Better: A Surgeon's Notes on Performance

"Gawande is a wonderful writer. He has a way of explaining the medical world in a manner that is both compassionate but also very much data driven. This is something that’s close to my heart because that’s we are trying to do, we are trying to use data in order to learn about people. In this book he has quite a few examples of perhaps counterfactual things; things that you wouldn’t have thought would be the way they are, and yet the data shows what’s actually happening. “When you’re anonymous on a search engine in your own room, there is no reason for you to lie” One of the examples I like most is about cystic fibrosis, which is a condition where there is one measure of success – how long people survive. There are several tens of centres in the US which treat cystic fibrosis and for many years their average survival numbers were not released to the public. Then they started releasing these numbers and when they did, people thought this would not be a good idea. They thought what would happen is that people would leave their centres and move to the best ones and the service overall would suffer. Yet what did happen was that all the centres improved, or on average they improved, because they had a way of measuring themselves against others and they had a way of knowing who they could turn to for help in order to improve themselves. To me, this a wonderful example of why you should have these data out there. Perhaps you should do it carefully but you should be able to have these data that help the system improve."