure things. The time from wound to care has been known to be directly related to life and death. Minimize Time – Maximize Life. Knowing this, they can minimize time in several areas.
3. Simple relentlessness – Ingenuity is bread of moderation and diligence. Once your eyes are open, the solution will appear. This is an easy daily behavior that produces tremendous results. Using simple relentlessness on identified issues yields explosive results. This is the 80/20 rule for steroids. Most people wouldn’t pay attention to the little things, but a simple checklist can save lives.
A great quote from the book is, “First and foremost, what the best can have is the ability to learn and change — faster than anyone else.” To that end, I want to talk about the five recommendations for being a positive deviant to become. This is the expression of using your ingenuity to solve complex problems.
1. Ask non-written questions 2. Don’t complain 3. Count something 4. Write something 5. Change – These 5 things were designed to use the “collective know-how”!
I hope you found this brief summary useful. The key to any new idea is to incorporate it into your everyday life until it becomes a habit. Habits are formed in just 21 days.
One thing to take away from this book is counting. If you don’t measure it, you can’t manage it. That’s a big deal. Spend time and measure things that matter, especially when you have a complex problem to solve.
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