There’s a fascinating article by Atul Gawande in a recent New Yorker about differences in how well doctors and hospitals treat their patients: complication rates, death rates, quality-of-life outcomes. Gawande writes:

In ordinary hernia operations, the chances of recurrence are one in ten for surgeons at the unhappy end of the spectrum, one in twenty for those in the middle majority, and under one in five hundred for a handful. A Scottish study of patients with treatable colon cancer found that the ten-year survival rate ranged from a high of sixty-three per cent to a low of twenty per cent, depending on the surgeon. For heartbypass patients, even at hospitals with a good volume of experience, risk-adjusted death rates in New York vary from five per cent to under one per cent—and only a very few hospitals are down near the one-per-cent mortality rate.

It is distressing for doctors to have to acknowledge the bell curve. It belies the promise that we make to patients who become seriously ill: that they can count on the medical system to give them their very best chance at life. It also contradicts the belief nearly all of us have that we are doing our job as well as it can be done. But evidence of the bell curve is starting to trickle out, to doctors and patients alike, and we are only beginning to find out what happens when it does.

Gawande goes on to discuss a cystic fibrosis specialist named Warren Warwick, who for forty years has directed the Minnesota Cystic Fibrosis Center at Fairview-University Children’s Hospital, in Minneapolis. This CF Center is considered the best in the U.S. What has taken it to the right edge of the bell curve? What accounts for its excellence? Science? Yes, but other centers also pay close attention to the latest research and methodologies. A focus on patient care? Certainly, but that’s not unique to the Minnesota CF Center, either. Other hospitals work very hard to provide top-quality care, both in and out of the hospital. No, it turns out that the distinguishing characteristic of the Minnesota CF Center is its director, Warren Warwick. And what makes Warwick so special? Gawande describes it as a “combination of focus, aggressiveness, and inventiveness”:

We are used to thinking that a doctor’s ability depends mainly on science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously.

Let’s imagine for a moment that we’re discussing excellence in education, or in artistic performance, or in any human endeavor. Can the lessons Gawande learned in his analysis of health care outcomes be generalized to apply to other fields? I believe they can. In my own field of English literary studies, however, the sheer agency implied by words like “aggressiveness and consistency and ingenuity” is not very much in fashion these days. We study cultures, not persons, and the idea of a “great life” is sometimes greeted with disdain–if not outright derision.

Yet Gawande’s article teaches another lesson: that teams and collaboration are crucial, but true excellence requires personality. Without personhood, without decisive interventions by people with “focus, aggressiveness, and inventiveness,” excellence is unattainable. Worse yet, the idea of excellence may vanish, or be denied.

Near the end of his article, Gawande cites a Cincinnati CF center that has made considerable strides forward by adopting many of Warwick’s methods. “Yet you have to wonder,” Gawande says, “whether it is possible to replicate people like Warwick, with their intense drive and constant experimenting.” I don’t know about replication, but I do believe that education has as one of its primary goals the nurture and encouragement of those personal qualities. We teachers present information. We foster learning communities. We facilitate the learner’s progress through a course of study. Yet we should also coach our students in the focus, aggressiveness, and inventiveness that can lead to true greatness–a greatness that ultimately relies on personhood, and on personal agency.