Atul Gawande

Boston Physician Atul Gawande wrote The Checklist Manifesto in 2009  stressing that medicine should adopt “pilot’s checklists” to ensure that operating room teams are “ready for takeoff” before a scapel is ever opened. BIDMC implemented The Checklist Manifesto ideas in software in 2010. Here’s the “Time Out” done among all OR team members before a case beings - it includes a list of staff participating in the timeout, the agreed upon procedure, the verification of consent, appropriately marked operative site, patient identity verification, and best practices for prophylaxis...

Health care needs a better business model. HHS reports that U.S. health care spending will surpass $10,000 per person this year, will grow almost 6% annually for the foreseeable future, and will consume over 20% of GDP by 2025.  About half of our spending goes for labor costs, with health care employment remaining one of the "bright spots" in our economy.  Indeed, health care jobs continued to soar even when the economy tanked in our most recent recession. Despite that steady growth, we continue to talk about a physician shortage, especially for primary care.  Medical school enrollment is at new highs, yet it is not projected to dent the demand...

Health care fraud is bad.  Everyone agrees about that (except those who profit by it).  We'd similarly agree it is all too pervasive.  Just in the past few days racketeering charges have been brought against former executives of Insys Theraputics, numerous charges brought against leaders of Forest Park Medical Center (Dallas), 18 people in Pittsburgh were charged in a prescription fraud scheme, a New Jersey chiropractor was arrested for health fraud, and the feds settled a $4.5 million fraud case against a Florida orthopedic clinic. The list goes on and on, week after week, in every state, for every type of medical specialty, and against most health insurers.  Some estimate that fraud could account for up to 10% of health care spending.  But that's chump change: estimates are that other kinds of wasteful spending, such as unnecessary care and excessive administrative costs, are easily double that...