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FC NOW: The Fast Company Weblog

June 29, 2007

Positive Deviance — A Surgeon’s Notes

It’s hard not to be both amazed and irritated by the career of Atul Gawande. Most of us struggle along in a single profession; Gawande is at the top of three demanding professions at once.

He is best known as a staff writer for the New Yorker on medicine.

Gawande writes with elegance and insight — at least in part because he’s a Harvard-trained surgeon, on the staff of Brigham and Women’s Hospital in Boston, and an assistant professor at Harvard Medical School.

And he’s the author of two books, Complications and Better, on how medicine and doctoring work, both of which have become bestsellers, and both of which show for us ordinary patients how medicine is both more human than we’d ever guess, and more amazing.

At its core, Gawande’s writing is about work and workplaces. For people working in medicine, their performance is always right in front of them: Did we, the patients, get better, and happily so?

Gawande’s current book, Better, is specifically about how to do better at work. It concludes with a bracing and simple prescription for what Gawande refers to as positive deviance — “five suggestions for how one might make a worthy difference, for how one might become...a positive deviant.” That is, how to do things differently in a way that lets you perform better, or more potently, no matter your job. Gawande’s thinking was inspired, in part, by a Fast Company story on positive deviance.

Gawande’s suggestions are aimed at doctors and medical students — they are detailed in a commencement address he gave at Harvard Medical School in 2005 — but we’d all be better at our work, better at taking care of ourselves, our customers, and our colleagues, if we follow them. Here’s a summary from the book:

• Ask an unscripted question. “Make yourself ask an unscripted question: ‘Where did you grow up?’ Or: ‘What made you move to Boston?’ ... Sometimes you discover the unexpected. ... I found out that a quiet, carefully buttoned-down nurse I work with had once dated Jimi Hnedrix. If you ask a question, the machine begins to feel less like a machine.”

• Don’t complain. “To be sure, a doctor has plenty to carp about: predawn pages, pointless paperwork, computer system crashes, a new problem popping up at six o’clock on a Friday night. ... Yet nothing is more dispiriting than hearing doctors complain. ... Resist it. It’s boring, it doesn’t solve anything, and it will get you down. You don’t have to be sunny about everything. Just be prepared with something else to discuss...”

• Count something. “Regardless of what one ultimately does in medicine — or outside medicine, for that matter — one should be a scientist in the world. In simplest terms, this means one should count something. ... If you count something you find interesting, you will learn something interesting.”

• Write something. “It makes no difference whether you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group. Just write. What you write need not achieve perfection. It need only add some small observation to the world. ... I did not write until I became a doctor. But once I became a doctor, I found I needed to write. ... Writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness.”

• Change. “In medicine, just as in anything else people do, individuals respond to new ideas in one of three ways. A few become early adopters, as the business types call them. Most become late adopters. And some remain persistent skeptics who never stop resisting. ... Make yourself an early adopter. ... I’m not saying you should embrace every new trend that comes along. But be willing to recognize the inadequacies in what you do and to seek out solutions.”