> I don’t think his ideas are shallow or one dimensional, but I havent read all of his work.
You wouldn’t. He adds depth through humanity, while eliding the pile of data that contradicts his points - data you have no reason to notice is missing. While the hc QI community was getting over checklists because of the number of studies showing it to be a largely ineffective intervention, he ignored the pile and kicked off a second wave. That’s not really visible to the lay reader.
>I'd certainly push back against the comparison to Malcolm Gladwell -- atul gawande is a practicing surgeon and professor at one of the most well respected hospitals in the world. If Malcolm Gladwell wrote about the 10,000 hour rule from his personal experience becoming, say, a chess grand master through 10,000 hours of practice, then the comparison would be more apt.
AG does not write about healthcare QI from the perspective of someone that works in ops or hc QI. It’s a real profession, and one he hasn’t practiced.
He writes about macroeconomics and corporate management (and if that seems wildly dissimilar to you, you have some appreciation of how far afield he pokes his nose) from the perspective of the factory worker. And when he at least stuck to his area of medical expertise, at least he had some subject matter expertise to inform his perspective. He’s expanded outward from there, with neither academic nor medical expertise on the topic. There’s nothing terrible about that, but he’s -not- 10k hr guy writing about 10k hrs. He’s a guy with a passion, who has read up a bunch on topics he’s passionate about, and written about them well. They have some small overlap with his profession (diagnosing endocrine disorders; cutting out thyroids, Not reorganizing hc delivery processes), which adds some insight. Yeah, he’s slightly better than MG, but not by an awful lot.
Those are good points. I am not familiar with the research on checklists as a QI tool so will take your word for it. However I think his articles on the "cost conundrum" and "hot spotters" are pretty insightful and his analysis is accurate and at least among the HC admins / professionals I know the insights are respected. I don't think that he's right that frequent fliers are the cause of the USs high cost of healthcare but his analysis is reasonable
I don't mean to offend if you work in HC ops or QI, but I'd rather have someone take a macroeconomic perspective than an ops perspective when looking for solutions to high HC cost. I'm aware of the HC QI field and know a few ppl who work in that space and I know how hard it is to move the needle with that work. You are fighting against a system that in many ways is not incentivized to work with you. I know there's been a lot of great work done in HC QI but frankly it hasn't moved the needle on cost of care. I think it's time to look at changing the broader system to allow all the good HC QI ideas to actually get implemented broadly
I hear your point about intellectual overreach. However many people call it another thing, but with a positive connotation: the "beginners mind". That in fact is one of the 3 criteria bezos had for the CEO. That mindset facilitates learning, growth, risk taking and innovation. Yes you'll make mistakes but that's part of the plan. The experts who never step beyond their area of expertise won't be as successful because healthcare is too interdisciplinary to have leaders who won't reach out intellectually to people from other fields, and too broken for incremental improvements to turn the tide
> While the hc QI community was getting over checklists because of the number of studies showing it to be a largely ineffective intervention, he ignored the pile and kicked off a second wave
It seems like there are problems getting people to agree to do checklists or keep with them, but if you come up with the right checklist and get the right buy-in, you do see fewer complications.
> but if you come up with the right checklist and get the right buy-in, you do see fewer complications.
Bingo.
What the state of the research shows is that you have an active QI-focused culture and buy-in, checklists work over the medium long term, but not better than anything else. If you don’t have those things, the checklists do nothing after 3-6 months (a lot of studies hide this by rolling up the study period, but everyone in the field knows how rapidly the effect decays). I haven’t seen any meaningful data on them >2 years out, but let’s let that slide, out of pragmatism.
What that suggests is that checklists are irrelevant to this discussion. It’s just a lot harder to sell something as vague and nebulous as “creating a safety-focused and quality-driven culture” than it is to sell “checklists!”.
You wouldn’t. He adds depth through humanity, while eliding the pile of data that contradicts his points - data you have no reason to notice is missing. While the hc QI community was getting over checklists because of the number of studies showing it to be a largely ineffective intervention, he ignored the pile and kicked off a second wave. That’s not really visible to the lay reader.
>I'd certainly push back against the comparison to Malcolm Gladwell -- atul gawande is a practicing surgeon and professor at one of the most well respected hospitals in the world. If Malcolm Gladwell wrote about the 10,000 hour rule from his personal experience becoming, say, a chess grand master through 10,000 hours of practice, then the comparison would be more apt.
AG does not write about healthcare QI from the perspective of someone that works in ops or hc QI. It’s a real profession, and one he hasn’t practiced.
He writes about macroeconomics and corporate management (and if that seems wildly dissimilar to you, you have some appreciation of how far afield he pokes his nose) from the perspective of the factory worker. And when he at least stuck to his area of medical expertise, at least he had some subject matter expertise to inform his perspective. He’s expanded outward from there, with neither academic nor medical expertise on the topic. There’s nothing terrible about that, but he’s -not- 10k hr guy writing about 10k hrs. He’s a guy with a passion, who has read up a bunch on topics he’s passionate about, and written about them well. They have some small overlap with his profession (diagnosing endocrine disorders; cutting out thyroids, Not reorganizing hc delivery processes), which adds some insight. Yeah, he’s slightly better than MG, but not by an awful lot.