Dr. Atul Gawande: Personal Connections Drive Innovations' Spread

Human connection — speaking with individuals one-on-one — is often the difference between an innovation becoming widely adopted quickly and one making little headway, according to an article by Atul Gawande, MD, in The New Yorker.

In "Slow Ideas," Dr. Gawande, a surgeon at Brigham and Women's Hospital in Boston and a healthcare writer, compares different approaches to trying to instill new norms in a community:

1. "Please do X." Asking someone to do a certain practice, such as in the classroom and public-service campaigns, is successful "only up to a point," he wrote.

2. "You must do X." While punishment can motivate people to do the correct behavior, it can also turn them off to the behavior completely, leading to people quitting.

3. Offering incentives. Although this approach can be successful, it requires careful tracking of outcomes, statistical calculations and decisions about how to split incentives between multiple caregivers.

"Neither penalties nor incentives achieve what we're really after: a system and a culture where X is what people do, day in and day out, even when no one is watching," Dr. Gawande wrote.

He described a project in Bangladesh that sought to spread the use of a salt-and-sugar solution to prevent deaths from cholera, a diarrheal illness. Although the results showing the effectiveness of this solution were published, it was not widely used. To encourage people to use this treatment, a group of people went from door to door talking to and educating people in villages across Bangladesh. From 1980, when the campaign started, to 2005, child deaths from diarrhea dropped 80 percent, according to Dr. Gawande.

"Human interaction is the key force in overcoming resistance and speeding change," he wrote. "People talking to people is still how the world's standards change."

More Articles on Dr. Atul Gawande:

Dr. Atul Gawande: We Can't Afford "Cowboys" in Healthcare
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