Teamwork, by and large, is hardly ingrained in healthcare, an autocratic system if there ever was one.
And the system is costly. "Healthcare costs are the fundamental issue of our generation," he said. Gawande used a historical analogy to illustrate the seriousness of the problem.
In the 1900's, it was food. Forty percent of income was spent on food and 50% of the population depended on agriculture for employment. Governments rose and fell over this issue. It was responsible for tens of millions of deaths. The market couldn't solve it. Food was largely produced by tenants and sharecroppers. It didn't pay to invest in mechanization.
Food shortage was one of the reasons Communism developed. It failed too. The incentives were all wrong. But through a combination of government and private solutions, the food problem was largely solved in the developed world. It was solved by providing farmers with knowledge and power. It used comparative effectiveness and financed incentives. The government funded agricultural extension services, the National Weather Service, and other programs. Financial incentives helped develop a nation of farmers who owned their land. In one generation, outlays for food went from 40% of income to 20% and only 20% of employment depended on farms.
The most difficult skill in this transition attempt is leadership, Gawande contends. "The hardest thing to do is lead institutions -- to make those necessary changes.