Improve performance

Photo/Dennis Sparks

I have learned important things about leadership from surgeon Atul Gawande’s books: Complications: A Surgeon’s Notes on an Imperfect Science, Better: A Surgeon’s Notes on Performance, and The Checklist Manifesto: How to Get Things Right. His books illustrate how doctors—and those engaged in other complex endeavors, including educators—are challenged as they apply an imperfect science to their decision-making, struggle to work collaboratively with colleagues, and treat “patients” who are not always cooperative with their “doctor’s” best efforts.

“We look for medicine to be an orderly field of knowledge and procedure,” Gawande observes in Complications. “But it is not. It is an imperfect science. . . . There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing.” Gawandi describes “quick learning” surgical teams as being lead by surgeons who “. . . convened the team before each case to discuss it in detail and afterward to debrief. He made sure results were tracked carefully.” These doctors became partners with their teams rather than standing outside and above it. Gawande also noted that when surgeons were learning new skills things sometimes got worse before they got better, a medical variation of the “implementation dip,” a phenomena which is well known among those who seek to improve teaching and learning.

In Better Gawande discusses what it takes to be good at something—diligence, doing the right thing, and ingenuity. He includes a discussion of one my favorite approaches to improvement, positive deviance inquiry, as it is used to minimize hospital infections. Gawande suggests ways doctors can become positive deviants—don’t complain (“nothing is more dispiriting in medicine that hearing doctors complain”), count something (“if you count something you find interesting, you will learn something interesting”), write something (“it need only add some small observation about your world”), and change (“be willing to recognize the inadequacies in what you do and to seek out solutions”), practices that I also belief would improve the practice of school leadership. “[F]ind something to try, something to change,” he concludes. “Count how often you succeed and how often you fail. Write about it. Ask people what they think. See if you can keep the conversation going.”

Gawande’s The Checklist Manifesto explains how clear goals, measuring progress, decentralized decision-making with accountability, teamwork, clear communication, and the use of checklists contribute to improved performance. His primary teaching tool are compelling stories from public health, surgery, building construction, Hurricane Katrina, and the January 2009 crash of US Airways 1549 into the Hudson River. He views “the miracle on the Hudson” as less about the heroic acts of individuals that the power of teamwork, training, and protocols: “The crew of US Airway Flight 1549 showed an ability to adhere to vital procedures when it mattered most, to remain calm under pressure, to recognize were one needed to improvise and where one needed not to improvise. They understood how to function in a complex and dire situation. They recognized that it required teamwork and preparation. . . .”

EL columnist Thomas Hoerr links Gawande’s ideas to school leadership in his essay, “Checking for Checklists.” Hoerr notes that in Complications Gawande “. . . wrote about how important it is for a surgeon to have a great deal of experience doing a particular operation. You want to be operated on by someone who has done this specific surgery many times. Gawande talks not just about repeated experience— which is important—but also about the analysis and reflection that accompany it. The merit of experience is not just in having the experience, but in learning from it.” Hoerr acknowledges that as leaders “. . . it’s clear that we spend much more time planning than reviewing. We spend hours making plans, acquiring new information, and learning new skills. We spend far less time gathering data on our performance and learning from our experiences.”

About The Checklist Manifesto Hoerr writes, “This August when my faculty and I plan for the coming year, one of our tasks will be to consider what checklists we might create. How might checklists address the necessary steps for eliciting student engagement, differentiated instruction, or principal renewal? I can envision checklists that ensure that we have reviewed all aspects of a student’s progress, that teachers have incorporated all of our talking points in their presentations to parents, and that I have spoken to all the relevant stakeholders before I initiate action. Then we need to evaluate the effectiveness of the checklists during and at the end of the school year. We might decide that a checklist isn’t applicable to some situations, but even so, the reflection and dialogue will be beneficial.”

Take a moment now to . . .

• select one of the terms in bold from above that is most relevant to your work and make a commitment to engage in that practice or use that technique.

3 Responses to “Improve performance”

  1. 1 Mike June 14, 2010 at 7:08 am

    This post should be taped to everyone educator’s refrigerator for easy reference. It says so much about what can be right about education.


  2. 2 Chuck June 14, 2010 at 8:39 am


    “The Checklist Manifesto” is my summer reading recommendation on Twitter (#sumread10). Like you, I have been pondering how checklists may be incorporated into our work as educators. As Gawande says in his book, it is not that we don’t know what to do, it is erring or forgetting that often sabotages our efforts. I also hope to follow his advice in developing checklist that don’t become overly long and burdensome. The monitoring and evaluation of the checklists will be essential. An domain that is essential for effective teacher and principal leadership is ongoing communication with all stakeholders. That is where I hope to begin our process. Thanks for sharing your wisdom on this topic!

  3. 3 Mark Zimmerman June 14, 2010 at 11:29 am

    Hi Dennis –

    Thanks so much for the post on the work of Gawande. A friend who is a senior nursing exec at City of Hope sent me The Checklist Manifesto after we discussed the way his work is affecting the world of medicine. The description of the book in paragraph 4 is a description of the work we do at QLD in schools. Can’t wait to read it.

    Best regards,


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