HUBweek Change Maker: Atul Gawande

Renowned surgeon, writer, and public health researcher

With four best-selling books — including Complications; Better; The Checklist Manifesto; and Being Mortal: Medicine and What Matters in the End — Atul Gawande, MD, MPH, is an accomplished surgeon, writer, and public health researcher who inspires clinicians, patients, families and policy makers to re-examine their understanding of medicine. He practices general and endocrine surgery at Brigham and Women’s Hospital (BWH), is a professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health (HSPH) and the Samuel O. Thier Professor of Surgery at Harvard Medical School. Atul is the founder and executive director of Ariadne Labs, a joint center for health systems innovation at BWH and HSPH dedicated to reducing suffering worldwide through scalable solutions that drive better care at the most critical moments in people’s lives. He is also the chair of Lifebox, a nonprofit organization focused on making surgery safer globally. On top of all this, he has been a staff writer for The New Yorker magazine since 1998, is the winner of two National Magazine Awards, and serves on the board of directors of the New America Foundation. Most days you can find Atul working on research at Ariadne Labs, surgery at Brigham and Women’s Hospital, or his writing wherever he may be.

At Ariadne Labs, what problem are you working to solve? Can you share a little bit about the initiatives you’re working on? We work on what I believe is the biggest untapped scientific opportunity to save lives and reducing suffering: developing scalable solutions for better care at the most critical moments in people’s lives everywhere. There is a massive gap between what science has discovered and what we actually deliver in health care. And the reason is the rising volume of knowledge, technology, and skill has overwhelmed our capabilities as practitioners and organizations.

At Ariadne Labs we are showing that science and innovation can unlock better ways to deliver care — more simply, more humanely and with better results. During the past year, our three anchor programs in childbirth, surgery and serious illness have all completed major scientific trials that are demonstrating the impact of our work:

  • Childbirth: We completed the BetterBirth trial of a coaching-based system for childbirth involving 160,000 births in 120 birth facilities in northern India. We have demonstrated that use of a childbirth checklist drives marked improvements in the safety and quality of childbirth.
  • Surgery: In a five-year project with the state of South Carolina, hospitals saw a 22 percent reduction in post-surgical deaths after completing the nation’s first statewide Surgical Safety Checklist program.
  • Serious Illness Care: In a randomized trial involving all of the Dana-Farber Cancer Institute, we designed and tested a Serious Illness Conversation Guide. The preliminary data show it has produced more, earlier, and better goals-of-care conversations with substantial reductions in depression and anxiety during the last weeks of life.

What impact do you (personally or collectively) hope to have through this work? We want to enable health systems to deliver the best possible care for every patient, every time, everywhere. We’re showing that it can be done. In 2009, we proved in 8,000 patients in 8 cities worldwide that using a safe surgery checklist markedly reduces complications and deaths. Our work since then to test methods for scaling adoption has made it the standard of care for at least half of the world’s 300 million operations. And we’re doing similar systems innovation work in multiple fields of health care — from childbirth (how we come into the world) to care at the end of life (how we leave this world).

What’s the biggest challenge you’ve faced in your career?

My biggest challenge is a constant one: finding the right balance in how I try to provide creativity and impact — whether it is through surgery, research, leadership, writing, or family.

One thing people might find surprising about you or what you do at Ariadne? How little of it I actually do. I tend to get a lot of credit and attention for all of the accomplishments at Ariadne Labs — too much. Our programs are led by teams of world-class clinicians, scientists, project managers, and experts of all kinds. Not only do they deserve much of the credit that I receive, they are constantly teaching me and giving me the ideas I get to write about.

3 things you wish you knew when you first started out:

  1. Talk less.
  2. Listen more.
  3. Learn how to delegate effectively.

Best advice you’ve ever received? One of the best pieces of advice I have heard was to say yes to everything you can before you’re forty. After that, say no.

What’s next? At Ariadne Labs, we’re expanding and strengthening our existing programs; building a pipeline of work on new system problems (from the epidemic of unnecessary cesarean sections in the U.S. to how to enable better primary care in the low and middle income world). In my writing, I am working on my next articles for the New Yorker, and, with any luck, a plan for my next book.

You will find Atul on a HUBweek 2017 Future Forum panel this fall examining the future of medicine and the life-saving potential of health systems innovations. Registration for HUBweek 2017 opens this June.

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The HUBweek Change Maker series showcases the most innovative minds in art, science, and technology making an impact in Boston and around the world.