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#42 Atul Gawande: The Path to Perpetual Progress

Oct 2, 2018 1h 21m 17 insights
The world-renowned surgeon, writer, and researcher Atul Gawande shares powerful lessons about creating a culture of safe learning, the critical difference between a coach and a mentor, and how to ensure constant improvement in key areas of your personal and professional life.   Go Premium: Members get early access, ad-free episodes, hand-edited transcripts, searchable transcripts, member-only episodes, and more. Sign up at: https://fs.blog/membership/   Every Sunday our newsletter shares timeless insights and ideas that you can use at work and home. Add it to your inbox: https://fs.blog/newsletter/   Follow Shane on Twitter at: https://twitter.com/ShaneAParrish
Actionable Insights

1. Adopt Coaching for Excellence

Embrace a coaching model over a purely teaching model for continuous professional improvement. Coaches provide an external perspective to identify blind spots and help set specific goals for improvement, leading to significant advantages in performance.

2. Create Psychological Safety

Foster an environment where everyone, from the highest to the lowest level, feels safe to speak up and contribute with an equal voice. This psychological safety is crucial for open communication, learning from mistakes, and building high-reliability organizations.

3. Prioritize Patient Goals & Values

Always ask individuals about their goals and priorities for quality of life, not just quantity of life, especially in serious or end-of-life situations. This ensures care aligns with their desires, reducing suffering, unnecessary costs, and often leading to better outcomes and even longer life.

4. Establish Non-Punitive Failure Review

Implement a protected, regular forum, like a Morbidity and Mortality (M&M) conference, for open review of failures and complications without fear of punishment. This fosters a culture of ownership, continuous learning, and an obsession with identifying and fixing problems.

5. Implement Process Solutions

Create better process solutions, such as checklists, that make it easier to do the right thing than to not do the right thing. This systematizes operations and demonstrably leads to better results by reducing dumb mistakes.

6. Assign Clear System Ownership

Ensure that someone is clearly responsible for seeing the system as a whole, for its function, and for plugging in solutions. A lack of clear ownership is a significant barrier to effective system performance and problem-solving.

7. Systematize Performance Management

Improve organizational performance by hiring for talent aligned with goals, establishing clear goals and objectives, measuring achievement against those targets, and standardizing key operations. This structured approach leads to substantially better quality outcomes.

8. Focus on Follow-Through Innovation

Shift focus from solely breakthrough innovations to understanding and implementing ‘follow-through innovation’ – the intelligent and structured application of existing knowledge to manage complexity. This approach recognizes that effective execution and scaling of solutions are as vital as discovery.

9. Apply Cross-Domain Ideas

Actively seek ideas from one domain and apply them to another to find novel solutions. This approach leverages existing knowledge in new contexts, often revealing valuable insights at the ’edges between things’.

10. Unknot Complexity with Time

When faced with a gap between aspirations and reality, dedicate time to unknot the underlying complexity. This involves digging deep to understand the complicated reasons for the gap and then figuring out how to bridge it.

11. Measure Outcomes Systematically

Regularly measure what you are doing and whether it is actually providing benefit to identify waste and areas for improvement. This data-driven approach allows for managing against specific endpoints and improving value.

12. Allow Trainees to Struggle Safely

When teaching or coaching, create a safe space where trainees can learn by struggling for a controlled period before intervention. This approach, similar to parenting, is crucial for their development and ability to connect the dots themselves.

13. Delegate & Integrate Care

Delegate components of complex tasks to appropriately trained team members, reserving the most experienced individuals for system integration and oversight. This optimizes team efficiency and ensures that all parts of the care come together effectively.

14. Communicate Your Goals Clearly

As a patient, clearly communicate your personal goals and priorities for what matters in your life to your clinician. This enables them to act as a counselor and help match care choices to your individual values and desires.

15. Demand Goal-Aligned Care

As a patient, understand that you have a right to ask and demand that your clinicians help you pick choices that best achieve your personal goals within what’s possible. This empowers you to receive care that truly aligns with your values.

16. Prioritize Quality Sleep

Ensure you get plenty of sleep to maintain performance and well-being. This is a fundamental personal habit for sustained effectiveness, even when engaged in demanding work.

17. Practice Ruthless Prioritization

Be ruthless about prioritization, focusing on no more than a couple of things at a time. This allows for deep work and prevents spreading oneself too thin, even if it means rotating focus over longer periods.