Book Review: Better

I recently finished Atul Gawande’s “Better” and found it interesting and relevant to the personal finance world.

Dr. Gawande is a practising surgeon and in this book discusses how to improve (get “better”) as an individual, organization and industry.  He uses medicine as the domain of discussion, but manages to generalize his insights to universal ideas and approaches (or at least presents them clearly enough that it’s easy to “translate” them to your own life).

The book is made up of three parts (diligence, doing right and ingenuity) each of which is broken into 3 chapters.  Each chapter explores a different domain in medicine and illustrates where the field could do better and an example of a practitioner who is doing so.

As an example, the first chapter talks about how infections spread WITHIN hospitals, and how often doctors unintentionally spread these infections (going from patient to patient without properly sanitizing in between).  He discusses this from a historical perspective (when the first doctor realized that washing up before surgery was important) and how it’s still a problem today.  He discusses how many times they’ve tried different approaches to get hospital staff to be more diligent about hand washing and how each approach has failed.  The approach that SEEMS to have worked was undertaken at a Pittsburgh veterans hospital.  Inspired by research into malnutrition in developing regions, instead of dictating a new “approach” to sanitation at the hospital, they began organizing groups where they would ASK the hospital staff how they could reduce infections, identify employees who had been most successful at avoiding infections and helped them communicate good ideas to the rest of the staff, published the best and posted the results on a month-to-month basis.  They’ve managed to get the MRSA wound infections (the one responsible for most deaths in hospitals) down to 0.

Extrapolating an idea like this to an organization (or family) that keeps struggling with a well defined problem would be fairly straightforward.  Talk to the people involved and ask them why a problem keeps happening.  Ask them for suggestions on how to improve it.  Publish the results.  Repeat until you hit the desired outcome.

The other 8 chapters are along the same lines, talking about:  fighting infectious diseases, how mobile military surgical units work, patient nudity during examinations, malpractice lawsuits, doctor’s salaries, medical personnel involved with executions, when to let a patient die, the benefits  (and drawbacks) of using a metric to measure your success, where you are on the bell curve of performance (and how to move toward the higher end), and how to not use difficulties as an excuse to not perform (and instead work around them).

I was particularly impressed by the author’s willingness to acknowledge the other side of issues (such patients suing their doctors or participating in executions).  He was able to state his opinion, yet still express the other viewpoints in a respectful manner, admitting which arguments did support the other side.  His suggestions, taking these into account seemed very well thought out and reasonable.

One thing he doesn’t discuss is when it makes sense to focus on improvement.  With medicine as your domain, HOPEFULLY the view is that it’s always good to be better (people’s lives are at stake after all).  If you look at his ideas in the context of your own life, it’s a judgement call when its worth focusing on getting better and when it isn’t.  As an example, Mike is good at what he does for a living, but it isn’t the core of his identity.  If he was going to focus on “improving” his career it’s going to come at the expense of his homelife or his blogging empire.  He has the three balanced in a way that works for him, and most of the ideas from this book would only be relevant if he was trying to shift his focus more heavily to one area (e.g. say he wanted to pull back to part time at work and spend more time blogging).  There is a cost to improvement (which the author acknowledges in passing, but dismisses as the stakes in medicine are so high).

I would certainly recommend this book, both as an interesting read and as something that might give you ideas on how to get better at something that is important to you.  Where Malcom Gladwell’s Outliers focuses on performance from a high level perspective (put 10,000 hours into something and you’ll get good at it), this book focuses on a similar issue but close up to the problems and dealing with immediate concerns.