I’m currently reading, Better: A Surgeon’s Notes on Performance, by Atul Gawande. Gawande is a Harvard professor and surgeon . He is also interested in human performance in medicine, and beyon. Early on in the book, he makes two statements that highlight critical elements of high performance.


Statement One


In the first main section of the book–on the quality of diligence–Gawande wrote about the goal of eradicating polio from the planet. As he explored that goal, here’s what he said:

Beneath the ideal is the gruelingly unglamorous and uncertain work. If the eradication of polio is our monument, it is a moment to the perfection of performance—to showing what can be achieved by diligent attention to detail coupled with great ambition.


The second part of that statement jumped out at me: showing what can be achieved by diligent attention to detail coupled with great ambition. 


Now that’s a powerful statement.


Think of what can be achieved when diligent attention to detail is couple with great ambition. 


Statement Two


A bit later in the book Gawande wrote about the amazing strides, in the last 20 years, that have been made in treating battlefield injuries. During the last 20 years, the number of soldiers that survived traumatic battle field injuries has significantly increased. This has occurred because of a number of ingenious solutions to battlefield medical problems. At one point, Gawande discussed the amazing percentage of soldiers that survived injuries, during the Iraq war, and specifically during the battles for Fallujah. Here’s what he wrote about medical staff—on the front lines– that treated injured soldiers soldiers. Pay particular attention to paragraph two, but read both.


Six hundred and nine American soldiers were wounded in the first six days of the November battle. Nonetheless, the military teams managed to keep the overall death rate at just 10 percent. Of 1,100 American soldiers wounded during the twin battles for Fallujah, the teams saved all but 104— a stunning accomplishment. And it was only possible through a kind of resolute diligence that is difficult to imagine. Think, for example, about the fact that we even know the statistics of what happened to the wounded in Fallujah.


It is only because the medical teams took the time, despite the chaos and their fatigue, to fill out their logs describing the injuries and their outcomes. At the 31st CSH, three senior physicians took charge of collecting the data; they input more than seventy-five different pieces of information on every casualty— all so they could later analyze the patterns in what had happened to the soldiers and how effective the treatments had been. “We had a little doctors’ room with two computers,” Murphy recalls. “I remember I’d see those guys late at night, sometimes in the early hours of the morning, putting the data in.”


Holy smokes. During the chaos of battle, the medical staff filled out logs of data that helped them analyze their performance and make adjustments to that performance.


So…if you put both of these statements together, here what we get:


Attention to detail coupled with great ambition


The precision of capturing critical treatment data ON THE FRONT LINES of Fallujah


The kind of diligence it takes to enhance performance.



Gawande’s two statements reveal characteristics associated with high performance of any kind. There is also a mountain of research to back up his statements. If you’re interested in this type of research, the work of Karl Weick is a good place to begin.


Here’s the bottom line:


High performing groups are preoccupied with performance (in big and small ways). First, they are preoccupied with understanding poor performance. They learn, learn, learn, from failure in an attempt to decrease failure. High performing groups are also preoccupied with success. But it’s not the reward of success that preoccupies them, it’s the process that led to success that preoccupies them. High performing teams learn from success; they examine what action and processes led to success AND how to repeat those actions and processes through discipline and adaptation of strategies. They are vigilant about collecting the right data— EVEN when the bombs are dropping around them. And they USE that data to analyze and adapt performance based on what the data reveals.


May Gawande’s statements inspire us to the same kind of focus on performance.