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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

#131

Post by southern_cross »

entee wrote: post #12

Atul 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…

Dunno about this guy, but having once worked under one of the other potential CEOs who was on their short list, I can safely say that he probably would have been a much worse choice!

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#132

Post by bookofjoe »

leroy_masochist wrote: post #90
kahirsch wrote: post #54

Earlier quoted context omitted.

That's not at all the case. http://atulgawande.com/about/ Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital. He is Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. He is also Executive Dir…

Fair enough, he's a popularizer and also a top-tier surgeon. I agree with parent comment -- there is a difference between being the person/people who came up with brilliant ideas and being the person who brought them to the masses in a pithy, cogent and engaging manner. One might even make the argument that the latter task is relatively more important than the former for people in high-visibility figurehead type posi…

>and also a top-tier surgeon.

The only people who can differentiate between 1)surgeons who are expert in the O.R. whose patients do well in the long run and 2)those whose reputations exceed their abilities and results are anesthesiologists. Trust me, I was one for 38 years, at UCLA, the University of Virginia, and in private hospitals. I will never forget the time a world-renowned cardiac surgeon at UCLA at the height of his career — holder of an endowed distinguished chair, first author of the then most widely acclaimed textbook in the field, whose surgical skills were so sub-par he was only allowed to operate with a senior cardiac surgeon as his "first assistant" — was repairing a child's AV septal defect by sewing on a patch (on full cardiopulmonary bypass) only to be interrupted by his "first assistant" who quietly told him, "You've got the patch on backwards." I was standing literally two feet from the two of them, behind the drape.

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#133

Post by sonnyblarney »

aaavl2821 wrote: post #123
sonnyblarney wrote: post #122

Earlier quoted context omitted.

Yes, but you still need someone with startupy hustle, and with a CEO mindset, as well as a knack for ops. In light of this, I'm truly perplexed by this choice. This is not a 'resarch organization' or something like 'doctors without borders' for whom this guy would be a great choice. Living outside of 'revenue' and 'products/services' all of one's career makes this a difficult choice.

I think one of the reasons tech startups haven't made a bigger dent in healthcare / biotech is bc they overweight startup hustle and underweight experience and domain expertise. Better to walk towards the right target than run really fast to the wrong one, and in fields like healthcare you can't pivot as quickly once you realize you're going in the wrong direction Basically all successful biotech CEOs are old, former…

I agree with all of what you are saying but I just don't buy that this is the guy. A prof, surgeon and 'successful author' is just not the right mix for this.

I would say: ex-surgeon Hospital administrator of a progressive hospital. Ex-director of technology and services for a healthcare provider or insurer. Head of a prestigious applied research centre.

'Prof' and 'author' are intellectual, non-leadership, non-outcome, non-operational, non-managerial positions. He's imminently qualified to be the spokesperson and possibly 'Chief Medical Officer', but not CEO.

Does he even have a history of doing in-depth research on the operational and cost challenges of running a healthcare system?

The 'innovation' required here will not be medical - it will be political, operational ... fighting incumbent structures.

Someone with a kind-of relevant background who is also an ex-physician. There are many of those.

I'm still perplexed.

Amazon was hugely successful with AWS because it was an outgrowth of their business. They bought their way into groceries.

They will use their deep distribution and warehousing advantage to move into delivery. All of that makes sense.

But taking on incumbent, politicized structures? With armies of lobbyists to legislate their control of systems?

I think this guy is going to get eaten by the entrenched powers that be.

Though I wish him well and applaud Bezos for going after this.

Wallmart already has some opticians in their stores - I really wish they would move into pharmacies, then maybe 'family doctor locations' and then commoditizing common things and operations.

I actually think Wallmart is in many ways so much better positioned than Amazon to make their way into healthcare by grabbing the low hanging fruit and using their massive pricing power and physical installed base.

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#135

Post by arkades »

zjacobi wrote: post #119
arkades wrote: post #94

Earlier quoted context omitted.

> I don’t think his ideas are shallow or one dimensional, but I havent read all of his work. 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…

> 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 I just thumbed through meta-analyses on Google scholar and this definitely doesn't look like the results of recent research into checklists (e.g. https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.9381 ) It seems like there are…

> but if you come up with the right checklist and get the right buy-in, you do see fewer complications.

Bingo.

What the state of the research shows is that you have an active QI-focused culture and buy-in, checklists work over the medium long term, but not better than anything else. If you don’t have those things, the checklists do nothing after 3-6 months (a lot of studies hide this by rolling up the study period, but everyone in the field knows how rapidly the effect decays). I haven’t seen any meaningful data on them >2 years out, but let’s let that slide, out of pragmatism.

What that suggests is that checklists are irrelevant to this discussion. It’s just a lot harder to sell something as vague and nebulous as “creating a safety-focused and quality-driven culture” than it is to sell “checklists!”.

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#136

Post by aaavl2821 »

entee wrote: post #128
aaavl2821 wrote: post #104

Earlier quoted context omitted.

Your point seems true regarding that particular article, though I dont think that is sufficient to demonstrate that he doesnt understand the system. As a surgeon, I'm sure he knows the barriers to adoption of such a tool, and being the head of a large buying consortium for health insurance (Amazon / berk / jpm) could give him the market power to "wag the dog" and push payers to implement such policies. But i agree th…

Your point is an excellent positive case for his appointment :). I fully agree with you on monopolies and hot spotters. The monopolies are a pernicious issue that's incredibly hard to solve, and targeting hot spotters is not likely to be the silver bullet people hope it will be. I hope he succeeds given his perspective, I'm just skeptical that he can given the scale and structure of the problem. In particular the mon…

I agree that lack of ops / execution experience is a potential concern, but for me the characteristics that make me most positive are 1) ability to connect with a wide audience of physicians and 2) courage: a willingness to fight the "powers that be" and try things that probably won't work, as long as you get enough shots on goal to do something that does (not sure how courageous he is but his willingness to put himself out there in ways that most docs dont do is encouraging). Rushika Fernandopoulle at Iora has these qualities and they seem to make up for his lack of healthcare ops experience (though I dont know that his model is sustainable / scalable enough)

I think these are important because my hypothesis is that the way to tackle the monopoly issue is by reversing the trend of hospital consolidation and purchasing of independent providers, and putting more power in the hands of physicians rather than health systems or payers. But to do that you need to make being an independent physician feasible again, and to learn how to do that you need to connect with a lot of physicians and then be in a position to create services and products to help them become independent (probably by getting payers to pay independent docs more / reducing auth and other burdens; maybe this company has the heft to do so). I don't know that Atul Gawande's the perfect person for that, but I know that anyone who has run a hospital or payer is probably not right

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#137

Post by aaavl2821 »

sonnyblarney wrote: post #133
aaavl2821 wrote: post #123

Earlier quoted context omitted.

I think one of the reasons tech startups haven't made a bigger dent in healthcare / biotech is bc they overweight startup hustle and underweight experience and domain expertise. Better to walk towards the right target than run really fast to the wrong one, and in fields like healthcare you can't pivot as quickly once you realize you're going in the wrong direction Basically all successful biotech CEOs are old, former…

I agree with all of what you are saying but I just don't buy that this is the guy. A prof, surgeon and 'successful author' is just not the right mix for this. I would say: ex-surgeon Hospital administrator of a progressive hospital. Ex-director of technology and services for a healthcare provider or insurer. Head of a prestigious applied research centre. 'Prof' and 'author' are intellectual, non-leadership, non-outco…

I completely agree with you philosophically, and your idea that Walmart might be better positioned than amazon makes sense to me. Owning providers (versus paying health systems massive prices for access to providers) seems to be an emerging theme.

I've spoken to / heard talks from several ex-MD hospital admins of large health systems, informatics heads at massive university health systems, and leaders of large providers, and from hearing them I just have no confidence that they have the will to enact change. They are benefiting from the current system and to do something radical to fix the system would go against everything they'd learned in their careers, and probably burn many professional bridges (they'd be fighting their former colleagues)

I'd point to Rushika Fernandopoulle at Iora health as an example of a physician with no ops experience who has excelled in fighting incumbent structures. If Atul has that phenotype, I'd take that over hospital admin experience any day. But of course thats just my perspective and I understand picking Atul is a big risk

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#138

Post by codeisawesome »

creaghpatr wrote: post #101
JoshTko wrote: post #81

This is the type of topic where I feel that HN community tends to not provide valuable insight as it's outside of the community's collective expertise. How many individuals here have hired SVP+ level employees and how would that compare to the collective experience of Bezos, Buffet, and Dimon?

Bezos, Buffet, and Dimon are unfortunately not available today to discuss this topic in the HN forum so you're stuck debating the pros and cons with us [fellow?] peasants, sorry.

Off topic sorry, but this is such a British response. Funny.

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#139

Post by zrobotics »

verisimilitude wrote: post #83
sjg007 wrote: post #79

Earlier 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"!

After having worked with some A&Ps (aircraft mechanics) I was shocked that surgeons didn't operate with checklists. Doesn't matter how skilled you are, mistakes happen, especially when you are in a hurry. Aircraft mechanics also typically 'shadow' their toolboxes, which is where every drawer has individual cutouts for each tool to make it easy to verify that all tools are back in their place. And apparently instruments being left in a patient isn't that uncommon:

"According to the U.S. Department of Health and Human Services, it is anywhere between 1 in 100 to 1 in 5000.[1] However a study done in 2008 reported to the Annals of Surgery that mistakes in tool and sponge counts happened in 12.5% of surgeries.[8]"

Why are aircraft mechanics taking better precautions against this type of low hanging fruit than surgeons, aside from ego?

Ref:https://en.wikipedia.org/wiki/Retained_surgical_instruments

Re: Surgeon Atul Gawande selected as CEO of new health care company from Amazon

#140

Post by sonnyblarney »

aaavl2821 wrote: post #137
sonnyblarney wrote: post #133

Earlier quoted context omitted.

I agree with all of what you are saying but I just don't buy that this is the guy. A prof, surgeon and 'successful author' is just not the right mix for this. I would say: ex-surgeon Hospital administrator of a progressive hospital. Ex-director of technology and services for a healthcare provider or insurer. Head of a prestigious applied research centre. 'Prof' and 'author' are intellectual, non-leadership, non-outco…

I completely agree with you philosophically, and your idea that Walmart might be better positioned than amazon makes sense to me. Owning providers (versus paying health systems massive prices for access to providers) seems to be an emerging theme. I've spoken to / heard talks from several ex-MD hospital admins of large health systems, informatics heads at massive university health systems, and leaders of large provid…

"I just have no confidence that they have the will to enact change. They are benefiting from the current system and to do something radical to fix the system would go against everything they'd learned in their careers"

I hear you - but I also believe there are a number of them who imminently grasp the dysfunction and would like to do something about it. This is kind of out of my discipline but my Uncle was on the board of governors of a Hospital and he and the board watched as crazy stuff happened and definitely wanted to do something.

I worked in mobile at a once very succesfull handset manufacturer ... I watched the iPhone be borne and eat our lunch. As the execs failed, paradoxically, some of them knew what was happening and just could not get the system they were inside to change ... but a lot of us, were we to be in different systems, I think could be successful at it.

Anyhow. I wish him the best ...

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