Gawande on Coordinated Care

By Mike Segal

You probably remember Atul Gawande. Mr. Gawande, both a physician and a writer, authored an article in June 2009 in New Yorker Magazine that was read by many–including President Obama–called “The Cost Conundrum.” That article was quoted many times in support of accountable care organizations during the debate over healthcare reform.

Dr. Gawande has since written other interesting articles for New Yorker Magazine, and has authored a book. Recently, at a medical conference, he was quoted as making the following observations about achieving quality healthcare outcomes, which are quite interesting:

“Many of the healthcare organizations with the best results are among the least expensive, and the most successful behave like systems, for example like the parts that make up a car.

Changing from cowboys to pit crews will take three key skills that don’t exist right now except in small pockets:

  1. Recognize success and failure through the use of data. Current data can’t supply how many people had a heart attack last year or last month and what their survival rates are. If it could, physicians could pinpoint where the problems are.
  2. Devise solutions by thinking like other fields that are high risk and high failure. A well-designed checklist is the simplest way to get teams to work together. For example, a Boeing engineer helped develop a flight-deck type checklist for surgery, which Gawande tested in eight locations, with an average 35 percent reduction in complications and 47 percent reduction in death. Since then, VA has adopted it and has reduced deaths by 18 percent.
  3. Overcome the culture of resistance among physicians by making solutions simple enough to be implemented and accelerated.”
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