
Surgeon Atul Gawande selected as CEO of new health care company from Amazon - uptown
https://www.statnews.com/2018/06/20/surgeon-atul-gawande-selected-ceo-amazon-partners/
======
entee
Atul Gawande is a brilliant person with interesting ideas on how to make
healthcare more humane and robust. This is still probably a terrible choice of
CEO.

To my knowledge he has never run a large organization or dealt directly with
the complex backend of the healthcare system. The was healthcare is delivered
and paid for is full of independent, semi monopolistic players that have often
conflicting incentives. Oh and lets not forget that we have 50 states and 50
different sets of regulations.

Unless the plan is to create a brand new completely vertically integrated
system, you’re gonna have to deal with the existing infrastructure, and I’d be
much more confident in success if the person leading that effort had
experience there. Having worked with many physicians and insurance companies,
I can say from experience those skill sets are not the same.

Even if the idea is to be vertically integrated, someone like the CEO of the
Mayo Clinic or Kaiser would have been a better choice.

~~~
arkades
>Atul Gawande is a brilliant person with interesting ideas on how to make
healthcare more humane and robust

No, he’s not.

No offense to him, but he’s a -popularizer-. He takes various bits the HC
quality improvement folks have been talking about / doing for years and writes
(very articulate, engaging) articles that make it accessible to the wider
community, including the wider medical community that normally isn’t in on
those discussions. He also has a habit of relating it in a fairly shallow/one
dimensional way, compared to the real deb-

Malcolm Gladwell. He’s Malcolm Gladwell, but for healthcare.

~~~
kahirsch
That's not at all the case.

[http://atulgawande.com/about/](http://atulgawande.com/about/)

Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He
practices general and endocrine surgery at Brigham and Women’s Hospital. He is
Professor in the Department of Health Policy and Management at the Harvard
T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery
at Harvard Medical School. He is also Executive Director of Ariadne Labs, a
joint center for health systems innovation, and Chairman of Lifebox, a
nonprofit organization making surgery safer globally.

[http://atulgawande.com/research/](http://atulgawande.com/research/)

[https://www.ncbi.nlm.nih.gov/pubmed/?term=Gawande%20AA%5BAut...](https://www.ncbi.nlm.nih.gov/pubmed/?term=Gawande%20AA%5BAuthor%5D&cauthor=true&cauthor_uid=29862506)

~~~
leroy_masochist
Fair enough, he's a popularizer _and also_ a top-tier surgeon.

I agree with parent comment -- there is a difference between being the
person/people who came up with brilliant ideas and being the person who
brought them to the masses in a pithy, cogent and engaging manner.

One might even make the argument that the latter task is relatively more
important than the former for people in high-visibility figurehead type
positions such as CEO of a massively ambitious new healthcare venture.

The "Gladwell for healthcare" comparison is a good one, and I say that as
someone who has enjoyed reading Gawande's books.

~~~
bookofjoe
>and also a top-tier surgeon.

The only people who can differentiate between 1)surgeons who are expert in the
O.R. whose patients do well in the long run and 2)those whose reputations
exceed their abilities and results are anesthesiologists. Trust me, I was one
for 38 years, at UCLA, the University of Virginia, and in private hospitals. I
will never forget the time a world-renowned cardiac surgeon at UCLA at the
height of his career — holder of an endowed distinguished chair, first author
of the then most widely acclaimed textbook in the field, whose surgical skills
were so sub-par he was only allowed to operate with a senior cardiac surgeon
as his "first assistant" — was repairing a child's AV septal defect by sewing
on a patch (on full cardiopulmonary bypass) only to be interrupted by his
"first assistant" who quietly told him, "You've got the patch on backwards." I
was standing literally two feet from the two of them, behind the drape.

~~~
prepend
So what’s your point? Should no one try to differentiate good surgeons or bad
unless they are their peer for years?

There’s lots of crappy programmers with good reputations too. But it’s a weird
reply to “he’s a top tier surgeon” that you say it’s unknowable.

I’m sure you’re right, I’m not a surgeon so I have no idea how to evaluate a
good surgeon, but there must be some way to qualify the poor ones from the
great ones.

Your anecdote is a great example of high reputation, low skill. But is that
the only instance. Is it 10%? Are most board certified, practice for 20 years
surgeons good or bad? What’s the actionable intelligence, but it seems like
the conversation ends with “it’s unknowable.”

I am sort of aware of quality measurement, but not a healthcare practitioner,
but I’ve noticed this comment from lots of docs that the only way to know if
medicine is good or bad is to have a doctor review it.

------
glenscott1
I can thoroughly recommend reading Atul Gawande's "Checklist Manifesto". The
premise, on the face of it, is mundane, but the stories that back up the
claims are thoroughly enjoyable to read. [http://atulgawande.com/book/the-
checklist-manifesto/](http://atulgawande.com/book/the-checklist-manifesto/)

~~~
Tomte
The book is good, but the article it‘s based on is better, because there‘s
simply not enough material for a whole book, so it feels a bit forced.

[https://www.newyorker.com/magazine/2007/12/10/the-
checklist](https://www.newyorker.com/magazine/2007/12/10/the-checklist)

~~~
sotojuan
I wish every self help book had an article like this for it.

------
JoshTko
This is the type of topic where I feel that HN community tends to not provide
valuable insight as it's outside of the community's collective expertise. How
many individuals here have hired SVP+ level employees and how would that
compare to the collective experience of Bezos, Buffet, and Dimon?

~~~
creaghpatr
Bezos, Buffet, and Dimon are unfortunately not available today to discuss this
topic in the HN forum so you're stuck debating the pros and cons with us
[fellow?] peasants, sorry.

~~~
codeisawesome
Off topic sorry, but this is such a British response. Funny.

------
projectramo
When I read the checklist manifesto I thought it was going to change my life.
It didn't because I didn't put it into effect.

Then I thought it would be great if software did the work for me, including
communal checklists that people can share with me. (Got a new car, here is a
checklist template. Got a new house? Here is the checklist template? Is it an
investment property, use this checklist. Oh, that is good for Florida, but in
Texas, use this one.)

I found some software that is sort of close but nothing quite there.

Edit: Atul Gawande wrote the book so it is sort of tangentially related. I
could make it more relevant by explaining how his checklists make him a
general purpose leader or something, but I can't bring myself to do it.

~~~
acangiano
Have you tried Process Street?

~~~
projectramo
Just looked it up. It looks interesting for a company that wants to run a
process.

I was thinking more for individuals, and note that the key is having people
remember things you may not. For example, if the list has something like check
your roof for leaks if its been 15 years or something you may not think of.

~~~
acangiano
It's also something I always wanted after reading that book.

------
JacobDotVI
If you want to learn a little more about how Atul Gawande looks at the
healthcare system read Being Mortal. IMHO it's more relevant than Checklist
Manifesto, esp. wrt what Amazon could do here: [https://www.amazon.com/Being-
Mortal-Medicine-What-Matters/dp...](https://www.amazon.com/Being-Mortal-
Medicine-What-
Matters/dp/1250076226/ref=sr_1_1?s=books&ie=UTF8&qid=1529507999&sr=1-1&keywords=atoll+gawande+being+mortal)

While Checklist Manifesto is about operational efficiency and quality, Being
Mortal is about asking if we're doing the right things in the first place.

------
collinf
Literally just listened to his podcast he did with Freakonomics Radio
yesterday. Definitely a great mind.

For all of you developers/operations folks out there, I recommend reading his
book The Checklist Manifesto. Every team can learn so much from that book
about their everyday practices. We read it at our company book club, and began
taking checklists and documentation much more seriously which I attribute too
much better productivity, operations and less siloed dev.

~~~
schnevets
I was just about to mention that podcast episode! He clearly has a good,
realistic grasp of what can be done to improve healthcare outside of the
political mudpit. I was skeptical when this company was announced, but I am
now extremely optimistic.

[http://freakonomics.com/podcast/atul-
gawande/](http://freakonomics.com/podcast/atul-gawande/)

------
tbg7504
BWH culture is crumbling so I won't blame him for seeking other opportunities.
However, this is an odd/weak selection where I believe Amazon-Berkshire-Chase
will regret. Toby Crosgrove, former Cleveland Clinic CEO, would have been a
well-qualified candidate and better choice. He has over 10+ years of leading a
highly complex AMC and elevating the organization into the top 3 hospitals in
the country for many consecutive years. This man can get things done via
transformative, sustainable, and systematic changes. Alternatively, the CEO of
Iora Health would have been a good choice too. Let's pause and compare
performaces and outcome of between Cleveland Clinic under Crosgrove and Iora
Health under their leader, and Adrianes lab under Atul. The result is clear.
Atul doesn't have the experience only the Harvard brand. Being a CEO is
different from being a professor, surgeon, philosopher, or executive director
at the Adrianes Lab. In those roles and physician-led environment where MDs
are treated like kings, the medical directors can put in 5-10% of their time
with the expertise of administrators, interns, staffs and get away with having
the breadth but little depth and claiming to be a SME. Atul seems like a good
storyteller and highly intelligent physician, but he is absolutely an
individual contributor. Frankly, Boston is full of highly intelligent and
innovative people like Atul; the CEO of this venture should have more
experience or at least specializes in one of the three verticals. Atul would
have been a better executive advisor.

Concerns: \- He stated not wanting to give up his privileges of practicing at
BWH and professorship at Harvard meaning he can't be fully committed to
leading this new organization. This is not an academic medical center
environment where a physician can have multiple administrative titles and not
put in the hours and work. \- Atul's fame is credited to his publication, but
also from the prestige of Harvard's affiliations. He knows this and is trying
to strategic about not giving that up, but I would hope he realize that truly
effective leaders know they can't do everything. Most of those innovator
physicians stretch themselves too thin and get their hands into too many pots,
making them ineffective. If he's serious, then he needs to commit and
prioritize.

IMO, extreme network/lip service must have been invloved in his pursuit or the
new venture and company is only buying his fame, reputation, and brand for
marketing purposes.

~~~
xxpor
Didn't Cosgrove retire? Why would he be interested?

~~~
tbg7504
Yes, he recently retired. I don't know if he would be interested but only
meant to use it as an example of other well-qualified physicians leaders.

Full disclosure: I've worked in healthcare for prestigious AMCs, but have zero
affiliation with Cleveland Clinic or Iora Health.

------
aaavl2821
This is the kind of healthcare CEO most health tech startups should have --
someone who lives and breathes the system, intimately knows it's flaws but
still has the vision and desire to change it. That is the rare and valuable
skill in healthcare -- even more rare than engineering or operations skill

Rushika Fernandopulle, the healthcare CEO I most admire, fits this profile

------
Thriptic
I love Gawande; he's an amazing author and very thoughtful, systematic
physician. That being said, to my knowledge he has never actually run anything
before or operated on the back end of healthcare, so it seems like sort of a
strange choice for an org this size and of this type.

Additionally, his (publicly stated) thinking seems to primarily revolve around
systematizing routine practice to reliably increase outcomes for the majority
of patients (ie what he espouses in Checklist Manifesto). While this is
certainly important, routine patients are not responsible for most health care
spend, edge case patients are. A tiny minority of very sick people account for
a majority of health care spend, so I would argue that cost recovery should
center around creative management of these patients rather than more
systematic management of routine care, and the org should really be led by
someone whose thinking centers on that.

~~~
tonyedgecombe
To be fair the people running existing health care organisations are all
experienced at creating the sort of company they want to avoid.

------
refurb
It's interesting reading the comments here. People with no background (I
assume) in healthcare describe the guy as "brilliant" and "the perfect
choice".

People with years of experience in healthcare question think he's a poor pick
and just a famous name.

It's amazing what a good public relations strategy can do for someone!

~~~
karl11
People with years of experience in healthcare are invested in the status quo.

~~~
refurb
That’s Silicon Valley speak. People with actual experience on how something
works and have practical ideas on how to make it better as passed over by
people with better PR agencies.

------
sp332
"The new company will be based in Boston."

Just wondering if there's a big regulatory benefit to being in Massachusetts.

~~~
aaavl2821
Atul gawande is based there and the Boston area is actually ahead of the Bay
Area in terms of biotech startup scene and similar if not better in terms of
healthcare services

------
nelsonic
_Such Great Choice_! Atul Gawande is the definition of integrity. On this
basis alone I would subscribe as a individual or company co-founder. Bravo!

------
jaredhansen
Tyler Cowen's conversation with Mr Gawande[1] was well worth the time. I don't
know enough about him or the new company's plans to speculate on how this will
all work out (although: neither does anyone else in this thread), but he's
clearly a highly intelligent and thoughtful person with deep domain expertise.
I certainly wouldn't bet against.

[1] [https://medium.com/conversations-with-tyler/atul-gawande-
che...](https://medium.com/conversations-with-tyler/atul-gawande-checklist-
books-tyler-cowen-d8268b8dfe53)

------
baus
This gives me hope for the US health care system. Gawande’s ‘Being Mortal’
really helped me understand what was happening when my dad was dying. Highly
recommend it

------
tootie
He's written a lot for the New Yorker is very intelligent and thoughtful. No
idea how he'll adjust to being an executive of a corporation, but I think that
is a risk worth taking. It sends a message that they will be patient-first and
strongly evidence-based.

[https://www.newyorker.com/contributors/atul-
gawande](https://www.newyorker.com/contributors/atul-gawande)

------
mFixman
I've read most of Atul Gawande's books about the medical industry (Better,
Complications, and The Checklist Manifesto) and I found the three of them
extremely relevant to my career as a computer scientist. The latter book is by
far his most famous, but IMHO the other two are much better.

This is a bold choice by Amazon, but it seems like a good idea even if it's
just for name recognition.

------
ocdtrekkie
I don't know how to fix this title, but it reads at a glance as either: Atul
Gawande is going to be the CEO of Amazon, or that "Amazon" is the name of a
Berkshire healthcare company.

EDIT: Thanks to the mods for the title fix, this is much better.

------
conorh
He seems like a very smart guy and an excellent communicator - I wonder if
he'll be able to step up and make this role work. I will be rooting for him
because the industry needs some players with deep pockets to step in and
innovate.

On a side note I find it funny in a sort of inside baseball way that his
description of an operation that he does, that he describes in detail and
holds up as an example, drives my surgeon wife up the wall because it is not
great (she does a lot more of them).

------
yanslookup
Curious, what are the n-order effects of large corporations reducing the cost
of providing health insurance for their employees? My wages won't go up
(probably), their profits will go up but I'm sure many other things happen in
the middle. How will this affect taxes at the fed, state, local level? Will
one level see an increase/decrease in taxes collected? etc.

------
momentmaker
Had a conversation with someone that had a speculation that the recent
departure of Jonathan Bush of athenahealth because of Elliot Management might
get him appointed to this CEO position but I guess that didn't happen.

------
40acres
Solid choice. He's a brilliant guy and obviously has deep knowledge of current
flaws in out system.

~~~
slantedview
Fragmentation - such as the creation of this company - is the primary flaw in
the system. His leading that company stands in opposition to the ability to
fix healthcare.

~~~
aaavl2821
This is a separate debate, but id argue that consolidation, not fragmentation,
is the current primary flaw in the system

It's a zero sum consolidation arms race between payers and providers with
patients and physicians as pawns

------
amarant
this title could be improved, at first glance it seems to imply he will be CEO
of Amazon AND some healthcare company from Berkshire. that's not the case.

------
toufique
Great choice.

------
slantedview
Imagine if these three companies used their political clout to push for single
payer instead of setting up yet another insurance company.

~~~
decebalus1
If you're asking yourself why you're getting downvoted, it's because you
committed blasphemy by saying s * * * * p * * * * in the USA.

~~~
exolymph
I disagree — lots of HN denizens support a single-payer model. What's silly is
thinking that Amazon et al could trivially push it through within a reasonable
timeframe.

------
ggg9990
Ouch. This is an incredible man who is a bad choice of CEO. CEO is
fundamentally an execution-oriented, anti-creative role. Bezos know this and
it implies that

1) He’s going to CEO this himself 2) He wants this intiative to fail

~~~
mkull
I think you are confusing CEO with COO.

CEO typically is providing vision, mission & strategic direction while the
executive team he builds is more execution oriented.

~~~
ggg9990
Nah, the COO can’t really say “no” the way the CEO can to all the execs and
their pet projects for their personal agenda.

~~~
twblalock
Sure he can, if people know the CEO backs his decisions.

