Technology is not the main force driving healthcare improvements. At least that's what surgeon, writer and researcher Atul Gawande, MD, told Robert Wachter, MD, the associate chairman of the department of medicine at University of California, San Francisco, in an interview published by Quartz.
"The most fundamental, most valuable, most critical innovations have nothing to do with technology. They have to do with asking some very simple, very basic questions that we never ask," Dr. Gawande told Dr. Wachter. These include questions about patient goals as they near the end of their lives, or the question of whether a physician washed his or her hands.
Asking these questions, and learning from the answers, helps healthcare providers stay attuned to the core values of medicine. Instead of technology, Dr. Gawande believes ideas and values are what truly drive healthcare leadership to make changes. Even ideas that do not seem viable, but seem important, will bring about change because they will challenge the healthcare paradigm, according to Dr. Gawande. "Over and over again, it's the pattern I see — a powerful idea creates a momentum of its own," he said, referencing hospitalists, anesthesia and Dr. Paul Farmer, who brought HIV treatments to patients in Haiti, as examples of when ideas helped change the healthcare paradigm.
For instance, advancements in anesthesia once required a substantial redesign of the care delivery process. "You had to double the number of people working in operating rooms at a time when the United States had a lower GDP than China does today," he said. "'We've got a better way of doing surgery. Oh, and it will involve doubling the number of physicians you have providing the care?' Is that a great model? It was dismissed as totally non-viable — can't work. But it didn't matter. It was too important, and it became the driver of leadership change, rather than the other way around."
Now it is difficult to imagine doing it any other way. Dr. Gawande noted the change in the acceptable levels of patient pain between now and when he first started as a surgical resident."[Patient care is better] fundamentally because of values, more than technology. I think we've changed our values over time — that patient suffering matters."
That said, Dr. Gawande does see an opportunity to leverage one aspect of technology to improve care. That opportunity is data. The first part of great performance is asking those simple but hard-to-come by questions. The second step? "Once we've recognized the recipe for really great performance, the second thing we've discovered is that our most important resource for improving the ability of teams to follow through on those really critical things is data. Information is our most valuable resource, yet we treat it like a byproduct," he told Dr. Wachter.
As we begin to realize the diversity of genomic variables and external causes of disease, Dr. Gawande says, medicine becomes increasingly personal. The more personal medicine becomes, the more it difficult it becomes to use trends from data to improve health outcomes for populations. It may seem too blunt an instrument. However, Dr. Gawande, says data is still a critical tool.
"The danger is that [healthcare] becomes actually increasingly data-free; that every single person becomes a case of one. That becomes impossible to learn from. Period."
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