Thursday, April 19, 2007

Getting better all the time

I've been reading Atul Gawande's new book, Better, about medical performance and ways to improve it. One of his most important points is that positive deviants -- people who lie at the upper end of the bell curve -- exist everywhere, and consistently achieve above average outcomes. They range from mothers in Third World villages who raise well-nourished children in spite of overwhelming poverty, to doctors in India who achieve some of the best ulcer surgery results in the world under conditions that would terrify most Western doctors and patients, to cystic fibrosis clinics whose patients live more than ten years longer than those at average clinics. Superior performance in these cases does not come from better technology, but from better science: seeing which interventions make things better, applying them consistently, and never being satisfied that something is "good enough."

Medicine makes the contrast between good and merely average performance especially stark-- patients who get better care generally live longer -- but the bell curve exists in every field. It's the difference between the Hall of Fame baseball player with a lifetime batting average above .300, and a weak hitter with an average of only .250 or so. (For non-baseball fans, that's a difference of only 50 hits per thousand at-bats.) In semiconductor manufacturing, the difference is measured in percentage points of yield, or weeks of production ramp, and it adds up to millions of dollars.

Technology certainly helps -- those doctors in India could do even better with better facilities and adequate supplies -- but it is only a tool. Performance is a process.

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