Ariadne Labs’ design, test, and spread methodology translates to real-world impact.
By Erin Lawler and Stephanie Schorow
Early in his career, Asaf Bitton was studying public health issues in the South Pacific trying to understand the rapid rise of noncommunicable diseases, such as diabetes, heart disease, and obesity related conditions, in low- and middle-income countries. He once hiked into a remote mountain village where nearly half the adult population had amputations due to diabetes.
“We didn’t really have much in the way of offering care. I had the realization that an academic focus solely on describing problems and theories was not enough for me,” he said. “I wanted to be of service to people in communities. The reason that I was drawn to primary care was that it seemed to be the connection point between clinical medicine and public health.”
Many staffers at Ariadne tell similar stories – that dealing with medical issues they saw around them pushed them to pursue work that aimed to transform health care in the short term, not as some distant goal.
Even in medical school, June-Ho Kim, MD, MPH, Interim Director of the Primary Health Care program at Ariadne Labs, realized that he wanted to focus on implementing systemic changes. This drew him to primary care. “Basically primary care is not about being in the lab and developing the newest drug, but rather when you have that breakthrough drug, how do you make sure that it’s implemented responsibly and equitably and widely in a way that can reach everyone,” Kim said.
Many Ariadne staff and faculty are motivated by the idea that it’s not enough to do research and wait for someone to implement it. The lab focuses on solutions that, once rigorously tested, are disseminated and spread.
“Ariadne is not an academic center in the sense you create papers and wait for someone else to do something about it,” said Weintraub. “Our premise is to hone in on a problem, understand the problem deeply, and bring interdisciplinary expertise to think about a solution.”
The lab uses a unique approach to developing its innovations, something called the Ariadne Arc, which is based on the concepts of “design,” “test” and “spread.” To support this cycle, the lab has established platform teams to guide projects through the phases of the Arc. As solutions move across the Ariadne Arc, the Innovation, Science and Technology, and Implementation Teams collaborate with content and scientific experts at Ariadne Labs, as well as end-users, and bring methodologic expertise to ensure scalability, usability, and dissemination of solutions.
From the outset of every project, Ariadne applies human-centered design – a process that focuses on the experience of the end user to ensure that solutions and tools are practical and effective. “Humans are at the center of health care,” said Meghan Long, MHA, Assistant Director of the Innovation Platform. “Designing solutions with humans in mind creates lasting and sustainable change for patients and communities.”
These solutions and tools are then rigorously tested – through trials, studies, focus groups, and other means – and are adapted as needed. “We want to make sure that the work we do is rigorous and sound, and that we’re confident in our solutions,” said Robbie Singal, DrPH, who leads the Science and Technology Platform.
Finally, the lab promotes implementation and spread of the solutions to systems around the world, something considered from the very start of the design process. “We work with the teams to think about how we are trying to get the tool or problem we are trying to solve done in real-world environments,” said Francine Maloney, MPH, Director of the Implementation Platform. Maloney said she is “inspired by the direct impact we have on patients and clinicians.”
Said Weiseth, “We don’t just create a solution and then figure out what populations that works for. It has to work for everyone everywhere, and that forces you to think differently.”
While the lab has an impressive publication record, with studies published in major peer-reviewed journals nearly every month, those who publish also work on implementing what they discover.
To quantify the impact of Ariadne Lab’s efforts, every year the lab measures the number of solutions or knowledge products released, the number of times these tools are accessed, and how many lives the solutions have touched in the real world. Using these measurements, in 2021 Ariadne Labs touched 88.8 million lives; developed and disseminated 105 tools; and reached 400 health systems and 27,000 health care providers. More than 100 countries all around the globe accessed the lab’s work.
The concept of “lives touched” is paramount to Ariadne’s self-assessment process. This metric tracks how many patients Ariadne Labs’ tools and solutions reach in a clinical setting, not accounting for clinicians reached or patients reached outside of traditional health care settings.
Mary Brindle, MD, MPH, Director of the Safe Surgery Safe Systems Program at Ariadne Labs has been enthralled with the Ariadne Labs approach since she began a fellowship at the lab as a pediatric surgeon. “The idea that Ariadne’s priority wasn’t the publication, but was actually touching human lives, was tremendous, and it wasn’t just words. You could see it, you could feel it.”
What also distinguishes Ariadne is that its researchers don’t hesitate to address tough issues. “I think the thing that’s different about Ariadne is we ask really big questions and really hard questions and answer tricky problems,” Semrau said. Or as Bitton put it, “We tend to run toward hard things.”
Certainly, a difficult problem facing health systems is how to respond in cases of medical harm. Benjamin has long been keenly interested in the topic of patient safety. In 2021, he and other stakeholders launched the Pathway to Accountability, Compassion and Transparency (PACT) Collaborative. “PACT is really taking a lot of those skills of Ariadne’s Arc and applying it to improving the way health care responds to patient harm, to take it to a new level,” he said.
Bitton explained that Ariadne Labs’ “adaptable and agile” methodology allows the lab to gravitate to thorny problems, even in new clinical areas. “We are gaining momentum and understanding that even as we spread out into wider varieties of use cases, there’s a convergent synthesis on how we approach that and what our utility is in driving change forward.”
The versatility of Ariadne’s methodology is exactly what allowed the lab to play a role in developing solutions during the COVID-19 pandemic. “We realized that we could actually be pretty nimble and support the gap that we saw in communicating and educating about COVID-19,” said Benjamin.
Ariadne Labs’ faculty and staff — though not experts in infectious disease — jumped in to design, test, and spread desperately needed solutions. Weintraub, who had expertise in polio, smallpox and measles vaccine delivery, led work devoted to efficient and equitable vaccine delivery; Benjamin led work to develop evidence-based guidance for the general public and, later, a conversation guide for clinicians to use with those hesitant to get vaccinated. The Serious Illness Care Program launched a set of COVID-19-focused conversation tools that have been downloaded more than 10,000 times, and the lab organized a coalition of large vaccine distribution centers to exchange information and recommendations.
During a phase in the pandemic when clinicians in India were reaching a breaking point, Ariadne and mental health experts in Mumbai worked out programs for confronting stress and burnout. Said Brindle, “We weren’t the experts in mental health, nor were we the experts in the country. But what we could do is we could provide them this way of thinking about the problem that could allow them to bring in their expertise.”
Ariadne’s methodology is what sets it apart and allows the lab to achieve impact. “I think that we’re making progress farther and faster, and that’s notable in a field where it takes on average 17 years to go from the breakthrough moment to widespread use,” said Bitton. “I think we’re shortening that and if we find ways to replicate this structure, we’ll do more good faster.”
This approach allows Ariadne to continually explore new areas of innovation and keep pace with the changing challenges facing health care systems around the world.