Atul Gawande, Renowned Surgeon And Writer, Launches Innovation Lab

BOSTON — In some ways, the name Dr. Atul Gawande chose for his new health care innovation center — Ariadne Labs – says it all.

“Ariadne is the myth of the Greek goddess who showed Theseus the way out of the labyrinth with a simple thread,” Gawande explained. “We’re in the simple-threads business to show our way out of the labyrinth of health care complexity.”

Surgeon/writer Atul Gawande is opening Ariadne Labs, a center, for health care innovation. (Photo: Fred Field)

Surgeon and writer Atul Gawande is opening Ariadne Labs, a center for health care innovation. (Courtesy Fred Field)

Gawande, a surgeon at Brigham and Women’s Hospital, has been named one of the world’s most influential thinkers. The surgical checklist he promotes has been gaining traction worldwide since 2008, when it’s use in a World Health Organization project reduced deaths during surgery by nearly 50 percent. The list is a set of questions everyone in an operating room answers, starting with: Do we have the correct patient? What operation are we performing? And is the site marked?

Now, Gawande is expanding his focus from surgery to two other big health care moments: childbirth and death.

“We think in the course of a person’s life that you will turn to the health system for a few high-risk, high-failure health care moments, and also some of the highest-cost moments in that system,” Gawande said. It starts with childbirth and surgery — the average person has seven operations in their lifetime — all the way to the end of life.

“We know that almost 90 percent of patients say they want to die at home, yet less than 50 percent do,” Dr. Rachelle Bernacki tells an audience gathered for the first research meeting on end-of-life care at Ariadne Labs’ new office.

Boston can be the Silicon Valley of health care innovations.
– Atul Gawande

Bernacki is testing a set of questions that aim to make sure doctors understand the wishes of patients who face a prognosis of death within six months. “We start all conversations with, ‘What’s your understanding of where you are with your illness now?’” Bernacki explained. She is analyzing patients’ responses to seven questions and training doctors to have these difficult conversations.

Some health care experts who’ve wrestled with the end-of-life issue for years – like Stuart Altman, who has worked on health care reform at the state and national level for 45 years —  are thrilled to hear Gawande’s lab is taking it on.

“Atul Gawande is a true find,” Altman said. “There are few people — no, as a matter of fact, I don’t know anybody who really has a better insight into how our system works and where it doesn’t work and how it could be better.”

But Gawande knows there are hurdles ahead. His lab is getting off the ground with donations from individuals, the Gates Foundation and some government grants. He has support from Brigham and Women’s and the Harvard School of Public Health. But Gawande isn’t certain about long term funding.

In another hurdle, he has to persuade doctors and nurses to buy into his proposed solutions. But he’s optimistic.

“Boston is a place where, if we are not leading this, I don’t know who is,” Gawande said. He expects to work with major hospitals and medical schools to expand work that other organizations have started, “out of a belief that Boston can be the Silicon Valley of health care innovation.”

He says the theme in all his work, whether it’s health care policy, surgery, or writing for The New Yorker, is finding simple solutions for messy problems.

Readers? Anything you’re most hoping they’ll take on? The Ariadne Labs Website is here.

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  • Raymond R. Price MD FACS

    You should get your facts straight. The check list did not decrease deaths by 50%. The checklist helped improve implementing standard guidelines by 50 %. But so far there has not been any real correlation with improving outcomes. In fact, since checklists have been implemented, wrong site surgery has still increased in the US. So the checklist is helpful in making sure we are giving the right antibiotics at the right time, identifying patient’s allergies, etc. But in no way has it decreased deaths by 50%. This is very misleading in this article.
    Raymond R. Price MD FACS, Author of Global Surgery and Public Health: A New Paradigm

    • Martha Bebinger

      Hi Dr. Price – thanks for the comment. I fact checked Dr. Gawande’s assertion here:

      The “results” section says:

      “The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001)."

    • Spike McLarty

      In his Checklist Manifesto, Dr. Gawande talks about the surprising resistance he meets from doctors, administrators, and other health-care professionals, to a kind of process-improvement that has been taken for granted for decades in other areas like commercial aviation, commercial construction, and software engineering. Are you one of those ‘resistors’? What was the source of your facts? In particularl, I’m surprised by your implication that checklists have been implemented widely enough in ORs across the US that we should see a significant effect on e.g. wrong-site surgery – what is your source for that?

      • Dr Sharma

        Looks like Dr Price is not happy that the manifesto did better than his book.

  • Tom

    It’s going to have to go a looooong way to catch Seattle

    • Martha Bebinger

      Tom – interesting! Could you post a link to the best summary of what’s happening in Seattle?

  • KT McGraw

    Is there a website link for Atul’s lab or too soon? Thanks!

    • Martha Bebinger

      Hi KT – the link is in the first line, but I could have made it more obvious, sorry!

    • Carey Goldberg

      If you click on the first mention of Ariadne Labs, you’ll get to it. Will also make it more explicit at the bottom — thanks for reading!