Dr. Gawande is an excellent author. As long as I can learn from a Harvard graduate, I will spend time on it. “Better” speaks of certain simplistic conclusions of complex problems. Being a positive deviant is Dr. Gawande’s way of characterizing success and progress in medicine or any endeavor.

Why is this important to me? Inevitably, you will run into complex problems in your life. Taking a diligent approach to solving these problems will usually result in simple solutions. Better talk about how to do that. What does it take to be good at something where failure is so easy and effortless? Dr. Gawande tells the story of one of his patients who was admitted to his care when he was in medical school. The patient was stable and needed observation. The night before, he complained of insomnia and sweating. The older resident told her to watch her closely and agreed to see her at noon. That simple assumption nearly cost the patient her life. The senior resident checked her first and she had a fever and needed to be admitted to the ICU. She lived and was sent home well a few days later. The point of this story is that a simple assumption of controlling the patient in a couple of hours could have cost her her life. One simple thing separates life from death.

It is best divided into three main parts that I will briefly mention and then talk about Dr. Gawande’s recommendations for becoming a positive deviant.

1. Stagecoach: Every year, 2 million Americans acquire an infection in the hospital and 90,000 die from that infection. Infections are as complex as they can be contracted. Where do they come from? As a step? When did it start? What kind is it? All these questions are valid and are part of the complex puzzle. After much study, the proper solution is to WASH your hands. Now there is a strict procedure that doctors must follow, the keyword here is “should” and most do not.

There are small improvements that make BIG differences that are described in the book. Here is a simple example. The nurses in the operating room would normally run out of supplies and have to fetch more. So they leave the room and go back inside. Simple solution, make sure supplies are fully stocked so you don’t have to leave. This simple just-in-time delivery system solution eliminated infections by 90% in the operating rooms of the hospitals that used it.

2. Measure – Another part of diligence is measurement. In the Vietnam War, when a soldier was wounded, his average time from the field to the US was 45 days. Today is 4 days. Gunshot mortality has dropped from 16% in Vietnam to less than 5% today. The reason is not technology. It is in process. Today there are FSUs (Advanced Surgical Units). They follow the battalions of troops. Now when a soldier is wounded they perform incomplete mini surgeries to make sure they live and then the rest of the surgery is completed. This seems counterintuitive, but it works.

The key to understanding why Forward Surgical Units work is to measure things. It was learned that the time elapsed from injury to care is in direct correlation with life and death. Minimize time: maximize life. Knowing this allows them to minimize time in various areas.

3. Simplistic relentlessness: ingenuity is the bread of measure and diligence. Once the eyes are opened, the solution appears. This is mild daily behavior that creates great results. The use of simplistic ruthlessness in the identified problems generates explosive returns. This is the 80/20 rule on steroids. Most people wouldn’t look at the little things, but a simple checklist can save lives.

A great quote from the book is: “The best thing you can have, above all, is the ability to learn and change, and to do it faster than others.” To that end, I want to talk about the five tips for becoming a positive deviant. This is the term for using your wits to solve complex problems.

1. Ask unscripted questions 2. Don’t complain 3. Count something 4. Write something 5. Change – These 5 things are designed to harness “collective knowledge”!

I hope this short summary has been helpful to you. The key to any new idea is to incorporate it into your daily routine until it becomes a habit. Habits are formed in just 21 days.

One thing you can take out of this book is tell something. If you don’t measure it, you won’t be able to manage it. This is a big problem. Take time and measure the things that are important, especially if you need to solve a complex problem.

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