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Atul_Gawande's profile
Atul Gawande
Atul Gawande
Atul Gawande
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@Atul_Gawande

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Atul GawandeVerified account

@Atul_Gawande

Surgeon, Writer, Researcher, Dilettante. https://www.ariadnelabs.org/  http://www.lifebox.org/ 

atulgawande.com
Joined January 2011

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    Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

    Atul Gawande Retweeted NEJM

    In one of the largest facility-based randomized studies of child delivery, conducted in partnership w/ Govt of India and UP, @WHO, @PSIimpact & others, we sought to improve the uptake of essential birth practices & reduce neonatal/maternal morbidity & mortality. #BetterBirthhttps://twitter.com/NEJM/status/941066504417808384 …

    Atul Gawande added,

    NEJMVerified account @NEJM
    Adherence to essential birth practices increases with the use of the coaching-based @WHO Safe Childbirth Checklist program, but does not reduce maternal or perinatal mortality or maternal morbidity. http://nej.md/2BiSfjq  pic.twitter.com/HyaUAIKmCQ
    5:16 AM - 14 Dec 2017
    • 118 Retweets
    • 268 Likes
    • Jeffry Upperman Krish Paola Cubillos MD 🇨🇴🇨🇦 Fred Barrett Catherine Kozik Sambandam Anand APPLESHAMPOO Billiard Lentil Elizabeth
    8 replies 118 retweets 268 likes
      1. New conversation
      2. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        The key points: Poor quality of care at childbirth has been recognized globally as a major contributor to high rates of death for mothers and babies in childbirth. 1/12

        3 replies 21 retweets 27 likes
        Show this thread
      3. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        WHO’s Safe Childbirth Checklist was designed to help birth attendants & managers better insure women receive essential care for the biggest killers, eg washing hands + using clean gloves to prevent infections; monitoring and treating BP to stop eclampsia. 2/12

        1 reply 7 retweets 20 likes
        Show this thread
      4. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        We found coaching attendants and managers in rural clinics across Uttar Pradesh, India, to use the checklist to recognize and address gaps in practices, resources, and organization lifted them in 2 months from delivering 42% to 73% of essential safe practices. 3/12

        1 reply 7 retweets 19 likes
        Show this thread
      5. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        On the one hand, this was remarkable, rapid change at such large scale. On the other hand, it wasn’t enough to reduce stillbirths, perinatal mortality, or maternal mortality/morbidity. 4/12

        1 reply 6 retweets 25 likes
        Show this thread
      6. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        So what to make of this? A few important lessons: - Large scale improvement IS possible even in tough, resource-limited settings. - It required changes not just in bedside practices but also in mgmt practices. - The plan was good but did not produce sufficient change. 5/12

        4 replies 13 retweets 66 likes
        Show this thread
      7. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        What more is needed? We and others will test the question now. Possibilities: A. We should have stayed longer than 8 months. Our other large studies (eg in surgery) are showing 3 years or longer to produce large scale, sustainable change in outcomes. @AriadneLabs 6/12

        1 reply 5 retweets 24 likes
        Show this thread
      8. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        B. Managers and district leaders need stronger forms of accountability for quality improvement. 7/12

        2 replies 7 retweets 17 likes
        Show this thread
      9. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        C. We should implement supply and skill upgrades before implementing checklists/coaching. 8/12

        2 replies 7 retweets 18 likes
        Show this thread
      10. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        D. The NEJM editorial argues rural clinics are inherently too limited and deliveries need hospitals with surgical and other capabilities. http://www.nejm.org/doi/full/10.1056/NEJMe1713831 … 9/12

        1 reply 5 retweets 14 likes
        Show this thread
      11. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        E. ???? 10/12

        3 replies 1 retweet 8 likes
        Show this thread
      12. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        Bottom line: #BetterBirth was the most ambitious, difficult, and important effort I’ve ever been part of. It has provided deeper, more profound information than we’ve ever had about how we make progress in saving women and babies’ lives. 11/12

        4 replies 20 retweets 85 likes
        Show this thread
      13. Atul Gawande‏Verified account @Atul_Gawande 14 Dec 2017

        I could not be prouder of anything I’ve ever undertaken. @k_semrau @Vishwajeet_CEL @WHO @PSIimpact @AriadneLabs #BetterBirth 12/12

        7 replies 7 retweets 83 likes
        Show this thread
      14. End of conversation
      1. New conversation
      2. Purnima Menon‏ @PMenonIFPRI 15 Dec 2017
        Replying to @Atul_Gawande @WHO @PSIimpact

        Congratulations. I have found every evaluation of a large program we have done humbling and a lesson in collaboration. And more. Did you do any ethnographic research too? It’s great for behavioural insights. (Haven’t read the paper yet). Congrats @Vishwajeet_CEL too.

        2 replies 1 retweet 1 like
      3. Dr Devaji‏ @debu7018 15 Dec 2017
        Replying to @PMenonIFPRI @Atul_Gawande and

        Disappointed by the nature of understanding of "Complexity" and its relation to Impact in this study . A Complex Adaptive system has "Emergences" . The First emergence crucial here is seen in better "essential birth practices" .The nature of pedagogy followed is also critical.

        1 reply 0 retweets 1 like
      4. Dr Devaji‏ @debu7018 15 Dec 2017
        Replying to @debu7018 @PMenonIFPRI and

        2. It is incorrect to end with a statement that "we currently lack a complete understanding of the complex interaction among quality of care, context, and outcomes" We never will, completely as a) Complex systems do not become Smaller simple systems.b)the unit is the individual..

        1 reply 0 retweets 1 like
      5. Dr Devaji‏ @debu7018 15 Dec 2017
        Replying to @debu7018 @Atul_Gawande and

        c) Coaching is not a pedagogy for CAS..as Coaching foresees a linear trajectory of improvement which is in fundamental conflict with Complexity. Learning through game is.

        0 replies 0 retweets 1 like
      6. End of conversation
      1. New conversation
      2. Anupam Singh‏ @anupampom 15 Dec 2017
        Replying to @Atul_Gawande @DrSoumyadeepB and

        Most importantly..Every health policy shouldn't be implemented just because it is intuitive, must be subject to large RCTs before being implemented at scale, to prevent wastage of resources

        1 reply 0 retweets 1 like
      3. Anupam Singh‏ @anupampom 15 Dec 2017
        Replying to @anupampom @Atul_Gawande and

        Not every field is same, a procedure/homogenous disease with well defined inclusion criteria will performs well with checklists than others..

        0 replies 0 retweets 1 like
      4. End of conversation
      1. Marianne Parshley MD‏ @MParshleyMD 14 Dec 2017
        Replying to @Atul_Gawande @WHO @PSIimpact

        Why no reduction in maternal or perinatal mortality or maternal morbidity?

        0 replies 0 retweets 2 likes
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      1. G. Bryan Cornwall‏ @GBCornwall 15 Dec 2017
        Replying to @Atul_Gawande @WHO @PSIimpact

        Congratulations to @Atul_Gawande and @WHO team for your efforts to improve LIFE! #BetterBirth

        0 replies 0 retweets 1 like
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