Critical Review of Better
by Jen Barr
“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” (Gawande, p. 246). Atul Gawande believes that we already have the tools we need to improve performance at work or in any situation where there are risks and consequences. By developing diligence, doing right, and using ingenuity, we can make significant improvements in ourselves and our lives. As simple as this plan sounds, Gawande notes that there is much work involved in achieving these goals. He lays out a framework for perfecting them and uses examples from his own work as a surgeon to help illustrate his points. By the end, it does seem that better is possible, if one is willing to put in the work needed to improve performance.
Diligence requires paying attention to the multitude of small details that accompany any task. It means not taking shortcuts, skipping steps, or rushing through. Gawande states that under most of our ideals, there is time-consuming and grueling work involved. This becomes tedious and difficult to attend to. As an example, Gawande discusses the difficulty of getting hospital staff to wash or sanitize their hands, even though this would greatly reduce hospital infections. He notes how military soldiers in Iraq were facing severe injuries when they did not wear their Kevlar vests. The solution to these problems was really quite simple: the parties involved had to follow protocols every single time, no matter how mundane they seemed. Doctors and nurses had to cleanse their hands and the soldiers had to wear the vests. Both of these measures were successful. The infection rate decreased, as did the injury counts. The groups involved had to follow the small steps involved in successful performance each and every time.
Doing right seems simple enough: it involves behaving ethically and making the right choice when faced with difficult decisions. Gawande expanded upon this by pointing out the dilemmas that doctors often face in patient care. He stressed the importance of knowing limits and knowing what to fight for. He is reminded by a colleague that doctors should remember that what they do is about the patients, not themselves. It may not always be the right move to push to keep a patient alive, if that patient’s quality of life has seriously deteriorated. In doing right, we must attempt to make better choices and utilize intelligent and wise decision-making processes. In order to do this, we must know what the appropriate boundaries or limits are and always try to use our abilities appropriately. To illustrate his point, Gawande points to health care providers that are involved in putting prisoners to death. According to Gawande, this is a violation of the medical ethical code; it is not the right way to use their medical abilities.
Gawande’s last suggestion is a little more difficult to grasp. He discussed the importance of ingenuity in bettering performance. Ingenuity is looking beyond standard established boundaries when dealing with problems. To make his point, Gawande gave examples of doctors who used unconventional methods when treating patients. The methods were not necessarily evidence-based, however they worked, and that was enough for the doctors. Gawande did caution, though, that when improving “on the fly,” it is important to constantly review the results and better them when necessary (p. 189). The main thrust of ingenuity is looking beyond technical skills and knowledge, in order to escape the average section of the bell curve. Gawande extolls the characteristics of focus, aggressiveness, and inventiveness as important dimensions to improving performance. One must have the technical skills and knowledge, but these characteristics can take performance to a new level, as illustrated by Dr. Warwick in his treatment of cystic fibrosis patients.
Intuitively, Gawande’s ideas on bettering performance make sense and could be applied in many situations, including education. In many school systems, both K-12 and higher education, there are tight budgets and teachers often do not have the money, supplies, and technology they would ideally like to have. Gawande offers a different perspective on how to handle these types of situations. Better performance does not require gadgets or new technologies. Instead, Gawande suggests making a science of performance by investigating what one currently has to work with, how well they know it, and how it could be improved. He points to perfecting performance by applying diligent attention to tasks, to ensure that each step is being followed as task completion is reached. By looking at resources available and effective teaching practices, and finding ways to either improve or to simply follow them appropriately, one could improve teaching performance. The challenge is to constantly pay attention to detail and to avoid shortcuts or skipping steps. Being diligent is hard work, over time, tasks become tedious and the urge to rush through or leave them out altogether becomes strong. But, through constant diligence, it is possible to improve performance.
Doing right requires intelligent decision-making and an assessment of capabilities. One must know his or her limits, as well as know what’s worth fighting for, both of which can be extremely difficult. This is challenging because it requires critical thought on what and when to push for and when to pull back. In practice, one needs to start with a personal moral code, which should be based on the ethics of his or her profession. In education, teachers have to decide how far to go in helping students and when to let go and understand that they may need to step back or handle a situation differently. Doing right requires diligence, in that one must be constantly vigilant when making decisions and should strive to take the time to pay attention to the details and make sure they are doing what is right.
Ingenuity is an important characteristic. It is what is needed to go beyond the average, and it requires focus, aggressiveness, and inventiveness. Again, this intuitively makes sense. When looking at peers or mentors who go above and beyond, they generally have at least one or two of these characteristics, in addition to strong knowledge and technical skills. This is usually what we think of as “thinking outside the box.” Ingenuity has a place in education. Again, resources may be limited, but finding new, inventive ways to use current resources can produce creative and effective teaching methods. It would be beneficial for anyone to strive for above average in any aspect of work or life.
The major strength of Gawande’s argument lies in the fact that we already have the tools needed to increase performance. We don’t need to spend money or find new ways to do things. By working hard and refusing to neglect the small details, we can do better. By making wise choices in the interest of helping others, we can better our students. By being ingenuous, we can make creative decisions that could reap great rewards. We already have the basics to do these things, we just need to put in the time and effort to realize our goals. Another strength I found in Gawande’s method, was in the afterword section, where he provides five suggestions to improve performance. These include asking unscripted questions, not complaining, counting something, writing something, and changing. It is not within the scope of this paper to elaborate on each suggestion; however, I found them to be quite important because they are all things that can be done without the need for further research or tools. These suggestions are central to what I feel is the greatest strength of Gawande’s text: we already possess what is needed to improve performance. The one red flag I found in Better was in the section on ingenuity. Gawande noted that some of the unconventional methods used by other doctors were not evidence-based, though they did produce results. I would be hesitant to suggest this strategy to people at large. Evidence-based research and methods are important, because the research has shown they work. I believe ingenuity is important, but it should be based on current evidence. Too many people going off of their own ideas and theories could be a detriment. Gawande does stress the importance of constantly monitoring results when working in this fashion, however.
Leaders, in education or otherwise, can use Gawande’s principles. I found Gawande’s work to be particularly relevant to Heifetz’s adaptive work, which is important to effective leadership. Gawande states that performance requires difficult work and that current performance must be analyzed to see what is and isn’t working. Adaptive work requires accurately seeing the gap in where an organization is and where is should be, which requires the science of performance Gawande described. In addition, adaptive work is often challenging and needs careful attention to detail by all involved to truly work. A leader that models diligence, doing right, and ingenuity will go a long way in helping those he or she serves to engage in needed adaptive work. Gawande uses data as a starting point when analyzing where performance needs to improve. He lists infection rates in hospitals, injury rates for soldiers, and improvement rates for cystic fibrosis patients as examples for the importance of collecting data. In his five suggestions, he discusses the importance of counting in order to see where performance is lacking. Identifying within school variations requires the use of data in order see where discrepancies lie. Leaders must track data and statistics in order to see where their organizations need to improve. After these are identified, they can encourage diligence so that proper techniques are followed.
As I read this book, I felt inspired in many ways to begin to improve my own performance. The section that spoke to me the most was the one on diligence. In both teaching and in private practice as a dental hygienist, there are a multitude of steps I must follow in order to carry out my job successfully. Often, these become overwhelming and there are times when I want to take the easy way out. Reading about some of the extraordinary circumstances Gawande describes, such as the attempt to eradicate polio or the sheer volumes of patients seen by the wartime doctors as well as the Indian doctors, makes what I face seem less daunting. Surely, if these individuals and groups could take on such extreme challenges, I can handle what is thrown my way at work. When the urge to be lazy or complacent comes along, I remind myself to be diligent, to not complain, and to serve those I work with as best as possible. Like Gawande, I am not always perfect and I do make mistakes, but the effort is worth it and as a result, I am doing better.
Ah, I havd been curious to come upon this section. I say this in truth, though with some humor, that I have been interested to read how a dental hygienist would speak to the issue of diligence, I always feel an extremely undiligent person around dental hygienists, and I suppose I am not alone, and I suppose this is a tiresome metaphor for all ofyou. But still, its eems a profession that is highly gronded in the value of diligence and wouldhave quite a ot to teach about how you bild it into sytems.
References
Gawande, A. (2007). Better: A surgeon’s notes on performance. New York, NY: Picador
Heifetz, R. (1994). Leadership without easy answers. Cambridge, MA: Belknap Press of Harvard University Press.
Narrowing the gap: Reducing within school variation in pupil outcomes. National College for School Leadership. Retrieved from https://angel.msu.edu/section/default.asp?id=US11-EAD-801-730-949597-EL-14-014.
by Jen Barr
“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” (Gawande, p. 246). Atul Gawande believes that we already have the tools we need to improve performance at work or in any situation where there are risks and consequences. By developing diligence, doing right, and using ingenuity, we can make significant improvements in ourselves and our lives. As simple as this plan sounds, Gawande notes that there is much work involved in achieving these goals. He lays out a framework for perfecting them and uses examples from his own work as a surgeon to help illustrate his points. By the end, it does seem that better is possible, if one is willing to put in the work needed to improve performance.
Diligence requires paying attention to the multitude of small details that accompany any task. It means not taking shortcuts, skipping steps, or rushing through. Gawande states that under most of our ideals, there is time-consuming and grueling work involved. This becomes tedious and difficult to attend to. As an example, Gawande discusses the difficulty of getting hospital staff to wash or sanitize their hands, even though this would greatly reduce hospital infections. He notes how military soldiers in Iraq were facing severe injuries when they did not wear their Kevlar vests. The solution to these problems was really quite simple: the parties involved had to follow protocols every single time, no matter how mundane they seemed. Doctors and nurses had to cleanse their hands and the soldiers had to wear the vests. Both of these measures were successful. The infection rate decreased, as did the injury counts. The groups involved had to follow the small steps involved in successful performance each and every time.
Doing right seems simple enough: it involves behaving ethically and making the right choice when faced with difficult decisions. Gawande expanded upon this by pointing out the dilemmas that doctors often face in patient care. He stressed the importance of knowing limits and knowing what to fight for. He is reminded by a colleague that doctors should remember that what they do is about the patients, not themselves. It may not always be the right move to push to keep a patient alive, if that patient’s quality of life has seriously deteriorated. In doing right, we must attempt to make better choices and utilize intelligent and wise decision-making processes. In order to do this, we must know what the appropriate boundaries or limits are and always try to use our abilities appropriately. To illustrate his point, Gawande points to health care providers that are involved in putting prisoners to death. According to Gawande, this is a violation of the medical ethical code; it is not the right way to use their medical abilities.
Gawande’s last suggestion is a little more difficult to grasp. He discussed the importance of ingenuity in bettering performance. Ingenuity is looking beyond standard established boundaries when dealing with problems. To make his point, Gawande gave examples of doctors who used unconventional methods when treating patients. The methods were not necessarily evidence-based, however they worked, and that was enough for the doctors. Gawande did caution, though, that when improving “on the fly,” it is important to constantly review the results and better them when necessary (p. 189). The main thrust of ingenuity is looking beyond technical skills and knowledge, in order to escape the average section of the bell curve. Gawande extolls the characteristics of focus, aggressiveness, and inventiveness as important dimensions to improving performance. One must have the technical skills and knowledge, but these characteristics can take performance to a new level, as illustrated by Dr. Warwick in his treatment of cystic fibrosis patients.
Intuitively, Gawande’s ideas on bettering performance make sense and could be applied in many situations, including education. In many school systems, both K-12 and higher education, there are tight budgets and teachers often do not have the money, supplies, and technology they would ideally like to have. Gawande offers a different perspective on how to handle these types of situations. Better performance does not require gadgets or new technologies. Instead, Gawande suggests making a science of performance by investigating what one currently has to work with, how well they know it, and how it could be improved. He points to perfecting performance by applying diligent attention to tasks, to ensure that each step is being followed as task completion is reached. By looking at resources available and effective teaching practices, and finding ways to either improve or to simply follow them appropriately, one could improve teaching performance. The challenge is to constantly pay attention to detail and to avoid shortcuts or skipping steps. Being diligent is hard work, over time, tasks become tedious and the urge to rush through or leave them out altogether becomes strong. But, through constant diligence, it is possible to improve performance.
Doing right requires intelligent decision-making and an assessment of capabilities. One must know his or her limits, as well as know what’s worth fighting for, both of which can be extremely difficult. This is challenging because it requires critical thought on what and when to push for and when to pull back. In practice, one needs to start with a personal moral code, which should be based on the ethics of his or her profession. In education, teachers have to decide how far to go in helping students and when to let go and understand that they may need to step back or handle a situation differently. Doing right requires diligence, in that one must be constantly vigilant when making decisions and should strive to take the time to pay attention to the details and make sure they are doing what is right.
Ingenuity is an important characteristic. It is what is needed to go beyond the average, and it requires focus, aggressiveness, and inventiveness. Again, this intuitively makes sense. When looking at peers or mentors who go above and beyond, they generally have at least one or two of these characteristics, in addition to strong knowledge and technical skills. This is usually what we think of as “thinking outside the box.” Ingenuity has a place in education. Again, resources may be limited, but finding new, inventive ways to use current resources can produce creative and effective teaching methods. It would be beneficial for anyone to strive for above average in any aspect of work or life.
The major strength of Gawande’s argument lies in the fact that we already have the tools needed to increase performance. We don’t need to spend money or find new ways to do things. By working hard and refusing to neglect the small details, we can do better. By making wise choices in the interest of helping others, we can better our students. By being ingenuous, we can make creative decisions that could reap great rewards. We already have the basics to do these things, we just need to put in the time and effort to realize our goals. Another strength I found in Gawande’s method, was in the afterword section, where he provides five suggestions to improve performance. These include asking unscripted questions, not complaining, counting something, writing something, and changing. It is not within the scope of this paper to elaborate on each suggestion; however, I found them to be quite important because they are all things that can be done without the need for further research or tools. These suggestions are central to what I feel is the greatest strength of Gawande’s text: we already possess what is needed to improve performance. The one red flag I found in Better was in the section on ingenuity. Gawande noted that some of the unconventional methods used by other doctors were not evidence-based, though they did produce results. I would be hesitant to suggest this strategy to people at large. Evidence-based research and methods are important, because the research has shown they work. I believe ingenuity is important, but it should be based on current evidence. Too many people going off of their own ideas and theories could be a detriment. Gawande does stress the importance of constantly monitoring results when working in this fashion, however.
Leaders, in education or otherwise, can use Gawande’s principles. I found Gawande’s work to be particularly relevant to Heifetz’s adaptive work, which is important to effective leadership. Gawande states that performance requires difficult work and that current performance must be analyzed to see what is and isn’t working. Adaptive work requires accurately seeing the gap in where an organization is and where is should be, which requires the science of performance Gawande described. In addition, adaptive work is often challenging and needs careful attention to detail by all involved to truly work. A leader that models diligence, doing right, and ingenuity will go a long way in helping those he or she serves to engage in needed adaptive work. Gawande uses data as a starting point when analyzing where performance needs to improve. He lists infection rates in hospitals, injury rates for soldiers, and improvement rates for cystic fibrosis patients as examples for the importance of collecting data. In his five suggestions, he discusses the importance of counting in order to see where performance is lacking. Identifying within school variations requires the use of data in order see where discrepancies lie. Leaders must track data and statistics in order to see where their organizations need to improve. After these are identified, they can encourage diligence so that proper techniques are followed.
As I read this book, I felt inspired in many ways to begin to improve my own performance. The section that spoke to me the most was the one on diligence. In both teaching and in private practice as a dental hygienist, there are a multitude of steps I must follow in order to carry out my job successfully. Often, these become overwhelming and there are times when I want to take the easy way out. Reading about some of the extraordinary circumstances Gawande describes, such as the attempt to eradicate polio or the sheer volumes of patients seen by the wartime doctors as well as the Indian doctors, makes what I face seem less daunting. Surely, if these individuals and groups could take on such extreme challenges, I can handle what is thrown my way at work. When the urge to be lazy or complacent comes along, I remind myself to be diligent, to not complain, and to serve those I work with as best as possible. Like Gawande, I am not always perfect and I do make mistakes, but the effort is worth it and as a result, I am doing better.
Ah, I havd been curious to come upon this section. I say this in truth, though with some humor, that I have been interested to read how a dental hygienist would speak to the issue of diligence, I always feel an extremely undiligent person around dental hygienists, and I suppose I am not alone, and I suppose this is a tiresome metaphor for all ofyou. But still, its eems a profession that is highly gronded in the value of diligence and wouldhave quite a ot to teach about how you bild it into sytems.
References
Gawande, A. (2007). Better: A surgeon’s notes on performance. New York, NY: Picador
Heifetz, R. (1994). Leadership without easy answers. Cambridge, MA: Belknap Press of Harvard University Press.
Narrowing the gap: Reducing within school variation in pupil outcomes. National College for School Leadership. Retrieved from https://angel.msu.edu/section/default.asp?id=US11-EAD-801-730-949597-EL-14-014.
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