Books: Better by Atul Gawande

I really like this book for a number of reasons.

First off, I like it because Atul Gawande gives the reader and unvarnished, honest look into the practice of medicine. He wants people to see how Medicine is not perfect, how much of it is about trial and error, and how physicians must deal with uncertainty and a lack of control just like all other professions do. It would be one thing just to point out all the inefficiencies that plague the work of doctors, but thankfully Gawande also offers helpful solutions, which leads to the second reason I like this book so much.

Secondly, this book is all about high-performance, which is totally consultant work! As a consultant I consider myself pretty experienced in performance measures, metrics, target setting, etc. In fact I might go so far to say that 80% of what I do involves measuring performance, and maybe 20% is actually spent on performing. But that's a different topic for a different blog post. In the case presented by Gawande, the health industry is service industry that seems woefully lacking in standards and performance measures. I figure this is probably because traditionally physicians have been viewed as authoritative experts, where their word was the end all be all. But in the modern world, medicine is more than just going to your local shaman. Today, doctor's are rarely isolated experts; they are a part of hospitals, teams, and other organizations. In any organization, there has to be rules and standards to follow to ensure that everyone is doing what is the common goal of that organization. In terms of medicine, the ultimate goal would be the best possible care for patients.

So gone are the days where the individual doctor is respected and trusted to be the ultimate authority. Instead, doctors now must work with (and compete among) other doctors/institutions to provide the best care possible. What defines quality of care? According to Gawande that is currently where there is a gap in the medical practice. There aren't enough measures for quality care. Processes that should be standardized to achieve maximum benefit, such as in hospital hand-washing, have not been done. As a result, a shockingly high number of people die each year from hospital borne infections. This is not an issue of science or technology, but the human behavior of our physicians and nurses. What's needed is awareness of the issues and change management to bring about effective change to procedures that could be done better and more safely in medicine.

Organizations, like people, need to be managed and held to standards. Otherwise the organization falls apart into individuals doing their own things out of sync of one another. In a hospital setting this is particularly dangerous because it leads to inefficiencies and mistakes--all at the cost of human life. It needs to be clearly communicated what everybody's role is in the organization and what expectations are for everybody on a team. It should be noted that there is a delicate balance between having standards and stifling individualism through authoritarian measures (been there done that :p).

It's interesting to see everything that I've observed in organizational structure and project management also apply to the medical industry. It seems like the excel/powerpoint skills I've learned these past two years as a consultant may come in handy after all. From consulting, it's becoming ingrained in me the need to document everything, quantify everything in terms of targets/percent completes, and to communicate all this effectively. I can only hope these skills will serve me well in whatever career I end up in the long-term.

Better by Atul Gawande