New Think Tank Aims To Solve End Of Life Issues

In some ways, the name Dr. Atul Gawande chose for his new health care innovation center — Ariadne Labs -- says it all.

"Ariadne is the myth of the Greek goddess who showed Theseus the way out of the labyrinth with a simple thread," Gawande explained. "We’re in the simple-threads business to show our way out of the labyrinth of health care complexity."

Gawande, a surgeon at Brigham and Women's Hospital, has been named one of the world's most influential thinkers. The surgical checklist he promotes has been gaining traction worldwide since 2008, when it's use in a World Health Organization project reduced deaths during surgery by nearly 50 percent. The list is a set of questions everyone in an operating room answers, starting with: Do we have the correct patient? What operation are we performing? And is the site marked?

Now, Gawande is expanding his focus from surgery to two other big health care moments: childbirth and death.

"We think in the course of a person’s life that you will turn to the health system for a few high-risk, high-failure health care moments, and also some of the highest-cost moments in that system," Gawande said. It starts with childbirth and surgery — the average person has seven operations in their lifetime — all the way to the end of life.

"We know that almost 90 percent of patients say they want to die at home, yet less than 50 percent do," Dr. Rachelle Bernacki tells an audience gathered for the first research meeting on end-of-life care at Ariadne Labs' new office.

"Boston can be the Silicon Valley of health care innovations."

Atul Gawande

Bernacki is testing a set of questions that aim to make sure doctors understand the wishes of patients who face a prognosis of death within six months. "We start all conversations with, 'What’s your understanding of where you are with your illness now?'" Bernacki explained. She is analyzing patients' responses to seven questions and training doctors to have these difficult conversations.

Some health care experts who’ve wrestled with the end-of-life issue for years -- like Stuart Altman, who has worked on health care reform at the state and national level for 45 years —  are thrilled to hear Gawande's lab is taking it on.

"Atul Gawande is a true find," Altman said. "There are few people — no, as a matter of fact, I don’t know anybody who really has a better insight into how our system works and where it doesn’t work and how it could be better."

But Gawande knows there are hurdles ahead. His lab is getting off the ground with donations from individuals, the Gates Foundation and some government grants. He has support from Brigham and Women’s and the Harvard School of Public Health. But Gawande isn't certain about long term funding.

In another hurdle, he has to persuade doctors and nurses to buy into his proposed solutions. But he's optimistic.

"Boston is a place where, if we are not leading this, I don’t know who is," Gawande said. He expects to work with major hospitals and medical schools to expand work that other organizations have started, "out of a belief that Boston can be the Silicon Valley of health care innovation."

He says 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.

This program aired on June 19, 2013. The audio for this program is not available.

Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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