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Writing Guide with Handbook

6.2 Proposal Trailblazer: Atul Gawande

Writing Guide with Handbook6.2 Proposal Trailblazer: Atul Gawande
  1. Preface
  2. The Things We Carry: Experience, Culture, and Language
    1. Unit Introduction
    2. 1 The Digital World: Building on What You Already Know to Respond Critically
      1. Introduction
      2. 1.1 "Reading" to Understand and Respond
      3. 1.2 Social Media Trailblazer: Selena Gomez
      4. 1.3 Glance at Critical Response: Rhetoric and Critical Thinking
      5. 1.4 Annotated Student Sample: Social Media Post and Responses on Voter Suppression
      6. 1.5 Writing Process: Thinking Critically About a “Text”
      7. 1.6 Evaluation: Intention vs. Execution
      8. 1.7 Spotlight on … Academia
      9. 1.8 Portfolio: Tracing Writing Development
      10. Further Reading
      11. Works Cited
    3. 2 Language, Identity, and Culture: Exploring, Employing, Embracing
      1. Introduction
      2. 2.1 Seeds of Self
      3. 2.2 Identity Trailblazer: Cathy Park Hong
      4. 2.3 Glance at the Issues: Oppression and Reclamation
      5. 2.4 Annotated Sample Reading from The Souls of Black Folk by W. E. B. Du Bois
      6. 2.5 Writing Process: Thinking Critically about How Identity Is Constructed Through Writing
      7. 2.6 Evaluation: Antiracism and Inclusivity
      8. 2.7 Spotlight on … Variations of English
      9. 2.8 Portfolio: Decolonizing Self
      10. Further Reading
      11. Works Cited
    4. 3 Literacy Narrative: Building Bridges, Bridging Gaps
      1. Introduction
      2. 3.1 Identity and Expression
      3. 3.2 Literacy Narrative Trailblazer: Tara Westover
      4. 3.3 Glance at Genre: The Literacy Narrative
      5. 3.4 Annotated Sample Reading: from Narrative of the Life of Frederick Douglass by Frederick Douglass
      6. 3.5 Writing Process: Tracing the Beginnings of Literacy
      7. 3.6 Editing Focus: Sentence Structure
      8. 3.7 Evaluation: Self-Evaluating
      9. 3.8 Spotlight on … The Digital Archive of Literacy Narratives (DALN)
      10. 3.9 Portfolio: A Literacy Artifact
      11. Further Reading
      12. Works Cited
      13. Works Consulted
  3. Bridging the Divide Between Personal Identity and Academia
    1. Unit Introduction
    2. 4 Memoir or Personal Narrative: Learning Lessons from the Personal
      1. Introduction
      2. 4.1 Exploring the Past to Understand the Present
      3. 4.2 Memoir Trailblazer: Ta-Nehisi Coates
      4. 4.3 Glance at Genre: Conflict, Detail, and Revelation
      5. 4.4 Annotated Sample Reading: from Life on the Mississippi by Mark Twain
      6. 4.5 Writing Process: Making the Personal Public
      7. 4.6 Editing Focus: More on Characterization and Point of View
      8. 4.7 Evaluation: Structure and Organization
      9. 4.8 Spotlight on … Multilingual Writers
      10. 4.9 Portfolio: Filtered Memories
      11. Further Reading
      12. Works Cited
    3. 5 Profile: Telling a Rich and Compelling Story
      1. Introduction
      2. 5.1 Profiles as Inspiration
      3. 5.2 Profile Trailblazer: Veronica Chambers
      4. 5.3 Glance at Genre: Subject, Angle, Background, and Description
      5. 5.4 Annotated Sample Reading: “Remembering John Lewis” by Carla D. Hayden
      6. 5.5 Writing Process: Focusing on the Angle of Your Subject
      7. 5.6 Editing Focus: Verb Tense Consistency
      8. 5.7 Evaluation: Text as Personal Introduction
      9. 5.8 Spotlight on … Profiling a Cultural Artifact
      10. 5.9 Portfolio: Subject as a Reflection of Self
      11. Works Cited
    4. 6 Proposal: Writing About Problems and Solutions
      1. Introduction
      2. 6.1 Proposing Change: Thinking Critically About Problems and Solutions
      3. 6.2 Proposal Trailblazer: Atul Gawande
      4. 6.3 Glance at Genre: Features of Proposals
      5. 6.4 Annotated Student Sample: “Slowing Climate Change” by Shawn Krukowski
      6. 6.5 Writing Process: Creating a Proposal
      7. 6.6 Editing Focus: Subject-Verb Agreement
      8. 6.7 Evaluation: Conventions, Clarity, and Coherence
      9. 6.8 Spotlight on … Technical Writing as a Career
      10. 6.9 Portfolio: Reflecting on Problems and Solutions
      11. Further Reading
      12. Works Cited
    5. 7 Evaluation or Review: Would You Recommend It?
      1. Introduction
      2. 7.1 Thumbs Up or Down?
      3. 7.2 Review Trailblazer: Michiko Kakutani
      4. 7.3 Glance at Genre: Criteria, Evidence, Evaluation
      5. 7.4 Annotated Student Sample: "Black Representation in Film" by Caelia Marshall
      6. 7.5 Writing Process: Thinking Critically About Entertainment
      7. 7.6 Editing Focus: Quotations
      8. 7.7 Evaluation: Effect on Audience
      9. 7.8 Spotlight on … Language and Culture
      10. 7.9 Portfolio: What the Arts Say About You
      11. Further Reading
      12. Works Cited
    6. 8 Analytical Report: Writing from Facts
      1. Introduction
      2. 8.1 Information and Critical Thinking
      3. 8.2 Analytical Report Trailblazer: Barbara Ehrenreich
      4. 8.3 Glance at Genre: Informal and Formal Analytical Reports
      5. 8.4 Annotated Student Sample: "U.S. Response to COVID-19" by Trevor Garcia
      6. 8.5 Writing Process: Creating an Analytical Report
      7. 8.6 Editing Focus: Commas with Nonessential and Essential Information
      8. 8.7 Evaluation: Reviewing the Final Draft
      9. 8.8 Spotlight on … Discipline-Specific and Technical Language
      10. 8.9 Portfolio: Evidence and Objectivity
      11. Further Reading
      12. Works Cited
    7. 9 Rhetorical Analysis: Interpreting the Art of Rhetoric
      1. Introduction
      2. 9.1 Breaking the Whole into Its Parts
      3. 9.2 Rhetorical Analysis Trailblazer: Jamil Smith
      4. 9.3 Glance at Genre: Rhetorical Strategies
      5. 9.4 Annotated Student Sample: “Rhetorical Analysis: Evicted by Matthew Desmond” by Eliana Evans
      6. 9.5 Writing Process: Thinking Critically about Rhetoric
      7. 9.6 Editing Focus: Mixed Sentence Constructions
      8. 9.7 Evaluation: Rhetorical Analysis
      9. 9.8 Spotlight on … Business and Law
      10. 9.9 Portfolio: How Thinking Critically about Rhetoric Affects Intellectual Growth
      11. Further Reading
      12. Works Cited
    8. 10 Position Argument: Practicing the Art of Rhetoric
      1. Introduction
      2. 10.1 Making a Case: Defining a Position Argument
      3. 10.2 Position Argument Trailblazer: Charles Blow
      4. 10.3 Glance at Genre: Thesis, Reasoning, and Evidence
      5. 10.4 Annotated Sample Reading: "Remarks at the University of Michigan" by Lyndon B. Johnson
      6. 10.5 Writing Process: Creating a Position Argument
      7. 10.6 Editing Focus: Paragraphs and Transitions
      8. 10.7 Evaluation: Varied Appeals
      9. 10.8 Spotlight on … Citation
      10. 10.9 Portfolio: Growth in the Development of Argument
      11. Further Reading
      12. Works Cited
    9. 11 Reasoning Strategies: Improving Critical Thinking
      1. Introduction
      2. 11.1 Developing Your Sense of Logic
      3. 11.2 Reasoning Trailblazer: Paul D. N. Hebert
      4. 11.3 Glance at Genre: Reasoning Strategies and Signal Words
      5. 11.4 Annotated Sample Reading: from Book VII of The Republic by Plato
      6. 11.5 Writing Process: Reasoning Supported by Evidence
      7. Further Reading
      8. Works Cited
    10. 12 Argumentative Research: Enhancing the Art of Rhetoric with Evidence
      1. Introduction
      2. 12.1 Introducing Research and Research Evidence
      3. 12.2 Argumentative Research Trailblazer: Samin Nosrat
      4. 12.3 Glance at Genre: Introducing Research as Evidence
      5. 12.4 Annotated Student Sample: "Healthy Diets from Sustainable Sources Can Save the Earth" by Lily Tran
      6. 12.5 Writing Process: Integrating Research
      7. 12.6 Editing Focus: Integrating Sources and Quotations
      8. 12.7 Evaluation: Effectiveness of Research Paper
      9. 12.8 Spotlight on … Bias in Language and Research
      10. 12.9 Portfolio: Why Facts Matter in Research Argumentation
      11. Further Reading
      12. Works Cited
    11. 13 Research Process: Accessing and Recording Information
      1. Introduction
      2. 13.1 The Research Process: Where to Look for Existing Sources
      3. 13.2 The Research Process: How to Create Sources
      4. 13.3 Glance at the Research Process: Key Skills
      5. 13.4 Annotated Student Sample: Research Log
      6. 13.5 Research Process: Making Notes, Synthesizing Information, and Keeping a Research Log
      7. 13.6 Spotlight on … Ethical Research
      8. Further Reading
      9. Works Cited
    12. 14 Annotated Bibliography: Gathering, Evaluating, and Documenting Sources
      1. Introduction
      2. 14.1 Compiling Sources for an Annotated Bibliography
      3. 14.2 Glance at Form: Citation Style, Purpose, and Formatting
      4. 14.3 Annotated Student Sample: “Healthy Diets from Sustainable Sources Can Save the Earth” by Lily Tran
      5. 14.4 Writing Process: Informing and Analyzing
      6. Further Reading
      7. Works Cited
    13. 15 Case Study Profile: What One Person Says About All
      1. Introduction
      2. 15.1 Tracing a Broad Issue in the Individual
      3. 15.2 Case Study Trailblazer: Vilayanur S. Ramachandran
      4. 15.3 Glance at Genre: Observation, Description, and Analysis
      5. 15.4 Annotated Sample Reading: Case Study on Louis Victor "Tan" Leborgne
      6. 15.5 Writing Process: Thinking Critically About How People and Language Interact
      7. 15.6 Editing Focus: Words Often Confused
      8. 15.7 Evaluation: Presentation and Analysis of Case Study
      9. 15.8 Spotlight on … Applied Linguistics
      10. 15.9 Portfolio: Your Own Uses of Language
      11. Further Reading
      12. Works Cited
  4. Navigating Rhetoric in Real Life
    1. Unit Introduction
    2. 16 Print or Textual Analysis: What You Read
      1. Introduction
      2. 16.1 An Author’s Choices: What Text Says and How It Says It
      3. 16.2 Textual Analysis Trailblazer: bell hooks
      4. 16.3 Glance at Genre: Print or Textual Analysis
      5. 16.4 Annotated Student Sample: "Artists at Work" by Gwyn Garrison
      6. 16.5 Writing Process: Thinking Critically About Text
      7. 16.6 Editing Focus: Literary Works Live in the Present
      8. 16.7 Evaluation: Self-Directed Assessment
      9. 16.8 Spotlight on … Humanities
      10. 16.9 Portfolio: The Academic and the Personal
      11. Further Reading
      12. Works Cited
    3. 17 Image Analysis: What You See
      1. Introduction
      2. 17.1 “Reading” Images
      3. 17.2 Image Trailblazer: Sara Ludy
      4. 17.3 Glance at Genre: Relationship Between Image and Rhetoric
      5. 17.4 Annotated Student Sample: “Hints of the Homoerotic” by Leo Davis
      6. 17.5 Writing Process: Thinking Critically and Writing Persuasively About Images
      7. 17.6 Editing Focus: Descriptive Diction
      8. 17.7 Evaluation: Relationship Between Analysis and Image
      9. 17.8 Spotlight on … Video and Film
      10. 17.9 Portfolio: Interplay Between Text and Image
      11. Further Reading
      12. Works Cited
    4. 18 Multimodal and Online Writing: Creative Interaction between Text and Image
      1. Introduction
      2. 18.1 Mixing Genres and Modes
      3. 18.2 Multimodal Trailblazer: Torika Bolatagici
      4. 18.3 Glance at Genre: Genre, Audience, Purpose, Organization
      5. 18.4 Annotated Sample Reading: “Celebrating a Win-Win” by Alexandra Dapolito Dunn
      6. 18.5 Writing Process: Create a Multimodal Advocacy Project
      7. 18.6 Evaluation: Transitions
      8. 18.7 Spotlight on . . . Technology
      9. 18.8 Portfolio: Multimodalism
      10. Further Reading
      11. Works Cited
    5. 19 Scripting for the Public Forum: Writing to Speak
      1. Introduction
      2. 19.1 Writing, Speaking, and Activism
      3. 19.2 Podcast Trailblazer: Alice Wong
      4. 19.3 Glance at Genre: Language Performance and Visuals
      5. 19.4 Annotated Student Sample: “Are New DOT Regulations Discriminatory?” by Zain A. Kumar
      6. 19.5 Writing Process: Writing to Speak
      7. 19.6 Evaluation: Bridging Writing and Speaking
      8. 19.7 Spotlight on … Delivery/Public Speaking
      9. 19.8 Portfolio: Everyday Rhetoric, Rhetoric Every Day
      10. Further Reading
      11. Works Cited
    6. 20 Portfolio Reflection: Your Growth as a Writer
      1. Introduction
      2. 20.1 Thinking Critically about Your Semester
      3. 20.2 Reflection Trailblazer: Sandra Cisneros
      4. 20.3 Glance at Genre: Purpose and Structure
      5. 20.4 Annotated Sample Reading: “Don’t Expect Congrats” by Dale Trumbore
      6. 20.5 Writing Process: Looking Back, Looking Forward
      7. 20.6 Editing Focus: Pronouns
      8. 20.7 Evaluation: Evaluating Self-Reflection
      9. 20.8 Spotlight on … Pronouns in Context
      10. Further Reading
      11. Works Cited
  5. Handbook
  6. Index

Proposal Trailblazer: Atul Gawande

Learning Outcomes

By the end of this section, you will be able to:

  • Describe a particular problem and a proposed solution.
  • Discuss the process of identifying a problem and proposing a solution.
  • Articulate how proposals to solve problems reach their intended audience.
The Checklist Manifesto, written by Atul Gawande, convinced surgeons to adopt procedural checklists to ensure the safety of patients.
Figure 6.2 Atul Gawande thinks graphically about solving problems. (credit: “Sketched Book - The Checklist Manifesto - How to Get Things Right” by Sacha Chua/flickr, CC BY 2.0)

“What do you do when expertise is not enough?”

Medical Problem Solver

Born in New York City, surgeon and author Atul Gawande (b. 1965) graduated from Stanford University in 1987 with a degree in biology and political science. A Rhodes Scholarship enabled him to study at the University of Oxford, where he earned a master’s degree in philosophy, politics, and economics. Returning to the United States from England, Gawande entered politics and worked for Al Gore’s (b. 1948) presidential campaign and later served as a health care adviser during the Clinton administration (1993–2001). Gawande graduated from Harvard Medical School with an MD in 1995 and an MPH (master of public health) in 1999. Among his main concerns and frequent topics of his written work have been patient care and medical ethics.

In the mid-2000s, Dr. Gawande came across a simple idea for improving medical care. Another physician, Peter Pronovost (b. 1965), a critical care specialist, had identified a solution to the problem of patients in intensive care units (ICUs) developing infections after having central intravenous lines inserted. The cause of the problem was human error. Doctors knew the steps they needed to follow to prevent infection when they inserted a central line, but some of them skipped at least one of the steps. When they did, the risk of a dangerous infection increased, which in turn increased the likelihood of a poor outcome for the patient—longer illness, additional surgery, or death.

Borrowing a method from airplane pilots, who must go through a checklist before being cleared for takeoff, Dr. Pronovost proposed a similar solution for ICU doctors: a checklist of five things they needed to do when inserting a central intravenous line. Dr. Pronovost ran an experiment in the ICU at the hospital where he worked. Doctors were instructed to follow the steps on the checklist, and nurses who assisted during the procedure were told to observe and speak up if a doctor skipped a step.

The checklist worked. The infection rate dropped dramatically, reducing ICU stays, saving lives, and saving money. Dr. Pronovost began writing checklists for other ICU situations. These checklists were successful as well in addressing particular problems.

Approached by the World Health Organization, Dr. Gawande worked with a team around the world to develop a checklist to improve the safety of surgery. As a surgeon, he was well aware of complications that could occur as a result of mistakes before, during, and after surgery. The team created a 19-point “safe surgery” checklist that was tested at eight hospitals around the world, including one in the United States. The checklist worked again—all eight hospitals saw the rate of significant postsurgical complications and deaths drop by an average of more than 35 percent, with no additional costs.

The problem the two doctors identified is both simple and complex. The problem is not that doctors lack knowledge; the problem is that because the situations they encounter are often complicated and urgent, doctors do not always correctly apply what they know.

The solution proposed by Dr. Gawande and Dr. Pronovost is similarly both simple and complex: to improve accuracy, use a checklist. However, other doctors needed to be convinced that a simple change like this would improve medical care. To persuade others, Gawande and Pronovost wrote articles for medical journals in which they presented the problem they studied, the methods they used, the results of their experiments, and the solution they recommended. Dr. Gawande then went on to apply the checklist solution to preventable problems in fields outside of medicine in his book The Checklist Manifesto: How to Get Things Right (2009), which became a best seller.

Discussion Questions

1 .
How did Drs. Pronovost and Gawande define the problems they were trying to solve?
2 .
What evidence did Drs. Pronovost and Gawande use to support their proposed solutions?
3 .
Who was the audience for the doctors’ proposals? Why might some audience members be hesitant about accepting the checklist solution?
4 .
Think about the relationship between doctors and nurses. Who has more authority in a medical setting? How might the doctors’ and nurses’ reactions to using the checklist differ?
5 .
In what ways is the problem the doctors tackled both simple and complex?
6 .
In what ways is the solution the doctors proposed both simple and complex?
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