June 24, 2013 — For the past few years, Atul Gawande, professor in the Department of Health Policy and Management at Harvard School of Public Health and a surgeon at Brigham and Women’s Hospital, has led a small community of researchers working on simple, scalable ways to make health care better — including a checklist for surgical teams that has dramatically reduced complications and deaths at more than 4,000 hospitals around the world. Last fall, Gawande and his team launched a new center to house their efforts, Ariadne Labs, a collaboration between Brigham and Women’s Hospital and Harvard School of Public Health. On June 18, 2013, the center held an open house in its new space, located in the Landmark Center in Boston’s Fenway neighborhood.
The center’s aims are reflected in its name, Gawande told WBUR during the June event. “Ariadne is the Greek goddess who showed Theseus the way out of the labyrinth with a simple thread. And we’re in the simple threads business. To show there are ways out of the labyrinth of health care complexity,” Gawande said.
In addition to the safe surgery checklist, the researchers are continuing to expand their work in improving care during childbirth and at the end of life, and exploring ways to transform other complex and costly health care domains such as cancer care and primary care.
The safe surgery checklist, developed in collaboration with the World Health Organization in 2008, has become recognized as the global standard of care. The simple act of a surgical team stopping to answer a set of 19 questions such as “Do we have the right patient?” and “What operation are we performing?” has been proven to reduce deaths by more than 40% and complications by one third.
Gawande and his colleagues have applied a similar approach to the safe childbirth checklist. A pilot study conducted in a South India childbirth center found that the checklist program dramatically improved health workers’ adherence to 29 essential clinical practices such as rates of appropriate hand hygiene during the first vaginal exam (from 1% to 98%) and rate of use of a sterile blade to cut the umbilical cord (from 12% to 99%).The team is launching a randomized trial to test the checklist in 120 rural and urban hospitals in India, and is working with four other countries to launch population-wide implementation and evaluation programs of the checklist.
The center’s latest effort is a seven-question checklist to guide doctors through difficult conversations with their dying patients, which is now in a trial study. The questions assess the patients’ understanding of their illness, their fears and worries, and their desires and priorities during the end of their life. Many doctors find it difficult to discuss end of life issues with terminally ill patients, but research has shown that these conversations improve the likelihood that a patient will die at home or in hospice rather than in an intensive care unit, and may even prolong a patient’s life, according to Susan Block, an oncologist at Dana-Farber Cancer Institute and the project’s senior researcher.
Gawande told WBUR that the theme in all his work, whether it’s health care policy, surgery, or writing for the New Yorker, is finding simple solutions for messy problems. He expects to continue working with the area’s hospitals and medical schools to develop solutions. “It is out of a belief that Boston can be the Silicon Valley of health care innovation,” he said.
— Amy Roeder
Photo: Aubrey Calo
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