by Atul Gawande (Hardcover, 2007)|
Mark Lamendola, author of over 6,000 articles.
When I was an MBA student, I became fascinated
with the continuous improvement philosophy espoused by Deming. This is
the philosophy that drives Toyota and many other companies to achieve
ever-higher levels of quality. Coincidentally, at that time in my life a
coworker named Atul exemplified this philosophy in everything he did. So
here we are with a book authored many years later by a person named Atul,
and that book talks about improving performance.
In some areas of endeavor, constant improvements
in performance are mandatory for a business to survive. A prime example
is the online business world. Sites that don't constantly improve and
innovate lose customers and die. We can go back to the Toyota example
and see exactly why Toyota dominates the US auto market. While American
automakers have been playing infighting games, Toyota has focused on
making a better car. They have continually eliminated defects and
instituted improvements, no matter how minor.
In other areas, improvement is completely at odds
with the culture. A prime example is the typical government agency.
"Customers" of government agencies have no choice in vendor. Bureaucrats
continue to draw their salaries, while 20 or 100 people do the job of
one person about as poorly as is humanly possible. This has led to
countless jokes about the DMV. It's also responsible for the adage,
"Government takes the path of least competence." Behavior that isn't
tolerated in performance-driven companies is actually rewarded in many
government organizations. There are exceptions, and I will note one of
those in a moment.
In between these two ends of the spectrum, we find
the medical care industry. And it's here were Atul Gawande lives and
breathes. In this book, he shatters many myths about medical care. For
example, it's simply not true that the quality of care is consistent
from care center to care center. In fact, enormous variations exist and
the consequences can be profound.
Gawande is obviously a clear thinker. This is
evident in the fact that he so adroitly addresses so many facets of
medical care in less than 300 pages. While this book isn't a page turner
in the traditional sense--that is, it doesn't have cliff-hangers that
make you keep reading--I was surprised at how well it maintained my
interest and how quickly I finished reading it. The writing is clear and
engaging, even though the author is discussing a very complex industry.
As Gawande points out, the real challenges before
doctors today lay not in breakthrough technology but in the proper
application of what they already have. This is not to say doctors are
misapplying things. As the title implies, doctors (and all medical
professionals) have room for improvement--for being better--at how they
apply the tools they have.
This isn't just theory or some windbag expressing
an unfounded opinion. As you have probably guessed, "Atul Gawande" isn't
an Irish name. His family is originally from India, and Gawande gives us
numerous examples of the amazing results Indian doctors obtain despite
not having the tools and budgets we are accustomed to in the United
We don't have to travel to India to see how
medical professionals can ratchet up the quality of care by using the
constant improvement philosophy. Gawande brings us to one Cystic
Fibrosis clinic in America and then another, so we can see how different
approaches produce different results.
Earlier, I mentioned government agencies as
examples of incompetence. Interestingly, the Veteran's Administration is
way ahead of private industry when it comes to medical care. Gawande,
who doesn't work in the VA, probably is not aware of the quality
revolution that took place there.
Once the most dismal of medical care providers
(following the typical government agency formula of focusing on bloated
processes and ignoring results), the VA is now an example of
productivity and quality that the private sector can only envy. In fact,
the VA actually provides healthcare while the mainstream medical system
has mostly limited itself to providing disease care and injury fixes.
"Better" is a book written by a practicing
surgeon, and it looks inside the medical system. It can help medical
professionals see ways to improve how they do things. But if you're not
a medical professional, is this book worth reading? In my opinion, yes.
The chapter on medicine's bell curve would justify that all by itself.
Anyone who might need a specialist (for example, a neurologist) would
benefit from understanding the points Gawande makes when he discusses
the differences in quality of care at various centers.
This book reminds me of books that have been
written about other industries and on business process improvement in
general. Perhaps the most famous of the business process improvement
books is Tom Peters' seminal work, "In Search of Excellence." Customers
in a business to business relationship look to such books as "Lean
Thinking" to better work with their vendors and suppliers. These books
address many of the same fundamental issues Gawande covers in "Better."
One way to improve is to drive defects out.
Another way is to look at what's working and adapt it to your situation.
A third way, and Gawande provides plenty of examples, is to simply look
for (and try) ways of doing things better. Just as books about Toyota's
"quality miracle" have driven improvements in hundreds of other
industries, so can the lessons learned in this book drive improvements
in other industries.
So, in that sense it has very broad application in
addition to providing insight into curing the ills of our medical care
system. It's an excellent resource for any business person. But it's
also an excellent resource for any consumer of medical services. You
don't have to settle for "good enough." You can seek, and get, better.