Donald Berwick: Healthcare’s Greatest Motivational Speaker?

The Centers for Medicare and Medicaid Services (CMS) is planning an exhaustive patient-safety initiative that will draw from already-known strategies for safer care. “Let’s make the best the norm,” said Dr. Donald Berwick, CMS administrator, citing as evidence of the efficacy of such initiatives the unfavorable patient events that – happily — are now virtually nonexistent at some of the nation’s hospitals.  Berwick is renowned for his “100,000 Lives” and “Protecting 5 Million Lives from Harm” campaigns, which he initiated when he headed the Institute for Healthcare Improvement before moving to CMS.

Berwick praised the Patient Protection and Affordable Care Act, as well as the information technology it supports to create the best possible healthcare delivery system.  Both offer tools that will allow coordinated-care plans for patients and encourage caregiver teams to manage those plans.  One of the tools will be accountable care organizations (ACO).  Berwick said the regulations defining ACOs under Medicare as “imminent.”  According to Berwick, the regulations will be in the form of a “notice of proposed rulemaking,” with a 60-day public comment period.  “This will be our first stab at that definition.”

Quality News Today notes that “Motivational efforts and inspirational talk may seem more the bailiwick of Super Bowl coaches than government bureaucrats.  But when one considers that Berwick’s successful career as a national leader in healthcare quality improvement boiled down to fostering an internal drive on the part of individuals and organizations to do better work, the efforts perhaps are no surprise at all.”  Berwick said that CMS’ strategy will focus on building operational excellence; improving care for individuals; integrating care for populations; and improving the health of populations and communities.  “We do have tremendous knowledge about how to make care safe,” Berwick said.  Some organizations have remarkable records in patient safety, but there are only “pockets of excellence.”  Berwick wants to “bring excellence to scale” and believes that CMS is up to the task.  “We can do well with a joyous work force, we can’t without it,” Berwick said,  “I myself will be teaching the first four 90-minute classes on improving the work.”

John Rother, executive vice president for policy for AARP, the Washington-based advocacy group for people 50 and older, applauds Berwick’s emphasis on patient safety. Changes have saved “lives and money,” Rother said.

Unfortunately — and despite excellent intentions — errors still occur in hospitals, even with the new safeguards. Ten years ago, the Institute of Medicine published its landmark report “To Err Is Human:  Building a Safer Health System.”  The report estimated that 44,000 to 98,000 deaths occur every year because of preventable medical errors in American hospitals.  According to Manoj Jain, an infectious-disease specialist and an adjunct assistant professor at the Rollins School of Public Health at Emory University in Atlanta, “But, to make hospitals really safe, we need to take a leap.  We need to build a culture in which patient safety is the priority not just for the quality improvement director but also for every nurse, doctor, administrator, aide, housekeeper, dietary worker and hospital board member.”

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