Better by Atul Gawande: Chapter 1

I had originally tried to combine the intro and chapter 1 of Atul Gawande's Better, but chapter 1 actually had some of the most profound "wow" moments in the book. The focus is on hand washing, in the context of diligence in the pursuit of excellence. The basic problem is this: doctors don't wash their hands enough, so how do we get them to do it? Much like Starbucks' solution to not wasting milk was pioneered by one of its in-store baristas rather than management, the most effective tactic for hand washing was to outsource the solution to the employees of the hospitals.


  1. What I found most fascinating about this story was where the idea for solving the problem came from: a surgeon read a story about Jerry Sternin and his organization Save the Children, which was able to drastically reduce child malnutrition in Vietnam using methods suggested by Vietnamese village members themselves. Sternin deemed this the Positive Deviant method - essentially he searched out those amongst the population who were succeeding at staving off malnutrition in their children, and got them to share their practices.

    The genius of this approach was that it empowered those in the community, making them feel responsible for the solution. Sternin's view was that outsiders dictating change to a group of people was ineffective, but finding positive deviants from within a group and championing them did ultimately bring change.

    Seeing this story and thinking to apply it to hospital hand washing is also genius. When Gawande titles this section diligence, I think that is only half right. The other half is the ingenuity and analytical ability to recognize a solution in an entirely different field which will translate horizontally to a problem you are facing. This is the big lesson I learned here. The solution itself - relying on the suggestions of hospital staff by asking "how can we solve the problem" - has so far been effective. Gawande writes that it is "the most exciting idea for combating hospital infections that anyone has had in a hundred years."

  2. In a 'my book is better than your book' kind of way... Thomas Friedman uses the word 'collaboration' so often and it is my failing for not passing it on.

    Asking 10,000 people to think of a solution and being surprised when one of them comes up with a particularly ingenious solution does not represent ingenuity by the system or leader, rather it represents collaboration and the law of large numbers.

    The empowerment aspect along with the Positive Deviant method are intriguing, but I think more and more often in the future, the way to solve a difficult problem requiring a new innovation will simply be to ask A LOT of people, not relying on the particular genius or skill of an single individual. The world is now an aggregate of individuals, not an aggregate of groups.

  3. You make a fair and accurate point about collaboration, which is often termed crowd-sourcing when it occurs in large scales online.

    I think the issue when facing problems like malnutrition, hospital hand washing, and things like deforestation, etc. is that you need to rely on a particular population of people to actually DO the work. The villagers in Vietnam must feed their kids properly. The surgeons in the hospital must wash their hands diligently. In looking to positive deviants amongst those groups to provide solutions, you are breaking down the mental resistance to change. The inertia from not wanting to break habit or tradition is overcome by tangible success from their own people.

  4. Does your form of "collaboration" not fall into the recent crowd sourcing phenomenon?

  5. I admit - I don't read everyone's comments...

  6. Recently ran across this article about how the mobile industry is helping the hand-washing dilemma faced in many hospitals today.