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Atul Gawande On Checklists, Coaching, And What's Wrong With Healthcare

Atul Gawande, the writer, surgeon, and CEO of a new healthcare venture from Amazon, Berkshire Hathaway, and JPMorgan Chase.
Maggie Penman/WGBH News

Atul Gawande is a Renaissance man. The surgeon and New Yorker writer recently added “CEO” to his already sparkling resume, when it was announced that he would head up the new healthcare venture from Amazon, Berkshire Hathaway, and JPMorgan Chase.

To say that the details about the new healthcare nonprofit are scant is generous. It has not been publicly announced what the nonprofit is for or even what it's called.

What we do know about the venture is that it’s focused on lowering healthcare costs for employees of the three Fortune 500 companies, and improving employee satisfaction with their care. But since it’s coming from Jeff Bezos, Warren Buffet, and Jamie Dimon, it will likely be even more ambitious than that.

“The three of our companies have extraordinary resources, and our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans,” Dimon said in a January press release announcing the new venture.

Gawande would not discuss the new project when he appeared Thursday night to give a talk at Suffolk Construction’s headquarters in Roxbury.

His hour-long talk was focused primarily on his philosophies as a leader, and his ideas for improving healthcare in the U.S.

For one thing, he told the audience at Suffolk’s HQ, the American healthcare system sometimes gives people too much care. In discussing problems with childbirth in U.S., he pointed to the excess of cesarean sections as an example of care that’s often unnecessary and perhaps even inadvisable.

“One of our issues is, we do too much of many things, like c-sections. About a third of our deliveries in the United States are by surgery, which is markedly higher than they ought to be,” Gawande said.

On the other hand, many women get too little care in the days and weeks after they deliver.

“After you’ve gone home, there are some critical things that can kill the mom and the baby. High blood pressure, bleeding issues, and pulmonary embolism,” he said, are among the major complications women can have after childbirth. “When you are disconnected from relationships in the healthcare system, when you don’t have a number to call that someone is going to actually answer on the other end and bring you in, where you have two and three thousand dollar deductibles if you have insurance at all, and showing up at an emergency room can be financially devastating, you have no entryways into the system.”

He also discussed communication between doctors, in his own operating room at Brigham and Women’s Hospital, and beyond.

He talked about checklists — which he said can help doctors avoid simple mistakes, and communicate better with each other to avoid misunderstandings. And he also talked about the importance of coaching. He himself used a “coach” —a former professor of his —to help him become a better surgeon, years into his career.

“It requires a culture of humility,” he said of the coaching approach, which he is piloting among surgeons.

The common theme with both these ideas is that human beings – even brilliant surgeons – are fallible. Sometimes they might forget an important step, or make a mistake, and that’s why they need to work as teams. For a CEO, this could be a refreshingly humble – and collaborative – approach.

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