1. Gould, Kathleen Ahern PhD, RN

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Each year, we plan to do better, be better, and feel better. We strive to improve, to heal, to become the best version of ourselves. Atul Gawande's book entitled Better: A Surgeon's Notes on Performance1 articulates this ambition for health care. Each year, I find I must read it again, to inspire and encourage me[horizontal ellipsis] and to help me to believe we can be better.


Often the book is about our failures, poor outcomes, and challenges that seem insurmountable. However, Gawande inspires us to learn, change, and do better. The book is filled with historical accounts and personal stories. One of my favorite sections in the book takes us back to the year 1953, when a woman, named Virginia Apgar, had a simple idea that transformed childbirth.


Dr Apgar was appalled by the care many newborns received. Babies who were born malformed or too small or just blue and not breathing well were listed as stillborn, placed out of sight, and left to die.1


Although Apgar had little authority in the male-dominated profession, she worked to create a tool that allowed nurses to rate the condition of the babies from 0 to 10. Using the tool required careful observation, documentation, and interprofessional collaboration. Because the tool created a visual scale and produced data that could be counted, physicians saw the score as a measurement of their work and a source of competition, encouraging them to produce better outcomes for newborns. Since 1953, the Apgar score has been a universal tool. It is simple and easy to use and is completed collaboratively by physicians, anesthesiologists, nurse anesthetists, and nurses who realize that a better score is related to better outcomes! It is a model that has survived for over 60 years.


Each year, there are challenges like the one Virginia Apgar recognized. This year is no different; perhaps the problems are different, names have changed, and locations have shifted, yet the feeling endures[horizontal ellipsis] how can I (we) do better for our patients?


We are directed to evidence-based practice, looking for empirical direction; informed with the voice of the patient and the expertise of our clinical practice. It is within the data, the stories, and our own experiences that we will find the answers. Never before have we had the gift of big data, experienced researchers, informed patients, and hospitals realigned through accountable care models. We have tools and teams that Apgar did not have access to in 1953, yet she developed a tool that still guides us in 2015!


Population health geared toward prevention and health maintenance will change our lives and direct new patterns of care for patients. New patterns will need new tools and new approaches to traditional patient care and education. Much has changed and will continue to change as we face these challenges, all requiring the best of who we are.


The grammatical use of the word retains its core meaning in all forms. Let us use the word to inspire us and direct our work toward improved patient outcomes, for ourselves, and for our families. Join me as we commit to doing better in 2015.2






Adjective, compar. ofgoodwithbestas superl.


1. of superior quality or excellence:


2. morally superior; more virtuous:


3. of superior suitability, advisability, desirability, acceptableness, etc; preferable:


4. larger; greater:


5. improved in health; healthier than before.


6. completely recovered in health.



Adverb, compar. ofwellwithbestas superl.


7. in a more appropriate or acceptable way or manner:


8. to a greater degree; more completely or thoroughly:


9. more:



Verb (used with object)


10. to increase the good qualities of; make better; improve:


11. to improve upon; surpass; exceed:


12. Cards. to raise (a previous bid).





13. that which has greater excellence or is preferable or wiser:


14. Usually, betters. those superior to one in wisdom, wealth, etc





15. better off,


a. in better circumstances.


b. more fortunate; happier:


16. better oneself, to improve one's social standing, financial position, or education:


17. for the better, in a way that is an improvement:


18. get/have the better of,


a. to get an advantage over.


b. to prevail against.


19. go (someone) one better, to exceed the effort of; be superior to:


20. had better, would be wiser or more well advised to; ought to:


21. no better than one should be,Disparaging. Morally inferior; immoral or amoral.



Kathleen Ahern Gould, PhD, RN


Editor in Chief Dimensions of Critical Care Nursing


Adjunct Faculty


William F. Connell School of Nursing


Boston College


Chestnut Hill, Massachusetts




1. Gawande A. Better: A Surgeon's Notes on Performance. Picador New York; 2008. [Context Link]


2. Better. Accessed August 12, 2014. [Context Link]