Gawande’s book, “Better: A Surgeon’s Notes on Performance,” tells the reader more about being in practice. Medicine is a practice that is poised between profession, craft, and science (Atul Gawande, 2007). The book contains many articles, some published in “The New Yorker.” Its main focus is on improving practice and doing things better even without all the required information. Gawande highlights three main requirements for successful performance in medicine: diligence, doing right, and ingenuity (Atul Gawande, 2007). This study will analyze the three requirements according to Gawande’s book and an examination of the relevance of the book to a registered nurse working as a home health nurse.
The first requirement is diligence, whereby Gawande emphasizes the importance of careful and persistent work effort in successfully executing medical therapy. Healthcare providers should be able to give sufficient attention to detail and avoid errors in providing healthcare services in unsuitable places where they face various obstacles. He gives an example of military medicine whereby only 60-70 surgeons in the Iraq war supported 130,000 troops (Atul Gawande, 2007). However, despite working in a hostile environment, there was still a decrease in the mortality rates from battle wounds. Another example is in India, whereby 37,000 vaccinators provided vaccination to over 4.2 million children within three days (Atul Gawande, 2007). The third example was hand washing to reduce the number of hospital-acquired diseases for patients, reducing the number of patients who get infections in the hospital. These three examples display the due diligence of the healthcare providers who have to ensure attention to detail and avoid errors to ensure better health outcomes.
The second requirement is “doing right,” which addresses several issues, including the litigious nature of the American society regarding healthcare providers. In explaining this issue, Gawande gives an example of a son injured by a medical error and an ex-clinician working as a medical malpractice lawyer (Atul Gawande, 2007). In this section, Gawande addresses the difficulties of correcting a medical error. According to Gawande, the litigation approach is singularly unsatisfactory in solving the problem and suggests adopting alternative methods to solve such cases (Atul Gawande, 2007). He suggests that there is a need for new methods which can be used to repay the victims as a result of medical errors. Although the healthcare field is working hard to reduce the number of medical errors, they are still likely to happen occasionally. Thus there is a need for a fair method of compensating the victim and ensuring that both parties are satisfied.
In addressing “doing right” further, Gawande addresses the issue of physicians in state-sanctioned executions. He gives an example of Doctor D, an anti-capital punishment activist in charge of six executions who gives all the money from those assignments to a children’s shelter. According to the doctor, death row is “legally” terminally ill and thus works to ensure that the person being executed feels the least pain in the execution process (Atul Gawande, 2007). Regarding this, Gawande raises moral and ethical concerns on whether it is right for his colleagues to do this.
The other issue is ingenuity; creativity based more on character and less on superior intelligence. He gives an example of innovations by two pediatricians, Warren Warwick and LeRoy Matthews, which help to achieve excellence (Atul Gawande, 2007). The two came up with the idea of having centers of expertise for cystic fibrosis (Atul Gawande, 2007). These centers have helped improve patient outcomes and have thus motivated more clinicians to become innovative.
Gawande’s teachings have some relevance in the field of a registered nurse working as a home health nurse. This practice involves visiting patients at their homes to deliver care to them. Hence, one of the key takeaways from Gawande’s book is diligence. This implies that registered nurses should be able to give sufficient attention to detail and avoid any errors even when faced with remote working obstacles (Atul Gawande, 2007). Thus, registered nurses should not use remote working as an excuse to provide poor-quality services to their patients. According to Gawande, registered nurses and other healthcare practitioners should be diligent in their line of duty.
The other important relevance of the reading to a registered nurse is adopting ingenuity. Creativity is essential in healthcare provision as it involves profession, art, and science (Atul Gawande, 2007). Thus, registered nurses must be creative in providing solutions to patients to ensure that they attain excellence and evolve to stay ahead. According to Gawade, creativity is one of the best methods of improving patient results. In addition, healthcare facilities should provide an environment that fosters creativity and innovation. Registered nurses can achieve ingenuity by adopting a self-improvement model which enables them to work beyond their limits in providing innovative solutions to services (Atul Gawande, 2007). For instance, in remote nursing services, a registered nurse can create innovative solutions to help carry out remote patient tests of patients and ensure real-time patient health monitoring.
In conclusion, Gawande’s book has provided a guideline for improving practice and doing things better in a dynamic environment. The author has used the examples of military, courtrooms, warzones, clinics, and execution chambers to show healthcare providers that they can still deliver their best regardless of the obstacles they face. He highlights three requirements for improving service quality: diligence, doing right, and ingenuity. Registered nurses should apply diligence and ingenuity in service delivery to improve healthcare outcomes.
References
Atul Gawande. (2007). Better: A surgeon’s notes on performance. Picador.