17 ms·

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

• pinewurst 8y ago
  He's certainly a mismatch for the likes of Amazon and I'll bet won't have a long tenure. Reading about their worker healthcare ("AmCare"), one pictures a rusty tin of stained bandages. And a permanent mark on one's employee record if the tin is opened.
• baus 8y ago
  I’d say hire that person as the COO. This will be a big organization. I think the person at the top needs to have a strong ideals about the direction of the organization
  • rattray 8y ago
    Agreed – there's so much complexity that wrangling it is it's own effort, worthy of delegation to a supremely skilled and experienced operator. If _all_ this company did was wrangle the complexity of the healthcare system, however, they wouldn't be a step function better than anything else. For the deeper, more radical changes, you need a visionary at the helm. Of course, Atul will need to be able to effectively recruit & work with a stellar team to fill the gaps you mention.
  • EpicEng 8y ago
    Healthcare/biotech companies typically have a CMO position (chief medical officer) which carries a lot of weight. I'm surprised that's not the way they went with a surgeon.
    • sulam 8y ago
      They probably offered that to him.
    • Thriptic 8y ago
      In an insurance context a CMO would be someone orchestrating coverage policy rather than serving in an advisory capacity iirc. It's a different role for the title.
      • EpicEng 8y ago
        Yeah that's fair. To be perfectly honest, everything being equal, I'll defer to Bezos and the like in choosing people for high level management positions.
    • entee 8y ago
      I agree, this is exactly where I’d have hired him. He’s be perfect as the soul and conscience of this company.
  • sonnyblarney 8y ago
    The CEO cannot be a figurehead. I really agree with the top commenter and am totally flumoxed as to how Buffet et. al. can back this. Not only is this going to require 'CEO abilities' - it's also kind of a 'mega corporate startup' - which is another thing very difficult to achieve. Amazon is ruthlessly operational, by the numbers etc. - this will collide with medical bureaucracy pretty hard ... it's almost as though you want an outsider ... Or, to buy a small company or two and combine them, a small team with the 'right chops' and then back them with scale, financing etc..
• blinkingled 8y ago
  Fair point but Atul strikes to me as a problem solver kind of person. He has obviously got the intellect and precedent in that area. What I also think is this is _the_ job that will benefit greatly from a guy who has a fresh outlook not sullied by existing ways of doing things. As another person said below, they could easily hire a COO to deal with existing aspects of the system and still have the overall direction in the hands of someone like Atul.
  • entee 8y ago
    That certainly makes some sense, but in that case maybe someone who has run a big organization, or built a product would be helpful. I look around and see very few successful startups that were successful on the vision of the CEO alone. So much of success comes from being able to break down walls and get things to work together that didn’t before. Maybe he can do it, but that’s really hard to do. I’d prefer betting on someone who has demonstrated that ability. Put another way it’s like giving $100M seed round to a visionary but completely unproven founder when the company is not even at garage stage. Might work out, but seems quite a bit more likely to fail than $100M given to someone who had done something like it before.
    • blinkingled 8y ago
      That's the traditional way of thinking and it might work well for traditional companies - but something as disruptive as this - I would vote for the visionary/thinker any day over the dyed in the wool, set in his ways guy. Jobs/Sculley and later Tim Cook situation comes to mind - Sculley had the whole CEO experience but look how that turned out and look at how Tim Cook took over operations part which Jobs had no interest or knowledge of and made it work so well. If they had Tim Cook as the CEO pre-iphone days - I am not sure if we would have seen the iPhone.
      • tbg7504 8y ago
        Great comparison, but other than articles what kind of products or scalable accomplishments has Atul Gawande achieved in healthcare that is comparable to the impact of the iPhone?
• ryanmarsh 8y ago
  Came here to say this. This is the equivalent of promoting your best developer into management. Atul is a smart hard working guy. I’m sure he’ll work hard and do ok, but on the face of it he’s a silly choice.
• aaavl2821 8y ago
  from my experience, getting these senior insiders to lead a newco would just result in more incremental innovation. Most of them came up in and benefited from the current broken system and are either too conservative to embrace drastic change or don't want to rock the boat. I don't think something like Kaiser could be easily rebuilt from scratch, but I don't know too much about the Mayo Clinic except for its reputation for clinical excellence and their active investments in innovation. Have they implemented new models to meaningfully lower cost of care? I also imagine Atul gawande has enough experience with the existing system to know what ideas have a chance of working vs running into a brick wall of conflicting incentives. He can hire somebody to lead negotiations with insurance companies and providers, etc
  • maxxxxx 8y ago
    "from my experience, getting these senior insiders to lead a newco would just result in more incremental innovation. Most of them came up in and benefited from the current broken system and are either too conservative to embrace drastic change or don't want to rock the boat. " Exactly. Reminds me of some parts of the IT department in my company. I don't trust anybody who has worked there for a few years because any reasonable person would have left or lost his mind. They certainly will not be innovators.
• sandworm101 8y ago
  His ideas aren't that impressive. All of his language still talks of "delivery" of health care. It's like listening to someone talk of new ways to deliver pizza. Your new delivery method may be revolutionary, but delivery is only a small part of the business. You are still delivering the same pizza. You aren't questioning whether the pizza is helping the people eating it, or whether it should be delivered in the first place. My hope lies with those who question the product, not the delivery methodology. The US needs to rethink health care, not how they provide or pay for it. They needs to rethink how many prescriptions they shovel into the population. They need to rethink how they pigeonhole patients. They need to get people exercising. Those changes aren't going to come from anyone still talking about "how we deliver health care".
  • blinkingled 8y ago
    > [...] rethink how many prescriptions they shovel into the population. They need to rethink how they pigeonhole patients. They need to get people exercising. Those changes aren't going to come from anyone still talking about "how we deliver health care". If you went to investors and used that as a pitch you'd be laughed out quick. Need to get people exercising? That's exactly the sort of unrealistic target that you don't want to have if you're going to run a company. Instead focusing on what could be realistically improved and doing that - which delivery inefficiencies are certainly a part of - that sounds like the most reasonable way to deal with something as big of a cluster f* the healthcare system in the US is.
    • sandworm101 8y ago
      >> to get people exercising? That's exactly the sort of unrealistic target that you don't want to have if you're going to run a company. Funny. Morning exercises were are part of Japanese corporate culture for a generation. In many European countries employers are expected to support employee fitness goals. My job (military) mandates that we all be given five one-hour periods each week to exercise. Not weekends, during the work day. It is totally normal for someone to go from meeting to the gym and back again during the day. Our civilian employees participate in this too, although they aren't tested. I think it totally reasonable for any large company to make exercise part of their corporate culture, particularly in the US where employers are so involved in health care. Anyone laughing such ideas out of the room needs to broaden their horizons.
• maxxxxx 8y ago
  Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a good communicator. Even if he fails, nothing is lost because the system can't get worse.
  • jonlucc 8y ago
    This is exactly the same logic I heard used by many people voting for Trump. The truth is that there usually is a real downside from failure, even if it feels like our huge systems are as bad as they can get. In other words, while we do have an expensive system with worse outcomes than peer nations, at least right now we have healthcare being delivered at a first-world level, and we shouldn't take that for granted.
    • where_do_i_live 8y ago
      Well... uhh... this guy is not in charge of everyone's healthcare - he's in charge of a rather small group of companies instead. The consequences of failure here are not exactly analogous to your example. 330 million people are not going to impacted by whatever is considered a failure here.
      • jonlucc 8y ago
        For now, but if I remember correctly, the goal is for these companies to offer this as their employees' health plans before expanding more broadly. For those people (and there are somewhere around a million customers between the companies), this could be worse than not being offered insurance.
        • adventured 8y ago
          They have no publicly stated goal to expand more broadly. That's nothing more than media speculation and or wishful thinking. Buffett has repeatedly said this is not an entity that is meant to offer services beyond the scope of the three companies or similar. They plan to share what they learn, and Buffett has said he hopes that can help other companies and the wider healthcare system. Here's probably the best talk he has given on the subject (13 minutes long, from a few months ago): https://www.youtube.com/watch?v=F4fuVC6zCJI https://www.youtube.com/watch?v=F4fuVC6zCJI
• deleted 8y ago
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• mattnewton 8y ago
  Bezos has a reputation as a micromanager- I am sure between him and a COO there will be training wheels long enough for the company to reach maturity.
• arkades 8y ago
  >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 8y ago
    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%5BAuthor%5D&cauthor=true&cauthor_uid=29862506 https://www.ncbi.nlm.nih.gov/pubmed/?term=Gawande%20AA%5BAut...
    • arkades 8y ago
      Oh, I know he’s a surgeon. He and I have very similar backgrounds, save that I spent a decade in hc QI and Health insurance mgmt before going to medical school, rather than picking it up subsequently. I point that out so you fully understand that when I say a doctor:healthcare QI as a bees:entomologist, I say that from both sides of the fence. It gives you some more insight in your little slice, but that’s it. And it’s just your little slice: I am not a surgeon, so I know jack shit about their operational processes. I do know from a recent kerfuffle in my hospital that even the surgeons don’t know much about how the OR department books rooms and schedules procedures. They certainly don’t have insight into the parts of the hospital that -aren’t- a core part of their job. Being a physician is an important window into how hc systems and organizations work, but it’s a tiny one. It doesn’t qualify one for hc QI by itself. As to his cv, by all means, check out where he’s first author, where he’s “contributing guy with a name” (second to last), how many of them are editorials or round tables, how many of them are endocrine surgery, etc. Actual first author, non editorial healthcare ops papers are thin on the ground. This feels like nitpicking. The guy is intelligent and accomplished, beyond question. But what he -isn’t- is a hc innovator just because he -writes- about the hc system and innovations therein. I’ve never seen him write on a topic that wasn’t already hot shit in the field for two decades; I’ve never seen him present the pile of conflicting data for his preferred solutions (eg, the Checklist Manifesto chose to elide how many hospitals implemented checklists to no improvement, despite plenty of the results being published before his book.)
• karl11 8y ago
  I would argue that you should give Jeff Bezos, Warren Buffett and Jamie Dimon more credit.
• desireco42 8y ago
  He will have great C suite of people to support him. He is compassionate, smart, good communicator, he will be fine as CEO and great choice for Amazon and others.
• qaq 8y ago
  I know appeal to authority is obviously a bad way to support an argument, but I would imagine one thing the most senior people at Amazon, Berkshire Hathaway and JPM are fairly decent @ is picking management talent. So if all 3 sides agreed on a pick I would imaging there was pretty compelling case.
  • killjoywashere 8y ago
    I took a short walk down this idea of a vertically integrated system, essentially building the system as a research lab (something like NIH building 10), including approaching some senior people. I sort of wonder if maybe they modified their expectations for the venture after a search revealed that experienced CEOs weren't interested. You have to address questions like "Where are you going to get physicians? Nurses? Ancillary staff of all kinds?" The real estate and financial models are trivial by comparison.
    • aaavl2821 8y ago
      I've also done some work trying to get people to implement different models of care outside of the traditional institutions, and getting physicians on board is just a big hurdle. As a group they are pretty conservative and risk averse, hugely busy, and there aren't a lot of places where they congregate, online or otherwise, so outreach is a bit of hand to hand combat. I have an untested hypothesis that one of the best ways to get physician mindshare is actually through think pieces in publications like the new yorker or new york times -- just the kind of articles Atul Gawande writes. The physicians that I know read these articles much more actively than they use linked in (most dont) or any other online community
      • entee 8y ago
        Another (darker) perspective: they don’t want to lose money. Healthcare in the US is expensive in no small part because we pay more for things (duh). One of those things is physician time. Primary care physicians in the US make $60K more a year than comparable nations [1]. Dirty secret of healthcare: “efficiency” translates to “I make less money” for almost everyone in the system, very much including doctors. All will protest and justify their cost, all will make good arguments in the individual case. In the aggregate though, we pay people too much (among many many other issues). [1] https://jamanetwork.com/journals/jama/article-abstract/2674671 https://jamanetwork.com/journals/jama/article-abstract/26746...
• Karishma1234 8y ago
  I would have agreed with you if Amazon wanted to build a clone of Mayo Clinic or Kaiser Medical. But they explicitly said they do not want just another medical company but something that is more radical. Atul might be the Trump like shock that the establishment of medical sector needs. Of course at the end of the day CEO appointments are gambles and I see this as one too.
• tssva 8y ago
  For months the word from the rumor mill has been they have been struggling to find someone willing to take the job. The ill defined mission of the organization along with perceived potential conflicts in priorities among the 3 companies has made candidates hesistent.
• debt 8y ago
  "Unless the plan is to create a brand new completely vertically integrated system" Judging by the companies involved, this is most likely the plan. Whatever they create will like cause the existing system change to it and not the other way around.
• southern_cross 8y ago
  Dunno about this guy, but having once worked under one of the other potential CEOs who was on their short list, I can safely say that he probably would have been a much worse choice!