Atul Gawande on Performance

Earlier today Alex Mallet reminded me of the excellent writing of Atul Gawnade by sending me a pointer to the New Yorker coverage of Gawande’s commencement address at the Harvard Medical School: Cowboys and Pit Crews.

Four years ago I wrote a couple of blog entries on Gawande’s work but, at the time, my blog was company internal so I’ve not posted these notes here in the past:

As a follow-on to the posting I made on professional engineering (also posted externally Edwin Young sent me a link to the following talk by Atul Gawande: Outcomes are very Personal. It’s from another domain, medicine, but is a phenomenally good presentation by a surgeon and his core premise applies equally to software: practitioners work and the outcomes of that work are spread on a bell curve. The truly great are much better than the average and often an order of magnitude better than the lowest performing. His book and the presentation is about the personal attributes and approaches of those at the very top. It’s well worth a view:

In my view, it’s an insightful presentation by a surgeon who loves data, loves understanding why we do well and how we can do better and is relentless in pursuit himself of doing everything better. Subsequent to watching the presentation, I read a book by the same author “Better: A Surgeon’s Notes on Performance” (

Software, like surgery, is part art and part science and there is tremendous variability between the average and the best. Gawande studies the best in different specializations to understand why the performance of some practitioners is way out there at the positive end of the bell curve and, through a series of essays, makes observations on how to do improve performance of the population Aoverall. Understanding that human performance is distributed on the bell curve means that, for whatever it is you are doing, there are average performers, terrible performers, and truly gifted performers. Gawade looks for what he calls positive deviance – it’s always there in a bell curve distributed phenomena – and tries to understand what they do differently. Worth reading.

A sampling of Gawande’s work:

· Book:

· Video:

· Commencement Speech Notes:


James Hamilton



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