Implementation: A unique approach to spreading health care solutions globally

Ariadne Labs
Jul 8 · 4 min read

By Sue Gullo, RN, BSN, MS

Illustrated by Courtney Staples

“Implementation” may sound like a term reserved for the company boardroom, but really we are all implementers. We regularly identify opportunities for change or improvement and then turn these ideas into action.

I do this every day when prepping for my commute to work. Do I travel the same route as yesterday or is there a faster one? If I leave earlier will I avoid traffic? Should I take the train instead? My goal is to determine the fastest route — and that changes according to the weather, traffic reports, and whether the Red Sox are playing that night, since I commute into Boston.

This process of putting a decision or plan into effect — implementation — also applies to health care. I speak from experience, having been a nurse for nearly 40 years and serving in director roles for 20 years that have helped design and implement patient safety programs globally.

While change can be exciting, everyone doesn’t initially embrace the new at first.

That’s an area where Ariadne Labs also lends its expertise. Our Implementation team leads health systems on an exciting journey, one that paves the way for anyone interested in implementing and spreading health care solutions designed for patients during their most critical moments. Our pathway provides a reliable, standardized toolkit to support implementers in the field to decrease variations, provide coaching tools, and develop a measurement strategy to analyze efforts. While change can be exciting, everyone doesn’t initially embrace the new at first.

Here’s a key example. I’ve been part of a movement to implement life-saving tools in diverse, clinical settings. One of these tools is the World Health Organization’s Surgical Safety Checklist, which was developed by a team led by Ariadne Labs and has received worldwide recognition for its life-saving effects. Most recently, Scotland saw a 36 percent reduction in post-surgical deaths since implementing the checklist as part of a national health safety program. I saw, at the frontline of care, how difficult it was for stakeholders, including surgeons, to grasp the concept of a surgical checklist. I heard many reasons why it would not work, how the tool was not necessary and could not improve the care of patients or outcomes.

I have so much confidence in the tool that I sought out a surgeon who used it for my own operation in 2009. I’ve since asked surgeons all over the world: “Would you use it if you needed surgery?” Almost all said yes. Yet they needed ample coaching and support to use it on their patients.

I’ve since asked surgeons all over the world: “Would you use [the Surgical Safety Checklist] if you needed surgery?” Almost all said yes. Yet they needed ample coaching and support to use it on their patients.

This feedback is crucial for change. I have also learned to ask three magical, albeit not simple, questions before beginning any implementation project:

  • What is it that we want to change?
  • How will we do it?
  • How will we measure it to ensure we are making an improvement?

The most important aspects of asking these questions is that I can capture the knowledge and opinions of the people who work in any system closest to the change you want to implement. These are the experts — whether they are based in hospitals, ambulatory clinics, community-based organizations, or advocacy groups — and can drive improvements.


One of these experts drew me to Ariadne Labs in 2018. A decade earlier, I first heard of a surgeon named Dr. Bill Berry, Ariadne’s associate director and senior advisor who was focused on global implementation of the Surgical Safety Checklist. I now work alongside and learn from Bill, which is a great gift. With Bill as a guide, I have continued to learn about the importance of relationship building and use of data for improvement and research. I now have a glossary of “Billisms”, such as “meet with everyone one-on-one who has a stake in the change.” Bill pushes us every day to fulfill the mission of Ariadne Labs: saving lives and reduce suffering by creating scalable solutions that improve health care delivery at the most critical moments for people everywhere.

Via this blog, Bill and I will lead you on an implementation journey. We will showcase Ariadne Labs’ global work to improve patient care when needed the most. I have learned to appreciate our successes but also to embrace the positive aspects that failures have taught us. I have learned that it is necessary to be transparent to gather the knowledge to create change and sustain it over time.

While joining us on our journey, we hope you, too, learn something from the process of implementation.


Sue Gullo is the director of Implementation at Ariadne Labs. She, Bill Berry, and other members of Ariadne’s Implementation team will contribute regularly to this blog.

Ariadne Labs

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Our mission is to create scalable health care solutions that deliver better care at the most critical moments in people's lives, everywhere.

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