Gawande: Why some ideas go viral—and why some are DOA

Relying on 'turnkey' solutions will not solve complicated, 'invisible' problems

Topics: Health Policy, Market Trends, Strategy, Surgery, Service Lines, Women's Services, Physician Issues, Quality, Performance Improvement

July 23, 2013

Writing this week in The New Yorker, Brigham and Women's Hospital surgeon Atul Gawande discusses why certain innovations spread rapidly, while others take longer or fail to catch on at all.

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Case study: Surgical anesthesia vs. antiseptics

As an example of how ideas spread—and why some lag—Gawande compares the swift trajectory of surgical anesthesia with the lagging adoption of antiseptics.

Nearly every hospital in America and Britain started using anesthesia within seven years of its discovery in 1846. However, it took nearly a generation before the modern standards of asepsis—which is entirely removing germs from the surgical field by using heat-sterilized instruments and requires sterile gowns and gloves for surgical teams—took effect, Gawande writes.

The key difference between the procedures: While anesthesia combatted a "visible and immediate problem (pain); the other combatted an invisible problem (germs) whose effects wouldn't be manifest until well after the operation," Gawande writes. And although both approaches "made life better for patients, only [anesthesia] made life better for doctors" by transforming the surgical experience.

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"This has been the pattern of many important but stalled ideas," Gawande writes. "They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful."

Case study: Going door-to-door to improve public health

As another example of innovation in action, Gawande cites the effort to combat cholera—how a simple, elegant solution languished for years before public health groups hit on the best strategy to put it into practice.

Specifically, The Lancet published results in 1968 that oral rehydration therapy—such as having a sick person drink a simple household mixture of sugar, salt, and water—could fight the deadly effects of cholera, which killed millions of people around the world every year. But "a decade after the landmark findings, the idea remained stalled," Gawande writes. "Diarrhreal disease remained the world's biggest killer of children under the age of five."

However, the Bangladeshi not-for-profit BRAC in 1980 piloted a "remarkably successful" public health campaign to get oral rehydration therapy for cholera adopted nationwide. The group's strategy didn't focus on the common tactic of using a public relations campaign—especially given that the population they were trying to reach was mostly illiterate—but by "going door to door, person by person, and just talking," Gawande writes.

BRAC's campaign showed "twelve million families how to save their children," Gawande writes. As other countries adopted Bangladesh's door-to-door approach, global diarrheal deaths dropped from five million to two million annually, despite a 50% increase in the world's population over the past three decades.

Other countries that tried to enact a cholera prevention strategy without putting "sandals on the ground" have failed, Gawande notes. He concludes, "People talking to people is still how the world's standards change."

Human psychology is the key

That element is why encouraging surgeons to adopt antiseptics, convincing parents to use a new kind of treatment, or even getting doctors to try a new drug boils down to human interaction and basic psychology, Gawande concludes.

"Technology and incentive programs are not enough" to convince others to change their minds, Gawande writes. "To create new norms, you have to understand people's existing norms and barriers to change. You have to understand what's getting in their way" (Gawande, New Yorker, 7/22).

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