It's hard to be ideological when you're in the operating room with a patient's life in your hands.

We assume that's at least part of the roots of the pragmatism that makes Dr. Atul Gawande such a refreshing voice in health reform. Gawande kicked off day two of the Health Action 2009 conference, reiterating the case for health reform that avoids the "lure of the ideal" to build off what we have and what is possible.

Much of Gawande's public presentation followed along the lines of his recent New Yorker piece that our colleague Joanne Kenen wrote about earlier this week. We'll focus on the highlights from a brief round table with Gawande and other health bloggers that followed his presentation.

Gawande reiterated the three basic attributes of a reformed health care system:

1. It should leave no one uncovered—medical debt must disappear as a cause of personal bankruptcy in America.
2. It should no longer be an economic catastrophe for employers.
3. It should hold all members of the health care industry collectively responsible for making care better, safer, and less costly.

As a practicing surgeon, Gawande's thoughts on point number three were particularly insightful. You can't manage what you don't measure, and we need to start measuring  health care in ways that are current and conspicuous in minds of patients, physicians, policymakers and politicians. We should be asking every three months, whether the care we deliver has improved and, if not, what can we do to make it better. But we can't do that when the best data researchers have to work with is often three years old. This data-gathering function could be filled by a Federal Health Board, Gawande said, or by HHS or any other number of ways so long as it's filled.

As for things we can do in year one, Gawande highlighted his recent work with the World Health Organization to develop a 19-item surgical checklist that can be used in both the developing and industrialized world. The Checklist is available here. It asks simple, but potentially life saving questions, like did the patient receive the right dose of antibiotics. We've blogged about their success before, and the WHO results are described in the New England Journal of Medicine.

In every pilot hospital, complications declined by double digits. In four hospitals located in industrialized nations, complications declined by more than a third. Training doctors and nurse to use a checklist can have a big impact now, as a delivery system proceeds with more long-term transformations.

For more on Gawande's thoughts on delivery system reform, check out this earlier post from a talk he gave at CAP last fall.