Asaf Bitton, MD, on Taking the Reins at Ariadne Labs

The influential lab's new leader speaks out about how he will use his background in primary care and a focus on dysfunctional systems to influence healthcare delivery around the world.

Atul Gawande, MD, MPH, has left the building. Or, to be more accurate, when he accepted the position as CEO of Haven, the Amazon, Berkshire Hathaway, and JPMorgan Chase healthcare organization, he stepped out of his role as executive director of Ariadne Labs. He still maintains ties to the organization as chairman of the Ariadne Labs Governance Council.

Since its formation in 2012, Ariadne Labs, a joint initiative between Brigham and Women's Hospital, and the Harvard T.H. Chan School of Public Health, has gained a prominent profile on the global stage with innovative approaches to change the way healthcare is delivered around the world.  

On May 1 Asaf Bitton, MD, MPH, a Harvard professor, Brigham and Women’s Hospital primary care physician, and veteran of Ariadne Labs, was tapped to fill the position as its executive director.

When asked by Ariadne Lab's communications director about how his style differs from Gawande's, Bitton responded, "Atul and I are quite different. I enjoy reading The New Yorker and reading books on the weekend, and he enjoys writing for The New Yorker and writing books on the weekend. All joking aside, I feel grateful to follow in his footsteps. He has been an incredible friend, partner, and colleague in this journey. What a legacy he is passing on …"

HealthLeaders spoke to Bitton recently to get a closer look at his own approach to innovation and how he will use this position of influence and his experience as a primary care physician to shape healthcare delivery. This is the first of a two-part series. Bitton's comments have been lighted edited for space and clarity.More details about Bitton's background appear in the announcement HealthLeaders published earlier this month.

HealthLeaders: What experience, person, or event has most influenced your path in life?

Asaf Bitton: My second year in college, I showed up to this class … called "The Burden of Disease in the Developing World." It was taught by Stephen McGarvey, [professor of epidemiology and anthropology, and director of the International Health Institute] at Brown University. That class opened up this whole world of understanding about health from not just a clinical perspective, but a sociological perspective, a global perspective, an equity perspective. It was the single most influential class I ever took in my life.

Steve then became an important mentor for me. I started doing global public health work with him in the Samoan Islands and would go to work with him there … on a variety of public and anthropological studies. Later on, when I was trained as a doctor, I came back and worked on an intervention in Samoa to improve diabetes care through community health workers. Steve showed me the opportunities that public health can have to impact populations. That inspired me to eventually have a career that combined public health and clinical medicine.

HL: Why do you think you were selected for this position, and why do you think your background in primary care was essential?

Bitton: As a primary care physician, I have a generalist perspective. That means that I bring a variety of tools to the problems at hand. I bring social science, clinical medicine, clinical research, public health. I've spent my career doing three things. The first is seeing patients, which I love. [Other activities include]:

• Building evidence around how we can improve outcomes for people within the clinical sphere as well as the public health sphere
• Innovating to translate what we're learning in that research process into action

I've done [these things] at the micro-level, in my clinic, building a patient-centered medical home. I've done it … in the Boston area, leading a collaborative of clinics as they innovate toward team-based primary care. I've done it at the national level, working as a senior advisor at CMMI [the CMS Center for Medicare & Medicaid Innovation] to build payment models that can foster the development of better primary care teams. And then I've done that at the global level through work on both global tobacco control and also global primary care and primary care measurement systems. I think it's this combination of evidence and innovation, and using a wide variety of tools, that helped me be ready for this next phase in this job.

HL: Tell us about your leadership style.

Bitton: I'm a very open, inclusive leader. I really believe that a leader's job is to create the space for people to be their best selves and to do their best job. I don't believe in micromanaging people. I believe in finding great people, entrusting responsibility to them, and then helping clear obstacles in their way to help them do great things.

HL: What did you learn from Atul Gawande?

Bitton: Atul has a lot of gifts. One of the greatest gifts that I learned from him has been how to take enormously complex problems with many angles and facets and how to clarify them, how to distill them down to their core essence so that you can actually approach them and try to make targeted interventions to improve outcomes around them. That principle of clarifying, precision, or distillation has been enormously helpful in my career and in my contact with him, and one that I certainly will carry forward.

HL: You've mentioned that Ariadne Labs is transitioning from focusing on critical moments in healthcare practice to concentrate on fragmented and dysfunctional systems. Can you comment further?

Bitton: Our work to date has focused on intervening with scalable solutions that help people at critical moments in their lives like birth, surgery, end of life care, and connecting with primary care. We've been able to show that many of our interventions are tractable and are effective at moving the needle in those critical moments. But we've also seen that in order for them to be effective … we have to better understand the context of the healthcare system in which we're trying to intervene, and we have to have aligned payment models that help those interventions happen at the right time.

We [also] have to have a better understanding of the person and the family unit trying to seek better care in that moment. For all those reasons, [Ariadne Labs is] going to still keep focusing on these critical moments, but we're also building tools to better understand the context and the readiness of systems to change.

We're building tools to understand—as systems expand and consolidate into bigger provider groups—how to keep them safe and how to keep them more aligned. And we're also building systems to help understand how primary care operates over large geographies so we can view, in one snapshot, a country's perspective on its performance. We're going to continue our work in these critical moments, [yet] we're [also] going to [look through] a broader and more systemic policy-based and financing lens.

HL: Can you share an example?

Bitton: We're looking at this challenge of hospital systems buying up either smaller hospitals or specialty practices. And we've found that many providers, often surgeons or specialists, might be doing procedures at multiple different hospitals in a month. In doing so, there may be safety gaps because they don't have the knowledge at each of the hospitals [because] they're not there every day. So we're building a set of communications tools and guiding principles to help hospital system administrators safely expand and help their newly acquired or newly connected specialist populations know how to operate in these new environments. This can present enormous risks, and we've found that this isn't even on the radar of most administrators.

HL: One day, when you look back on your time at Ariadne Labs, what would you like your legacy to be?

Bitton: My hope is that I will be able to catalyze the ability of Ariadne Labs to reduce suffering and improve the health of tens of millions of people through our ideas, tools, and partner communities of innovation. I hope my legacy at Ariadne is one of lasting impact, maintaining our thriving work culture, building good partnership, and enabling transformative ideas and tools to scale across the globe. And I hope we will do it with a smile.

Editor's note: We invite you to read Part 2 in this series, where Bitton shares broader perspectives about what changes need to occur in the American healthcare system and the role innovation will play in making that happen.