Performance (Atul Gawande)

 In a remarkable instance of synchronicity, I came across the work of Atul Gawande while listening to an episode of Desert Island Discs (a longstanding British radio programme), just before being invited to Madagascar, where, little did I know, I was about to collaborate with medical professionals drawing inspiration from Gawande’s research to deliver local training as part of medical capacity building in the country.

In Performance, Gawande draws on his experiences and research in hospital and healthcare environments to identify some of the more essential factors in improving performance.  Given the life-or-death context of healthcare, as well as the limits of budget-funding, individuals’ means and recruiting of staff, small improvements in healthcare outcomes can have extraordinary consequences for the lives of whole communities of people.

Gawande reflects on the increasing complexity of the healthcare environment, due to advances in medical research and technology.  Where once the knowledge relevant to any case could fit into the head of one trained doctor, now the multiplicity of interdependent factors result in complexity beyond the processing capacity of any individual.  In such circumstances the quality and comfortableness of the team to use their individual voices, and to relate to each other well, is essential to bring the combined intelligence and insight of the group to patient care.

In an increasingly complex world, Gawande’s insights are highly relevant, and connect especially well to the living systems theory of Margaret Wheatley.  Trust, intimacy and well-being allows the group to bring its full human capacity to addressing complexity with wisdom, accuracy and, as Gawande shows, potentially life transforming impacts through the reduction of unnecessary errors, ego-fueled blinkers, and the failure to truly see the wholeness of the situation and people.

We take inspiration from Gawande’s work in how we curate classroom and smaller discussions to activate contributions from the whole group as to how to approach the complexities of leading well in the current era.  We pay particular attention to those whose voices and insights might be at risk of being lost, and encourage group alertness to ‘airtime ratios’ to build greater awareness of the dynamics affecting what shapes group wisdom.  We help leaders to be alert to the lure of one-voice convenience and to build their capacity for the greater challenges and power of polyphony.  Gawande’s work also highlights the importance of relationship quality and trust, increasing the visibility of these factors in working life.