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Andy Leonard

Andy Leonard is an author and engineer who enjoys building and automating data integration solutions. Andy is co-host of the Data Driven podcast. Andy is no longer updating this blog. His current blog is

Finishing Up Better

More Better 

Last week I read and blogged about Better by Dr. Atul Gawande.

In Part III of the book, Dr. Gawande focuses on Ingenuity with three chapters entitled The Score, The Bell Curve, and For Performance. There are lots of good takeaways for software development in these chapters.

Full Disclosure 

One stood out in particular in The Bell Curve. This chapter's use case is Cystic Fibrosis treatment centers. The Cystic Fibrosis Foundation (CFF) has been collecting statistics on centers around the United States for decades. Motivated by a grant from the Institute for Health Care Improvement, the centers began "opening up" about their performance compared to other centers.

Everyone wants to feel like they're doing a good job - in medicine, software, and every other field on the planet. Almost everyone has good and noble intentions. But some folks just do things better than everyone else. Why not identify those folks - those Positive Deviants - learn what they're doing that's so different, and try to reproduce those results everywhere?

Excellent question.

The answers are difficult because they cover the range of excuses for every bad idea ever conceived in human history. In the best case and strictest sense of the word, it's due to ignorance: People simply do not know any better - they're doing the best they can. The worst case is probably incompetence with a dash of malice to hide the fact.

Opening up changes things. It opens the door for the sharing of best practices by those who have developed and are practicing them. How cool.

Pulling Away

Perhaps the most potent example of best practices is found in a statement about the leading CF centers:

"You look at the rates of improvement in different quartiles, and it's the centers in the top quartile that are improving fastest," [Bruce] Marshall [the head of quality improvement for the foundation] says. "They are at risk of breaking away." What the best may have, above all, is a capacity to learn and change - and to do so faster than everyone else.1

This theme, while emphatically true and accurate, is abused by Performance-Based Management. Beware too much of a good thing, regardless of the thing.


There are ways for us to do our jobs better. We can make software with higher quality and lower maintenance costs. We need to embrace the principles outlined in Better, identify and mimic those people who are Positive Deviants, and overcome all obstacles between the current state of affairs and our goal.

I not only know we can, I believe we're well on our way.

 :{> Andy

1 Better, Dr. Atul Gawande, p. 227.

Published Monday, May 5, 2008 12:01 AM by andyleonard

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