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Gawande on Cowboys and Pit Crews

Philip Betbeze, for HealthLeaders Media, July 19, 2011

Philip Betbeze is attending the American Hospital Association Leadership Summit in San Diego, where Atul Gawande, MD, spoke Monday.

It's hard to underestimate the pull of an Atul Gawande presentation in healthcare these days. The surgeon, writer and teacher has, over a very short amount of time, become a champion for the difficult work of cutting costs and improving quality—not necessarily in that order—in healthcare. That's why I was not surprised at the packed house when he spoke at the 2011 American Hospital Association Leadership Summit in San Diego Monday.

Gawande's message: We are in a battle for the soul of healthcare. Though he didn't say it in so many words, we're probably in a battle for the soul of the American Dream, and whether people realize it or not, that battle will likely be won or lost on whether we, as a nation, are successful in driving down costs and improving quality in healthcare. After all, much of the partisan battle going on in Congress right now over the national debt ceiling has its roots in the unsustainably high costs of healthcare.

"We cannot afford to have healthcare devour our economy," he said.


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Gawande spent a lot of time talking about using checklists in the operating room, which is not surprising, given that his 2009 book, The Checklist Manifesto, deals with the same subject.

In this struggle, he says, it is fortunate that people who have the most expensive care don't necessarily receive the best care. If that weren't true, our only solution to cutting healthcare costs would be rationing.

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3 comments on "Gawande on Cowboys and Pit Crews"


Dean White (8/2/2011 at 4:04 PM)
Dr Gawande is a star and his books have been insightful and relevant. I agree with his premise about most Cowboys but I would argue that Michael DeBakey, Denton Cooley, Sir William Osler, Ignaz Semmelweis (to name just a few) were all "Cowboys". Where would we be with the innovation and forethought of these pioneers.

Joseph Momia (7/21/2011 at 3:42 PM)
While I agree with Dr. Gawande on many things I believe he left out a crucial reason why health care costs are so high, it's the for-profit nature of the 'business'...if we adopted a Medicare for all system like Canada or any number of systems that work very well in other countries like Japan, Denmark, Switzerland, Germany, etc. all of whom provide better care for 40-50% of the cost in US. But of course in the uS we don't have a health care 'system', instead we have the health care-industrial complex where everybody tries to wring out as many $$$$ for themselves with no regard to the consequences! But the political debate won't allow this because all of our politicians are owned by the corporate whores who run this country, and they just won't use things like 'reason' and 'common sense' to solve the problems! The VA works very well for veterans and Medicare works great for most seniors and we can cover ALL Americans for much lower costs!

Phyllis Kritek, RN, PhD (7/19/2011 at 9:45 AM)
Kudos to Dr. Gawande! He is a bright light in what often appears to be a gathering darkness. I agree that checklists are invaluable. If you read his book, you learn that he discovered checklists from RNs. We understand his message. I look forward to his next tough message: the need for physicians to understand their relationship to pit crews. I have worked for over forty years with the cowboys and I know how they can destroy the good faith efforts of those in the pit crew. He is going to eventually have to tackle this challenge more directly and precisely. When he mentions an "autocratic" system, he is eventually going to have to mention who the autocrats are.