>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 on those discussions. He also has a habit of relating it in a fairly shallow/one dimensional way, compared to the real deb-
Malcolm Gladwell. He’s Malcolm Gladwell, but for healthcare.
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 Director of Ariadne Labs, a joint center for health systems innovation, and Chairman of Lifebox, a nonprofit organization making surgery safer globally.
Oh, I know he’s a surgeon. He and I have very similar backgrounds, save that I spent a decade in hc QI and Health insurance mgmt before going to medical school, rather than picking it up subsequently.
I point that out so you fully understand that when I say a doctor:healthcare QI as a bees:entomologist, I say that from both sides of the fence. It gives you some more insight in your little slice, but that’s it. And it’s just your little slice: I am not a surgeon, so I know jack shit about their operational processes. I do know from a recent kerfuffle in my hospital that even the surgeons don’t know much about how the OR department books rooms and schedules procedures. They certainly don’t have insight into the parts of the hospital that -aren’t- a core part of their job. Being a physician is an important window into how hc systems and organizations work, but it’s a tiny one. It doesn’t qualify one for hc QI by itself.
As to his cv, by all means, check out where he’s first author, where he’s “contributing guy with a name” (second to last), how many of them are editorials or round tables, how many of them are endocrine surgery, etc. Actual first author, non editorial healthcare ops papers are thin on the ground.
This feels like nitpicking. The guy is intelligent and accomplished, beyond question. But what he -isn’t- is a hc innovator just because he -writes- about the hc system and innovations therein. I’ve never seen him write on a topic that wasn’t already hot shit in the field for two decades; I’ve never seen him present the pile of conflicting data for his preferred solutions (eg, the Checklist Manifesto chose to elide how many hospitals implemented checklists to no improvement, despite plenty of the results being published before his book.)
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 positions such as CEO of a massively ambitious new healthcare venture.
The "Gladwell for healthcare" comparison is a good one, and I say that as someone who has enjoyed reading Gawande's books.
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.
So what’s your point? Should no one try to differentiate good surgeons or bad unless they are their peer for years?
There’s lots of crappy programmers with good reputations too. But it’s a weird reply to “he’s a top tier surgeon” that you say it’s unknowable.
I’m sure you’re right, I’m not a surgeon so I have no idea how to evaluate a good surgeon, but there must be some way to qualify the poor ones from the great ones.
Your anecdote is a great example of high reputation, low skill. But is that the only instance. Is it 10%? Are most board certified, practice for 20 years surgeons good or bad? What’s the actionable intelligence, but it seems like the conversation ends with “it’s unknowable.”
I am sort of aware of quality measurement, but not a healthcare practitioner, but I’ve noticed this comment from lots of docs that the only way to know if medicine is good or bad is to have a doctor review it.
I see your point, but I'm pretty sure he's at least pretty good, given that he has been promoted into a supervisory role by other surgeons who are familiar with how he does surgery.
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 dimensional, but I havent read all of his work. 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
> 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 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.
Those are good points. I am not familiar with the research on checklists as a QI tool so will take your word for it. However I think his articles on the "cost conundrum" and "hot spotters" are pretty insightful and his analysis is accurate and at least among the HC admins / professionals I know the insights are respected. I don't think that he's right that frequent fliers are the cause of the USs high cost of healthcare but his analysis is reasonable
I don't mean to offend if you work in HC ops or QI, but I'd rather have someone take a macroeconomic perspective than an ops perspective when looking for solutions to high HC cost. I'm aware of the HC QI field and know a few ppl who work in that space and I know how hard it is to move the needle with that work. You are fighting against a system that in many ways is not incentivized to work with you. I know there's been a lot of great work done in HC QI but frankly it hasn't moved the needle on cost of care. I think it's time to look at changing the broader system to allow all the good HC QI ideas to actually get implemented broadly
I hear your point about intellectual overreach. However many people call it another thing, but with a positive connotation: the "beginners mind". That in fact is one of the 3 criteria bezos had for the CEO. That mindset facilitates learning, growth, risk taking and innovation. Yes you'll make mistakes but that's part of the plan. The experts who never step beyond their area of expertise won't be as successful because healthcare is too interdisciplinary to have leaders who won't reach out intellectually to people from other fields, and too broken for incremental improvements to turn the tide
> 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
It seems like there are problems getting people to agree to do checklists or keep with them, but if you come up with the right checklist and get the right buy-in, you do see fewer complications.
> 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!”.
Yes! Great minds think alike, arkades! I completely agree with you and disagree with the two commentators. Atul is absolutely a good communicator/storyteller/popularizer (whatever terminology suits people). I used to read his Cheesecake Factory article where he discussed standardization of healthcare, which I thought it was good.
In the recent years, I find him at an excess amount of healthcare conferences speaking or writing on topics that's not within his realm of expertise such as patient experience, opioid pandemic, technology, artifical intelligence. The audience is often captivated by his stories and writing to not be able to differentiate how he's really repeating others' work and quick to write about what's currently trending in healthcare.
He's a good writer, physician, knowledgeable but not an executor.
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 on those discussions. He also has a habit of relating it in a fairly shallow/one dimensional way, compared to the real deb-
Malcolm Gladwell. He’s Malcolm Gladwell, but for healthcare.