Why we need Don Berwick leading CMS

For those who do not know Dr. Berwick, he is a professor of health care policy, pediatrician, and cofounder of the Institute for Healthcare Improvement (IHI). He was also one of the first and most effective voices to call for quality improvement in the health care system and many of us have followed the numerous, significant successes of IHI for almost 20 years.

There are about a bazillion articles on Dr. Berwick on the web but below you will find some interesting recent interviews and articles that highlight why Dr. Berwick’s leadership is exactly what we need right now.
· Interview/Audio on the 5 Million Lives Campaign at Healthblawg(2008)
· Interview “A Deficiency of Will and Ambition” in Health Affairs (2005)
· Interview/Video on innovation in BusinessWeek magazine (2008)
· Article “The Revolutionary” in Boston Globe (2004)
· Article “Dirty Words in Health Care” in Boston Globe (2008)

And for those who have never seen what has been described as the first “viral” video in health care, Dr. Berwick’s “Escape Fire” address at the 1999 annual meeting really hit home. I don’t have the video but the Commonwealth Fund published a report on the presentation, which should be required reading for anyone working in health care. But below, you can find another nice video of Dr. Berwick from IHI's annual meeting last year.



Now what really sets Berwick apart is that he has the best balance of gravitas, commitment, and understanding that is necessary to reform our health system. Some say he is primarily associated with hospitals but his efforts span the health care system...one just hears about his work with hospitals the most. He is not a political opportunist or an outsider perched high atop an ivory tower but a leader who has worked from within to help providers continually improve their performance without finger-pointing. Berwick, as all quality practitioners, does not blame individuals, but the system at large and often uses the quote “every system is perfectly designed to achieve exactly the results it achieves.”

This explains why Berwick is somewhat at odds with current CMS efforts to measure and penalize individual physicians. He believes incentives should be used for systems of care – not for individual practitioners and he has some pretty heavy hitters backing up his belief. Management and quality gurus WE Deming and Joseph Juran pointed out over 30 years ago that most of the possibilities for improvement lie in action on the system as opposed to individuals. Berwick also believes that the current proliferation of measures (there are now over 1000) leads to a “data smog” that keeps us from focusing our limited resources on those health objectives that really make a difference. Thus, Berwick epitomizes the balance between the “art” and “science” of health care as summarized in the famous Einstein quote "Not everything that counts can be counted, and not everything that can be counted counts."

Berwick also understands the balance between the science of “hypothesis testing” and the science of “continuous quality improvement.” It is interesting that the same management methodologies that have fueled well-run organizations over the past 20 years (e.g. lean manufacturing and six sigma) are almost completely lost in health care. This is understandable because health care entities do not typically compete on quality and price when much of their payment is dependent on Medicare and Medicaid fee schedules. But for those health systems who value improvement, Berwick’s IHI has worked to highlight, promote, and support their efforts. One example is Virginia Mason Medical Center, who has successfully implemented lean manufacturing principles to center care around their patients (see article from Seattle Post-Intelligencer).

We can leave the politics to the politicians but as we go down the path of serious reform, I want someone who has Dr. Berwick’s qualities at or near the head of the table…and you should too…the health of our country depends on it.

[Homework: while working on another project I worked to reconcile the fact that about 85% of all health care costs can be attributed to individuals (i.e. risk factors like obesity) and the rest to the system with Deming/Juran’s experience that 94% of improvement opportunity resides with action on “the system” and the rest to individuals (i.e. they are flipped). When doing this, I had my “a-ha” moment but would like to hear the thoughts of others on this]. ~BAA