The US government should create a new federal institute tasked with improving research into how health care is delivered, according to Atul Gawande. The well-known Harvard surgeon and New Yorker staff writer floated the idea at a unique stop during his cross-country book tour, when he spoke to the President's Council of Advisors on Science and Technology (PCAST) in Washington, DC last month.

“We need basic and applied research on the health system for the discovery of practical know-how,” Gawande told the PCAST members. “It is life-saving research. It is neglected work that would identify the systems innovations that could improve American health care.”

Lifting a page from his most recent book, The Checklist Manifesto, Gawande called for greater research ranging from simple health solutions, including checklists for standard surgical protocols, to more complex investigations, such as how to bundle payments for all services related to a single treatment.

Gawande's preferred solution would involve establishing a National Institute of Health Systems Innovation—designed, ideally, to stand alongside the National Institutes of Health (NIH). He noted, however, that it would also be possible to shore up delivery research at the NIH or other existing agencies, such as the Centers for Disease Control and Prevention's National Center for Health Statistics or the Agency for Healthcare Research and Quality.

“We could do much more and we could do it so much better,” Nancy Chockley, president of the National Institute for Health Care Management, a nonprofit group in Washington, DC that is unaffiliated with the NIH, told Nature Medicine. Right now, no one in government is doing health systems research at a large scale, she says, “and there's an incredible need to improve our system.”

Gawande's recommendations were warmly received, but some PCAST members voiced reservations about introducing new administrative bureaucracy. “I do have some concerns about the idea of creating a separate domain under which this type of research is done,” said PCAST co-chair and former NIH head Harold Varmus of Memorial Sloan-Kettering Cancer Center in New York.

Regardless of what organizational solution is devised, “it is a very different way of thinking,” noted Eric Lander, PCAST co-chair and director of the Broad Institute in Cambridge, Massachusetts.