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Atul Gawande has been chosen to head the Amazon-JPMorgan Chase-Berkshire Hathaway healthcare partnership. Gawande is a big name, and his appointment has created big headlines. But Gawande is far more than a big name. A close look at the goals of this partnership and at Gawande’s approach to improving the U.S. healthcare delivery system shows that he is a good choice and a real choice for this immense initiative.
Despite the size of Amazon, JPMorgan Chase, and Berkshire Hathaway, their healthcare partnership is an outsider effort. Over the years, large employers have tried in various ways to exert an influence on healthcare costs and delivery, but their influence pales in comparison with that of commercial insurers, government payers, and healthcare provider organizations. The most significant message of the Amazon-JPMorgan Chase-Berkshire Hathaway partnership is that they have collectively lost patience with traditional healthcare players to solve the problems of healthcare cost and quality.
Therefore, it was inevitable—even imperative—that CEOs Jeff Bezos, Jamie Dimon, and Warren Buffett would seek someone from outside the legacy entities of healthcare to lead this initiative. Gawande is a surgeon and an author. He works for a large healthcare system, but he is not a system executive. He publishes research in leading medical journals, but his communication vehicles of choice are The New Yorker, his bestselling books, and Twitter. Gawande, although a worker in the healthcare system, is not part of any established structure of that system. He is an expert, but he is not an insider.
A close corollary of an outsider’s role is what Jeff Bezos calls a “beginner’s mind.” According to Bezos, having a beginner’s mind means having the knowledge of an expert, but an openness to new ideas. At Amazon, Bezos credits this approach with creating “differentiated offerings instead of a me-too offering.” Bezos said that a beginner’s mind would be key to the success of the Amazon-JPMorgan Chase-Berkshire Hathaway healthcare partnership.
This subtle combination of expertise and openness constitutes the very core of Atul Gawande. For his Aug. 13, 2012, article “Big Med” in The New Yorker, Gawande went into the kitchen of a local Cheesecake Factory restaurant to learn how that company combines quality control, cost control, and innovation, and to find lessons for healthcare. For his 2014 book Being Mortal, Gawande interviewed more than 200 people—patients, family members, care providers—about their experiences with end-of-life care. Gawande is a healthcare expert, but he approaches healthcare with a desire to learn, innovate, and think about things differently.
Perhaps most revealing of Gawande’s “beginner’s mind” is his article “Testing, Testing,” in the Dec. 14, 2009, issue of The New Yorker. In that article, Gawande examined how a coordinated effort at small-scale testing, and then building on the lessons learned, helped America solve its agricultural crisis in the early 1900s. Gawande suggested that the same kind of “arduous, messy, and continuous” process of testing and learning—in other words, applying a beginner’s mind—could help America come to grips with the immense problem of healthcare.
The Amazon-JPMorgan Chase-Berkshire Hathaway healthcare partnership may be the most favorable environment we have ever had to test new and unexpected solutions to the incredibly complex challenges of our healthcare system. The essential elements needed are present: a dedicated population, a commitment of funds and time, and expertise in technological innovation.
Having a laboratory to test healthcare changes in the U.S., find the most impactful changes, and then scale those changes is something that gets Atul Gawande up in the morning. And will continue to for many mornings to come.