Atul Gawande on “Slow Ideas” and Maternal Health

Posted on

In Atul Gawande’s recent piece in the New Yorker, Slow ideas: Some innovations spread fast. How do you speed the ones that don’t?, he takes a careful look at the uptake of various medical innovations with special attention to the very different trajectories of surgical anesthesia and antiseptics. He examines possible reasons for why anesthesia spread fast and far while, despite clear evidence of the life-saving effect, antiseptic  methods took decades to become the norm in operating rooms around the world.

He raises important questions about the differences in the spread of these innovations: Did anesthesia take off for economic reasons? Were the differences in uptake due to technical complexity? What were the key differences? (You will have to read the piece to find out!)

Gawande goes on to discuss the concept of “important but stalled ideas” and focuses specifically on ideas that address the global problem of death during childbirth.

From the piece:

Not long ago, I visited a few community hospitals in north India, where just one-third of mothers received the medication recommended to prevent hemorrhage; less than ten per cent of the newborns were given adequate warming; and only four per cent of birth attendants washed their hands for vaginal examination and delivery. In an average childbirth, clinicians followed only about ten of twenty-nine basic recommended practices.

Here we are in the first part of the twenty-first century, and we’re still trying to figure out how to get ideas from the first part of the twentieth century to take root. In the hopes of spreading safer childbirth practices, several colleagues and I have teamed up with the Indian government, the World Health Organization, the Gates Foundation, and Population Services International to create something called the BetterBirth Project. We’re working in Uttar Pradesh, which is among India’s poorest states.

Gawande describes the concept of the BetterBirth Project:

With the BetterBirth Project, we wondered, in particular, what would happen if we hired a cadre of childbirth-improvement workers to visit birth attendants and hospital leaders, show them why and how to follow a checklist of essential practices, understand their difficulties and objections, and help them practice doing things differently. In essence, we’d give them mentors.

The experiment is just getting under way. The project has recruited only the first few of a hundred or so workers whom we are sending out to hospitals across six regions of Uttar Pradesh in a trial that will involve almost two hundred thousand births over two years. There’s no certainty that our approach will succeed. But it seemed worth trying.

Read the full story in the New Yorker.

Also, take a look at this piece on WBUR’s CommonHealth about Atul Gawande’s new health care innovation center, Ariadne Labs.