How you play the game

I firmly believe everyone should read everything Atul Gawande writes in the New Yorker. Doing so will make you a wiser, more thoughtful, more expanded person. Intellectually more attractive. Better.

So in case you missed it, here's Gawande's latest piece, Personal Best. In it, Gawande asks why some professions - like sports and singing - have coaches, and others - like his own, surgery - don't. He opens by noting that his own performance as a surgeon has plateaued. He has mastered the physical skills needed, and gained the experience that allows him to deal with exceptions to the norm:

As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn’t. It started to seem that the only direction things could go from here was the wrong one.

Gawande looks at case studies from school teachers to professional violinists, and then takes on a coach of his own, a retired surgeon, who observes him during an operation:

Osteen also asked me to pay more attention to my elbows. At various points during the operation, he observed, my right elbow rose to the level of my shoulder, on occasion higher. “You cannot achieve precision with your elbow in the air,” he said. A surgeon’s elbows should be loose and down by his sides. “When you are tempted to raise your elbow, that means you need to either move your feet”—because you’re standing in the wrong position—“or choose a different instrument.”

He had a whole list of observations like this. His notepad was dense with small print. I operate with magnifying loupes and wasn’t aware how much this restricted my peripheral vision. I never noticed, for example, that at one point the patient had blood-pressure problems, which the anesthesiologist was monitoring. Nor did I realize that, for about half an hour, the operating light drifted out of the wound; I was operating with light from reflected surfaces. Osteen pointed out that the instruments I’d chosen for holding the incision open had got tangled up, wasting time.

That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years. It had been strange and more than a little awkward having to explain to the surgical team why Osteen was spending the morning with us. “He’s here to coach me,” I’d said. Yet the stranger thing, it occurred to me, was that no senior colleague had come to observe me in the eight years since I’d established my surgical practice. Like most work, medical practice is largely unseen by anyone who might raise one’s sights. I’d had no outside ears and eyes.

Gawande also points out that coaching has become faddish in recent years - from life to Twitter, you can seemingly get coached in anything.  In fact, the project management/software development methodology we use at work, Scrum, has regular reviews and coaching as one of its central tenets; it's all about iterative improvements to the way a team works. Bringing in a set of outside eyes to review how a team is working together or a process is moving can be hugely beneficial, but I think it needs a framework in which the coaching isn't intrusive or threatening, but normal and welcomed.

As always, I can't help but compare this back to the days when I worked in museums and art galleries. Reviewing something after it's done - like the success of an exhibition - is pretty much useless. You can say all you like that you'll 'use these learnings in future projects', but let's admit it: we rarely do. But reviewing how things are going every day or every week or every fortnight, and deciding *then* how you're going to make things work better - that's coaching. That's how you get a little bit better all the time.