Donald Berwick, MD: The right leader at the right time

IHI Founder Dr. Donald Berwick

President Obama recently nominated Don Berwick, MD, to head the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the programs and payment of more than $800 billion annually. This is the largest source of payments to health care providers in the U.S. If he is confirmed, the appointment of Dr. Berwick may be the most significant first step since the passage of the Health Care Reform bill.

Health Care Reform: Still a mystery to most

These words mean lots of things to lots of people. It’s natural. Health care for most of us, whether we are patients or practitioners, is deeply personal. Most of us would agree that good health care ought to be available to everyone and we can’t really figure out why it has been such a big problem in the U.S. We look around the world, and most industrialized countries extended health care coverage to their populations long ago.

Among the reasons it is such a big problem, is that the U.S. waited too long. Because of the long wait, the cost of health care has ballooned to heights never imaginable: more than 16% of the gross domestic product of our economy, which is close to twice as much as most of the U.S. trading partners around the world. Now, understandably, we are as concerned about how we will pay for health care as we are about the right to health care. We have got to change the debate. Or, as I say so often in this blog, we have to change our language.

As long as we lived, decade after decade, with costs soaring out of control and tens of millions uninsured, the broken health care system became something to complain about, to be victimized by. Because health care is personal, it was and remains difficult to find solutions to the problems that were created by all these years of failure to act.

Enter Dr. Berwick

Don Berwick, the pediatrician and Harvard University public health and health policy teacher, founded the Institute for Health Care Improvement (IHI) about 20 years ago. His motivation:  to find the savings in health care by discovering, illuminating and spreading the  best practices in patient safety and quality outcomes so that we could achieve health care for “every man, woman, and child on the planet.” I know this to be true, because sitting with him in his Cambridge, MA office one day, those were his exact words.

In essence, the impact of Don Berwick as the head of CMS would be the same as placing those words as the preamble to the recently enacted law. Dr. Berwick is the right leader at the right time.

Dr. Berwick believes that we can achieve great health care by doing health care better, not by cutting services or cutting benefits. He has said many times that there is tremendous waste in the system: duplicative and unnecessary and untested procedures; hospital acquired infections; hospital re-admissions. IHI has become a major center in the world for the study of overall health care improvement. Improvement is seen as a constant search for efficiency, safety, and the best outcomes, largely based on prevention and always based on both patient-centered care and evidence-based medicine. 

IHI and Kaiser Permanente

Kaiser Permanente is the largest practitioner of health care improvement today. The connection between IHI and Kaiser Permanente is profound. Today, practitioners from all over the world learn from IHI and from Kaiser Permanente. 

Improvement requires leadership. Don Berwick is first and foremost a leader. So, think of the kind of leadership we are talking about and apply it to the expenditure of that $800 billion annually. Then you will see the opportunity for health care reform to become a reality for the rest of our days, our children’s days and beyond.

Today, the cost seems daunting. And it is, but if we all play a leading role in transforming the way health care is delivered in the U.S. -- that is to pay for what works, to reward what works -- we will create a system that saves money by creating health, not wasteful health care.