This book is an easy read but very thought provoking.
One of the most interesting bits was where he examines the difference between the average Cystic Fibrosis centres and the best ones. All human activity has a bell curve attached to it, but CF treatment is very well understood and systematic. So why does one centre have startlingly better results than another?
In essence the better centre didn’t compromise, they didn’t think that (for example) 80% lung function was good enough, the patients under their care were expected to have 100% or better.
It’s the difference between 99.99% and 99.5% – we’d all be happy with 99.5, but excellence is in the remaining fraction of a percent, because when you add this up over several years this tiny difference means a lot. The sums are simple 99.5 over 5 years will give 97%, 99.99 will still be 99.99 or thereabouts. If you take this up over a patient’s life of 30 or 50 years the difference would be even more apparent.
I’ve hit this in other walks of life, for example project management, where you maybe have a 0.9 chance of finishing on time every iteration. This means that the chances of still being on track are as low as 0.6 after 5 iterations – it’s just mathematics. When building software having a fire break every so often to deal down the technical debt and reset the projects is perfectly doable, but if you’re looking for excellence in medical care or some other industry that could kill people then you have to become fanatical about getting higher scores
There are plenty of other excellent articles in the book, the fight to eradicate polio and the crazy situation faced by doctors in India are really great articles, and I learned a lot about how we could really help the people in poor countries. I admire Gawande’s honesty about his own shortcomings, this gives the writing a validity that it would otherwise lack. And the nutty unjust system that is the law based compensation for medical errors, that wrecks the chances of the poor to get help and helps no-one but the lawyers.