Arriving at meaningful solutions is an inevitably slow and difficult process. Nonetheless, what I saw was: 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.

– Atul Gawande, Better, p. 246

Health care in rural India would shock most of us in the United States. As Dr. Atul Gawande describes in Better—his fascinating book about improving performance in health care—many hospitals in rural India are overcrowded and under-resourced. The demands upon their services continuously outstrip their resources.

They continuously must do more with not just less, but in some cases with nothing at all. They must improvise. They must make use of what is available and do their best.


Regardless, they innovate

Despite their circumstances, these doctors and other healthcare providers innovate. They quickly move from case to case, sometimes sending patients themselves to purchase commonplace medical supplies. And they develop much broader areas of knowledge and skill than most doctors in the United States. For example, Gawande describes his astonishment at the ability of the surgeons in these crowded hospitals and clinics to perform chemotherapy, a task typically reserved solely for oncologists.

Certainly, the overall quality of health care is better in the United States than in the places that Gawande describes. He readily acknowledges as much in the book, and he provides numerous examples from within the United States of what it takes to get better in the practice of medicine. His chapter on improving outcomes for cystic fibrosis patients is particularly gripping.

Three lessons for anyone wanting to get better

As someone typically on the outside of the healthcare industry looking in, I see three specific lessons from Gawande’s observations that apply to people, teams, and organizations.

First, getting better requires perspiration and an obsession about, not surprisingly, getting better.

Getting better is sometimes less about big ideas than it is about doggedly executing the little ones.

Getting better requires a relentless desire—the discipline, diligence, persistence—to perform basic tasks perfectly. It also requires a relentless desire to push the bar higher, to refuse to accept the status quo as good enough. Within teams and organizations, this style of leadership might be what some characterize as “micromanaging” and “intrusive.” Yet it’s often the hard-working, hands-on leader who pushes performance to new levels. It’s the leader who knows that perspiration is often just as (if not sometimes more) important than inspiration.

For those of us wanting to improve as individuals, we have to want it. And we shouldn’t confuse wanting to get better, which is a lot of hard work, with the idea of getting better. Anyone can fall in love with the idea of getting better; it takes much more to actually want to do the hard work of improvement.

Second, getting better requires a focus on the basics.

“Shiny things”—be they technologies, fads, or other attractive diversions—can easily distract us. And yet many times all we need to succeed are the basics. We don’t necessarily need the fancy new enterprise software we heard about at a trade show; we don’t necessarily need an entirely new strategy. At the personal level, those of us wanting to stay in shape likely don’t need some expensive, fancy gym membership. Instead, we simply need to understand the basic resources needed to do things well.

As Gawande describes when talking about his experiences in India:

More than one doctor told me that it was easier to get a new MRI machine than to maintain basic supplies and hygiene … Having a machine is not the cure; understanding the ordinary, mundane details that must go right for each particular problem is. (p. 242)

I had a similar experience while serving as an adviser to the Afghan National Police in 2013. A human resources information system was being built for them—at a huge expense. Yet most of them couldn’t read. And those who could read would have likely preferred some really great filing cabinets, folders and paper office supplies over a complicated computer system.

Third, getting better requires courage.

People aren’t going to like it when you question their standards or performance. People aren’t going to be happy when you push them out of their comfort zone. People aren’t going to like it when you perform at a level that makes them look bad, or when you start new habits that make them realize their own deficiencies.

So the idea that Better suggests to me is that when it comes to getting better, one must decide: Is it worth it? And if it is, go for it, with a renewed appreciation for diligence and perspiration, a focus on the basics and listening to other worthwhile voices, and the courage to forge ahead even when you think people might get upset or when you’re just plain scared.

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Gawande, A. (2007). Better: A surgeon’s notes on performance (1st Picador ed). Picador.

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