Atul Gawande leaves early as CEO of major U.S. healthcare venture Haven
Today Haven announced that Atul Gawande resigned as its chief executive. Haven was set up in 2018 by three billionaire CEO’s, Jeff Bezos of Amazon, Jamie Dimon of JP Morgan and Warren Buffett of Berkshire Hathaway, “because they have been frustrated by the quality, service, and high costs that their (1.2 million) employees and families have experienced in the U.S. health system.”
Such big companies spend an average of $20,000 a year to provide medical insurance for each of their employees and their families. This cost, which puts a big financial burden on the companies, rises by about five percent a year.
In July 2018 Gawande was hired as CEO of Haven, an independent organization not motivated by profit. Gawande, a healthcare policy expert under President Barack Obama, a surgeon and professor at Harvard’s hospital system and best-selling author, will stay on as chairman of Haven’s board. While CEO, Gawande continued working as a surgeon, writer, and professor.
Ambitious goals to change U.S. and global healthcare
At its founding Haven stated that its work will take time. Its guiding principles, are to “be an advocate for the patient and an ally to anyone – clinicians, industry leaders, innovators, policymakers, and others – who makes patient care and costs better…(to) create new solutions and work to change systems, technologies, contracts, policy, and whatever else is in the way of better health care. We will be relentless. We will insure our work has high impact and is sustainable. And we are committed to doing this work for the long-term.”
As Gawande states on his website, he had his own ambitious goals for Haven. While working to improve health care delivery for employees and their families, the intent was to “incubate better models of care for all.” He says he devoted “himself to building scalable solutions for better health care delivery in the U.S. and across the world.”
Bezos, Dimon and Buffett, whose companies together have a market value of $1.7 trillion, are reputed for selecting stable, long term senior managers to run their business operations. So Gawande’s departure raises questions about why he left after less than two years on the job.
Another oddity is that Gawande’s plans to resign as CEO were first disclosed by The Wall Street Journal on May 8, five days before today’s official announcement by Haven. Did Gawande have disagreements with the three companies backing Haven? If so what were they? Did the board find his practicing medicine, writing and teaching gave him less time and energy to focus on the demanding role of CEO of a major start up? Given that he was going to continue with these other interests, why was he selected as CEO in the first place?
Haven has had little impact so far
Some solutions appear easy for Haven to attain: use the purchasing power of three major companies to get discounts from hospitals and other health care providers; closely monitor to get better service from the health providers; and get price reductions from suppliers of drugs. Walmart and several other major companies are already using these tactics. But it appears Haven’s ambitions are much bigger.
In March 2019, Haven launched a website. “The good news is the best results are not the most complicated or expensive. The right care in the right place is often more effective and less costly than what we get today,” explained Gawande at the time of the launch. Then in October, Haven launched a health insurance plan for employees of the three companies. But it has not disclosed how the plan is working and how many employees have registered. “For all the fanfare, Haven has not made a dent in the dysfunction of US health care, or publicized any results from the few initiatives it has under way,” a report in The Boston Globe noted.
Haven has faced some major problems under Gawande. In 2019, Jack Stoddard its chief operating officer resigned after less than nine months on the job. He said it was for personal reasons, including his having to commute from Philadelphia, where his family lived, to Boston, where Haven has its main office. Also, that year an executive who joined Haven from United Health Group was sued for “stealing trade secrets” by United, a health care insurance company with a market value of $264 billion and a potential rival of Haven.
Son of Indian immigrant physicians
The son of Indian immigrant physicians, Gawande grew up in Athens, a small town in Ohio. Following degrees at Stanford and Oxford, he developed an interest in health care policy as a Congressional staff member, then became the chief health and social policy director for the 1992 presidential campaign of Bill Clinton. After a year with the Clinton administration’s unsuccessful effort at health reform, he returned to complete his medical degree at Harvard.
In Haven’s statement Gawande explained that his move from CEO to chairman will “enable me to devote time to policy and activities addressing the immediate and long-term threats to health and health systems from COVID-19.” Indeed, he will likely have a big impact in his new endeavor. He has led teams that created simple, scalable tools that rapidly changed medical practice nationally and globally during critical moments: a hospital worker checklist during the 2014 Ebola Virus Outbreak, a checklist for prescribing opioids to those in chronic pain, and a patient care checklist for the 2009 H1N1 (swine flu) epidemic.
For more than two decades, Gawande has worked on both direct patient care and population-level impact, asking a fundamental question: How do we fix health care systems to deliver better care for every person everywhere?
Innovation is the simple solution
Gawande has led the development of system innovations that have improved care for hundreds of millions of patients globally. Through his clinical practice, his writing and public health research, Gawande distilled a pivotal insight: The fundamental disease of health care systems is lack of execution. The cause is complexity. The solution is health systems innovation.
To drive solutions, Gawande has launched several start-ups and built supporting coalitions across the health care, technology, and other business sectors. He helped design sponge-tracking technology, now sold as the SurgiCount Safety-Sponge System, that has eliminated for hospitals in the U.S. one of the most persistent, harmful, and costly surgical errors: forgetting sponges in patients during procedures.
In 2012, Gawande became the founding executive director of Ariadne Labs, the Boston-based center he built from a start-up research center into a globally recognized leader of health systems innovation with 100 employees and more than 100 affiliate and associate faculty members across the Harvard system, and $20 million in annual revenue. Gawande and his team at Ariadne have designed and tested solutions to some of the most complex problems in health care including crisis checklists to prevent life-threatening errors in surgery, childbirth and to improve care for those with serious illness.
Writing to understand issues he could not explain
Around 1995, Gawande started writing after an editor friend asked him to write a column on being a doctor. Though he struggled at first as he told a reporter for The Denver Post, he enjoyed the process. “A lot of the topics I ended up writing about…were often things patients ask about and I don’t have answers for, and I wanted to get answers.”
Gawande is the author of four best selling books. In his first book, Complications: A surgeons notes on an imperfect science, using true cases he explores the power and the limits of medicine. The book, a 2002 National Book Award Finalist for Nonfiction, describes a science not in its idealized form but as it actually is―uncertain, perplexing, and profoundly human.
In The Checklist Manifesto – How to get things right, Gawande finds a remedy in the simplest of techniques: the checklist. First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches.
Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third. Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection.
In a 2010 New Yorker essay titled Letting Go, Gawande asked, What should medicine do when it can’t save your life? That question led Gawande to write Being Mortal: Medicine and What Matters in the End. With his accompanying, Emmy-nominated documentary, the launch of the Serious Illness Care Program at Ariadne Labs, and the co-founding of the Massachusetts Coalition for Serious Illness Care, Gawande played an important role in transforming the understanding of how to better care for individuals facing serious illness.
Gawande leaving as CEO of Haven is likely a temporary bump in the path of both parties. Haven’s backers Bezos, Dimon and Buffett are astute mangers who will find a new CEO and figure out how to improve and lower the cost of health care, at least for their employees if not the world. Gawande meanwhile will continue achieving major medical goals, including perhaps in helping tackle the COVID-19 pandemic. As he notes, at the heart of his work is a commitment to the highest principle of medicine: All people have lives of equal worth.
ADDITIONAL INFORMATION
May 18, 2020: In an interview with CNBC today, Atul Gawande spoke of how the Harvard medical system, with about 50,000 employees.has been safely operating through the current COVID-19 crisis, However, he evaded answering why he moved from CEO to Chairman at Haven, the big healthcare venture.
January 4, 2021. Haven shut down its operations.
