I can thoroughly recommend reading Atul Gawande's "Checklist Manifesto". The premise, on the face of it, is mundane, but the stories that back up the claims are thoroughly enjoyable to read. http://atulgawande.com/book/the-checklist-manifesto/
The book is good, but the article it‘s based on is better, because there‘s simply not enough material for a whole book, so it feels a bit forced. https://www.newyorker.com/magazine/2007/12/10/the-checklist
Surgeon Atul Gawande selected as CEO of new health care company from Amazon
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Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#92When I read the checklist manifesto I thought it was going to change my life. It didn't because I didn't put it into effect. Then I thought it would be great if software did the work for me, including communal checklists that people can share with me. (Got a new car, here is a checklist template. Got a new house? Here is the checklist template? Is it an investment property, use this checklist. Oh, that is good for Fl…
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#93Earlier quoted context omitted.
Jeff bezos mentioned they were looking for someone with expert knowledge, a beginner's mind, and a long-term perspective. Any leader of a current large healthcare organization would probably fail the 2nd and potentially 3rd criteria. In light of these criteria, the choice of Atul Gawande makes sense
That’s actually my point, I would argue Gawande doesn’t have expert knowledge. Being an expert surgeon is a very different skill set than an expert in healthcare delivery and management. Let’s take the checklist manifesto, a fantastic idea that unfortunately isn’t as widely applied as it should be. Why? Because if you ask most surgeons they’ll say, “yeah it’s a great idea, I do it already/I don’t need to do it though…
And he’s neither a fraud (e.g. Scott Thompson) nor a finger-on-the-trigger egoist (e.g. Elon Musk)
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#94Earlier quoted context omitted.
>Atul Gawande is a brilliant person with interesting ideas on how to make healthcare more humane and robust No, he’s not. No offense to him, but he’s a -popularizer-. He takes various bits the HC quality improvement folks have been talking about / doing for years and writes (very articulate, engaging) articles that make it accessible to the wider community, including the wider medical community that normally isn’t in…
I wouldn't call him a popularizer, I'd call him a good communicator, which is an essential trait to any leader, especially one trying to do something long term and visionary. Effectively communicating new ideas to the wider medical community, especially super busy physicians, is really hard, and is the first step towards driving physician-led change in the healthcare system. I dont think his ideas are shallow or one…
You wouldn’t. He adds depth through humanity, while eliding the pile of data that contradicts his points - data you have no reason to notice is missing. While the hc QI community was getting over checklists because of the number of studies showing it to be a largely ineffective intervention, he ignored the pile and kicked off a second wave. That’s not really visible to the lay reader.
>I'd certainly push back against the comparison to Malcolm Gladwell -- atul gawande is a practicing surgeon and professor at one of the most well respected hospitals in the world. If Malcolm Gladwell wrote about the 10,000 hour rule from his personal experience becoming, say, a chess grand master through 10,000 hours of practice, then the comparison would be more apt.
AG does not write about healthcare QI from the perspective of someone that works in ops or hc QI. It’s a real profession, and one he hasn’t practiced.
He writes about macroeconomics and corporate management (and if that seems wildly dissimilar to you, you have some appreciation of how far afield he pokes his nose) from the perspective of the factory worker. And when he at least stuck to his area of medical expertise, at least he had some subject matter expertise to inform his perspective. He’s expanded outward from there, with neither academic nor medical expertise on the topic. There’s nothing terrible about that, but he’s -not- 10k hr guy writing about 10k hrs. He’s a guy with a passion, who has read up a bunch on topics he’s passionate about, and written about them well. They have some small overlap with his profession (diagnosing endocrine disorders; cutting out thyroids, Not reorganizing hc delivery processes), which adds some insight. Yeah, he’s slightly better than MG, but not by an awful lot.
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#95Atul Gawande is a brilliant person with interesting ideas on how to make healthcare more humane and robust. This is still probably a terrible choice of CEO. To my knowledge he has never run a large organization or dealt directly with the complex backend of the healthcare system. The was healthcare is delivered and paid for is full of independent, semi monopolistic players that have often conflicting incentives. Oh an…
Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a good communicator. Even if he fails, nothing is lost because the system can't get worse.
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#96BWH culture is crumbling so I won't blame him for seeking other opportunities. However, this is an odd/weak selection where I believe Amazon-Berkshire-Chase will regret. Toby Crosgrove, former Cleveland Clinic CEO, would have been a well-qualified candidate and better choice. He has over 10+ years of leading a highly complex AMC and elevating the organization into the top 3 hospitals in the country for many consecuti…
Didn't Cosgrove retire? Why would he be interested?
Full disclosure: I've worked in healthcare for prestigious AMCs, but have zero affiliation with Cleveland Clinic or Iora Health.
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#97Earlier quoted context omitted.
Surgeons don't get to play God as much anymore. Checklists dominate and are the hallmark of a good institution. One of the biggest risks in hospitals are central lines and infection. So cleaning protocols / enforcement and as much automation as possible are ways forward. The ACA imposes financial penalties on hospitals if they don't reduce infection rates and readmission rates. You can only do that if you improve qua…
Also, I think Gawande _wrote_ "The Checklist Manifesto"!
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#98Earlier quoted context omitted.
I've also done some work trying to get people to implement different models of care outside of the traditional institutions, and getting physicians on board is just a big hurdle. As a group they are pretty conservative and risk averse, hugely busy, and there aren't a lot of places where they congregate, online or otherwise, so outreach is a bit of hand to hand combat. I have an untested hypothesis that one of the bes…
Another (darker) perspective: they don’t want to lose money. Healthcare in the US is expensive in no small part because we pay more for things (duh). One of those things is physician time. Primary care physicians in the US make $60K more a year than comparable nations [1]. Dirty secret of healthcare: “efficiency” translates to “I make less money” for almost everyone in the system, very much including doctors. All wil…
However I think it's odd to point out primary care as a culprit. Prices in the US are higher across the board, so just highlighting primary care salaries doesnt tell the whole story. Better metrics are 1) ratio of average salary of specialists to primary care and 2) total supply of specialists compared to primary care. The US lags on both metrics [2]
Hospital care is the number one driver of spend in the US (over 30% of spend) [1]. A day at a hospital in the US is twice as much as in comparable countries (can dig up source if interested). Pretty sure the U.S. spends more on inpatient care as % of total spend than other countries. US is middle of the pack in terms of drug spend as % of total HC spend. Hospitals have increasingly been buying primary care and specialty practices. When an independent practice gets bought by a large system, they can instantly charge more for the same procedure, bc they're now under the large system's contracts with payers. Literally nothing changes but negotiating leverage. If you want to find a big cause of healthcare spend inefficiency in the US, look there
[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
[2] https://www.milbank.org/2017/07/getting-primary-care-oriente...
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#99People with years of experience in healthcare question think he's a poor pick and just a famous name.
It's amazing what a good public relations strategy can do for someone!
Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon
#100Earlier quoted context omitted.
Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a good communicator. Even if he fails, nothing is lost because the system can't get worse.
Ah, the ol' MAGA argument.