Better: More Parallels Between Medicine and Agile Software Development


In the book Better: A Surgeon's Notes on Performance, by Atul Gawande, a discussion of how hand washing—a simple technique that is vital to infection control—brought to mind how the challenges teams have being agile often center on the challenges of having teams begin to apply basic practices, without customization.

I recently finished reading the book  Better: A Surgeon's Notes on Performance  by Atul Gawande.

Having read  The Checklist Manifesto: How to Get Things Right   (which I commented on  earlier) I expected to learn not just about medical practice, but also about parallels between medicine and software development. Much of what Gawande says about performance in medical environments has can be said to apply to agile software teams, in particular, the need to focus on core practices, the value of retrospectives, and the value of generalists.

A discussion of how  hand washing , a simple technique that is vital to infection control but that also requires culture change to implement with the discipline required to be effective, brought to mind how the challenges teams have being agile often center on the challenges of having teams begin to apply basic practices, without customization.

In the discussions of Polio vaccination and malpractice were excellent non-software examples of how we can benefit from retrospective practice, especially the prime directive , which reminds us that to improve we can't focus on blame, but rather on how decisions we made and how to make them better. A discussion of medical practice in war zones provided excellent anecdotes to relate when someone says that they can't gather data to measure performance and thus improve;  Gawande relates how combat doctors, those with the best excuses to not have time to do "paperwork" somehow find time to enter the data needed to track and improve the care of soldiers, while gathering data in hospitals seems to be hard.

In a profession where specialization is valued, Gawande discusses time spent in India, where understaffed hospitals mean that surgeons can't afford to specialize and yet get do well by collaboration, cross-training, and discussion; in short, how "generalizing specialists" help to eliminate roadblocks and help get the most value from a team.

Like all metaphors and comparisons, there are gaps. Doctors and Software Developers do different things, and work under different constraints. But by focusing on the differences you miss an opportunity to learn from those around you. This, to me, is the key lesson in  Better.

About the author

Steve Berczuk's picture Steve Berczuk

Steve Berczuk is a Principal Engineer and Scrum Master at Fitbit. The author of Software Configuration Management Patterns: Effective Teamwork, Practical Integration, he is a recognized expert in software configuration management and agile software development. Steve is passionate about helping teams work effectively to produce quality software. He has an M.S. in operations research from Stanford University and an S.B. in Electrical Engineering from MIT, and is a certified, practicing ScrumMaster. Contact Steve at or visit and follow his blog at

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