“We always hope for the easy fix”

“The one simple change that will erase a problem in a stroke.

But few things in life work this way.

Instead, success requires making a hundred small steps go right . . . .

One after the other, no slipups, no goofs, everyone pitching in.”

This quote from Atul Gawande, an award winning surgeon and public health researcher, appears uplifting in a “team building” kind of way.

But it disguises some deeper, essential truths in delivering operational efficiency, process change, technology programs, data initiatives, working capital improvements, in fact, any meaningful business outcome.

Gawande asks a key question: “What does it take to be good at something in which failure is so easy, so effortless?”

In our professions, as in medicine, we must grapple with systems, resources, circumstances, people – and our own shortcomings as well.

There are 10 essays in his book “Better: A Surgeon’s Notes on Performance”.  

The first essay, with the prosaic, down-to-earth title “On Washing Hands,” explores the incredible difficulty, the diligence demanded, in getting medical practitioners to be meticulous in a basic practice, the one thing that consistently halts the spread of infections.

Recognise any metaphor for driving process change?

He talks about the core requirements for success in medicine or in any endeavor that involves risk and responsibility (that’s us!):

• Diligence – giving sufficient attention to detail to avoid error and prevail against obstacles – central to performance & fiendishly hard.  
• Doing right – despite working in a fundamentally human enterprise, therefore troubled by human failings, it is difficult to know when “right” is to keep striving and when it is to stop.  
• Ingenuity – thinking anew is not a matter of superior intelligence but of character and demands a willingness to recognize failure (not paper over the cracks) and to change; it arises from deliberate, obsessive reflection on failure and a constant search for new solutions.

What does this mean for us?

1. It’s about getting “better” as a professional, continuously.
2. It is about the little things. Execution, “getting stuff one”, even the apparently mundane activities that hide away from the limelight, that we would prefer not to do, those magnets of procrastination.
3. It is about alignment of people and expectations across the activities that deliver the outcome for the customer (or patient!). We might call that the “end to end” process.
4. A focus on “defectivity”, a deliberate, obsessive focus on the things that go wrong, waste time, cause unnecessary friction, deliver no value. And, of course, their root causes.
5. There are no “silver bullets”, in technology or otherwise
6. Significant business outcomes need serious consideration of “the human in the loop” (HITL)
7.  . . . .

There is so much that resonates here, I recommend this reading for anyone trying to enhance performance in business.

There is a great synopsis by the “Iowa Writing Project” here . . . .   so credit to Sheila Benson, Jeremy Schraffenberger, Brooke Wonders and their team.

There is also a great review in the New York Times, if you have a subscription, here . . . 

If you, like me, are inclined, you can get the book or audiobook here  . . .

This thinking is also referred to as “the aggregation of marginal gains”, and is also the philosophy of successful athletes, and holds an opportunity for each of us in our professional work.

This philosophy is about searching for a tiny margin of improvement in everything you do. If you break everything down to it’s ESSENTIAL parts, and then improve each by 1 percent, you will get a significant and asymmetric increase in the overall outcome.

This was the approach adopted by Dave Brailsford, the newly appointed (back in 2003) Performance Director of the British cycling team, that had won just a single gold medal at the Olympic Games in over 100 years, and had NEVER won cycling’s biggest race, the Tour de France.

Brailsford’s approach changed history in that sport. There is a great synopsis of his approach to the aggregation of marginal gains in James Clear’s book, Atomic Habits. You can read that piece here . . .  

Food for thought, and action.

Thanks to Atul Gawande, Dave Brailsford, James Clear and everyone else that has contributed to making this recipe for performance improvement a practical opportunity for us all.

Thanks for reading.