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 because I’m that good”. In practice it doesn’t get applied because humans have ego and incentives get misaligned. It’s not actually that beneficial to reduce complications in surgery for the hospital as long as the patient is insured. And it’s not that beneficial for the insurance company to reduce costs because fundamentally as long as the insurance company can accurately predict how much costs will rise next year, they still make money. They just need to know how much premiums will go up.
Healthcare is full of great ideas and ways to make things better, but they often just don’t get implemented because the whole system is so poorly set up. I don’t see any evidence that Gawande for all his talents has a good approach or the expertise to break through all that.
I'd point to another article, his "cost conundrum" article actually was a pretty insightful piece that I think gets at the core of one of the main drivers of high HC spend: local monopolies [1]
Another article of his, the "hot spotters" [2], was very influential among providers, administrators and even VCs as well. However, I dont think he's right that addressing frequent fliers is the solution -- you see the same cost concentration among a few patients in all countries, and even across time, so it doesnt appear that that phenomenon is the cause of the US' unique expensiveness
i dont know of many other people who have ideas that demonstrate the same combination of independent thinking, reach / visibility and understanding of the system as atul gawande (i actually dont think there are many great ideas to improve healthcare, most dont even diagnose the problems accurately). some of his ideas will be wrong, but he has new and solid hypotheses, and being able to test those and learn is a great way to make progress
[1] https://www.newyorker.com/magazine/2009/06/01/the-cost-conun...
[2] https://www.newyorker.com/magazine/2011/01/24/the-hot-spotte...
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 monopolies issue seems utterly intractable. Maybe some combination of remote care and creating vertically integrated treatment centers can help? I don't know, healthcare is really hard. I just hope this isn't a flash/vision over nitty gritty execution appointment.
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
And he’s neither a fraud (e.g. Scott Thompson) nor a finger-on-the-trigger egoist (e.g. Elon Musk)
"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
Nothing new under the sun. A guy who found that doctors should wash hands between autopsies and deliveries was ostracized by colleagues and died in asylum. [1]
[1] https://www.npr.org/sections/health-shots/2015/01/12/3756639...
He's kind of celebrated for an article he wrote in the New Yorker on healthcare delivery and management. (see 'This magazine article saved $500M in unnecessary Rx spending' https://www.cnbc.com/2015/05/08/this-magazine-article-saved-...)
It impressed Munger, Buffett's partner sufficiently that he sent a cheque for $20,000 to Gawande at the time as a gift without knowing the guy. https://www.cnbc.com/2018/06/20/charlie-munger-once-wrote-at...
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.
Basically all successful biotech CEOs are old, former big pharma execs or academics -- two fields not known for their hustle. And they can grow big, fast: look at CEOs of Juno, avexis, kite; those companies were bought for $9-12B cash just 5ish years post series a
The biggest health tech companies are Cerner and Epic. They were founded in the 1970s I think. Have avoided disruption bc they know the system. Many other successful health tech companies are founded by dyed in the wool industry veterans or doctors with a good understanding of the field who work 9-5
Plus Atul probably has some hustle. He became a best selling author while being a surgeon and prof at Harvard. Takes initiative to decide to write books and actually pull off getting them sold. He sure knows how to build an audience -- probably has a bigger audience than any health tech startup CEO
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.
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
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 ...
The Internet was wide open 10-15 years ago. Today, not so much.
A CEO of anything in healthcare, especially something like this, had better have a lot of domain expertise.