The last time Atul Gawande started a company, he named it after a Greek myth.
Ariadne Labs, based in Boston, Massachusetts—where Gawande also works as a surgeon at Brigham and Women’s Hospital and teaches at Harvard—has been trying since 2012 to innovate in an area that has historically resisted innovation: healthcare delivery. You may not have heard of Ariadne, but you’ve certainly heard her story. It’s the one about the Labyrinth and the Minotaur.
If you don’t know her name, it’s because most tellings cast Theseus, the prince of Athens who eventually slays the monster, as the hero of the tale. But a closer read makes clear that, really, it’s Ariadne, the princess of Crete and the minotaur’s half-sister, who matters. She falls in love with Theseus, and saves his life by wisely instructing him to take a ball of twine and attach the thread to the labyrinth’s entrance so he can find his way through the maze, and by bravely risking her life to hide his sword so he can retrieve it in time. Theseus kills the minotaur, escapes the labyrinth, and leaves Crete with Ariadne, bound for Athens and marriage.
Explaining his new company’s name and mission in 2013, Gawande told WBUR public radio, “We’re in the simple threads business, to show there are ways out of the labyrinth of healthcare complexity.”
Perhaps the most influential thing the lab has worked on is the development of healthcare checklists, based on Gawande’s hugely influential “safe surgery checklist.” After Gawande’s original checklist was implemented in eight hospitals as part of a study in the mid-2000s, post-surgery death rates in those facilities fell by 50%. Today, the surgery checklist is used all over the world, and Ariadne Labs has attempted to replicate its success by bringing checklists to other areas of healthcare delivery. It’s not a sword cutting off the head of the monster; it’s the twine helping to guide better decision-making.
Another thing that was likely left out the version of the Labyrinth myth you read in grade school: Ariadne and Theseus do not live happily ever after. On their way back to Athens, Theseus abandons Ariadne on the island of Naxos, where she dies, alone, as he sails back home.
Ariadne Labs is far from dead, though Gawande has stepped down from his role of executive director (he’ll remain chairperson of the company), and there are genuine questions about whether simple threads will always work. Many of Ariadne Labs’ recent efforts, including the highly publicized deployment of a World Health Organization-sponsored checklist to reduce deaths among newborns and their mothers in India, have failed.
Gawande, who has been writing and speaking on the problems of the US healthcare system for most of his adult life, has long bemoaned the field’s resistance to innovation. As an influential book author, New Yorker contributor, and public speaker, Gawande has become one of the foremost champions of change in healthcare delivery and policy. His ideas are about to be put to their biggest test yet. In January, three of the biggest and most powerful American companies—the tech juggernaut Amazon, banking giant JPMorgan Chase; and Warren Buffett’s Berkshire Hathaway holding company—announced they were forming a joint healthcare venture; in June, they chose Gawande to run it.
Nearly six months later, almost nothing is known about Gawande’s plan for his second startup, other than that it will seek to provide the combined 1.2 million employees of its three sponsor companies with better healthcare at a lower cost to the employers than exists now. No one involved in the venture is speaking to the press about it. Emails sent to Gawande directly were rerouted to public relations, and attempts to speak to him by phone and in person were similarly forestalled.
But based on Gawande’s prior work, and on recent trends in employer-sponsored healthcare, it’s not hard to imagine what’s in store for the Amazon/JPM/Berkshire partnership. Despite huge improvements brought on by the 2010 Affordable Care Act, the US still lags far behind other similarly wealthy countries when it comes to healthcare penetration and efficacy. Gawande, who cut his teeth as a member of the Clinton administration’s healthcare reform team, has long been a critic of how care is delivered in the US.
Companies across all sectors, ranging from tech and financial services to retail and manufacturing, have, in the past five years or so, started to tweak their employee health programs to stem the rising costs of healthcare, which impact the bank accounts of both employers and employees. But simultaneously, facing a competitive labor market, more employers are seeing better employee healthcare as a differentiator that can help them recruit and retain the best of the best.
The problem is, the last time employers used healthcare this way, they laid the tracks that led to the very problems with the US system they’re now trying to solve.