Friday, December 2, 2011

“A Healthcare Icon is Forced Out of Service to Our Country”

It’s rare that you find an individual who is really about a goal and not so much about themselves.  Donald Berwick, M.D. is someone who for decades has embodied a zeal for improving healthcare through the eyes of the patient.

In the summer of 2010, ironically just a few weeks after I joined GBMC HealthCare, my old mentor Dr. Berwick was named as a recess appointment by President Obama as administrator of the Centers for Medicare and Medicaid Services (CMS).  During his brief time at the agency, you could palpate the difference in the tenor of the CMS operation at headquarters because he bolstered the spirits of people working there and gave them new hope.

Dr. Berwick is the person best-equipped to have pulled off the redesign of our national healthcare system to meet the “Triple Aim” of Better Health, Better Care and Lower Cost but as of today he’s going to be gone from service to our federal government.

My professional relationship with Dr. Berwick goes back several decades to when I was finishing my chief residency at the University of Massachusetts in pediatrics. I had gone into the residency with the intent of becoming a community-based general pediatrician but then got turned on to academic medicine.  During my fellowship at Boston Children’s Hospital / Harvard Medical School in general academic pediatrics, I had the good fortune of being assigned Dr. Berwick as my research mentor.

Don is known today as a healthcare policy expert and the universe’s  leading authority in the area of healthcare quality improvement but when I was assigned to him in 1982, Dr. Berwick was a practicing pediatrician and vice president for quality-of-care measurement at Harvard Community Health Plan. He was exploring the work of people like Harvey Fineberg and Jack Wennberg who were writing about variation in medical care. Even back then, it was known that much of what we do in health care does not actually benefit the patient and that there is a broad gap between what the evidence says should be done and what is actually done.

Dr. Berwick studied the science of decision-making and became the  president of the Society for Medical Decision Making. He had a curiosity about the logic of using diagnostic information to help patients and how to help clinicians understand this logic. I had the good fortune of being present when Dr. Berwick dedicated the annual SMDM meeting to quality improvement and to Avedis Donabedian MD, the father of quality improvement in healthcare, who was given a lifetime achievement award.

Berwick began studying the history of quality improvement in industrial America and learning about the greats of the continuous improvement movement, such as W. Edwards Deming and Walter Shewhart, and realized that the tenets of industrial quality improvement were also applicable to health care.

Dr Berwick aligned with Dr. Paul Batalden, a pediatrician working for the Hospital Corporation of America, and they applied for a grant for a national demonstration project on quality improvement in healthcare.  They studied 16 different hospitals across the country and set out to redesign systems to get better outcomes for the American people.  The initiative was successful and spawned a book called “Curing Healthcare” and at the end of the project they used the momentum to start a new organization.  The Institute for Healthcare Improvement  (IHI) is now almost 25 years old and has been the international leader in improving healthcare, working domestically and internationally.

Dr Berwick got the idea a decade ago to borrow concepts from political campaigning to reduce harm in U.S. hospitals.  He started the 100,000 Lives Campaign and then moved on to the 5,000,000 Lives Campaign, both of which were very successful at improving care.  The federal government has learned from those initiatives and has grasped much of what he started even before he got to CMS. GBMC has participated in and learned from these initiatives. Our wonderful results in reducing central line associated bloodstream infections (CLABSI) are a direct offshoot of the work that Dr. Berwick began.

It was because of all of his wonderful accomplishments that President Obama invited Dr. Berwick to become the head of CMS and to implement the Affordable Care Act.  The fact that the most intelligent leader in healthcare who has accomplished the most internationally in improving health systems would be willing to join the federal government and take on a huge federal agency was a gift to the American people.

But now, sadly because of political payback, stupidity, and pettiness among elected officials who did not like the healthcare reform act, his term is ending prematurely and Dr. Berwick is going to have to leave before the  job is done. It is very disappointing that the American people don’t even know who he is or what he was trying to do. I believe the best person to fix our healthcare system is being thrown out by people who don’t understand healthcare or the American dilemma of spending almost twice what other developed nations spend on healthcare and having outcomes that are often not as good.

Donald Berwick has not spent one moment in his life in the “victim box”. He never focuses on the problem, instead he quickly gets in action on the solution. So, rather than lament Dr. Berwick’s departure from CMS, we must rededicate ourselves to the continual improvement of our healthcare system starting with what we control at GBMC. We must work hard and speed-up our transformation towards better health, better care, lower cost, and more joy for those providing the care!

Please share your thoughts on Dr. Berwick’s work or how we can make change happen faster in our system.

On a happier note, please join me in welcoming Deloris Simpson Tuggle to our family as the new vice president of human resources and organizational development/ chief human resources officer for the GBMC HealthCare system.  Deloris is an industry veteran with more than 20 years of experience in human resources and organizational development. Deloris will officially join GBMC on December 5.

Deloris Simpson Tuggle
As we continue our metamorphosis from an outstanding hospital into an outstanding system of health we need leaders who understand our vision and see their role as extended beyond the borders of our beautiful campus; Deloris is this type of person.

Deloris will have responsibility and oversight for planning, organizing and providing leadership and direction for the organization’s human resources functions including policy development, interpretation and administration; recruitment, orientation and retention of employees; compensation and benefits programs; performance management and competency assessment; employee relations and labor relations; and training and development programs.

Deloris comes to GBMC from the Dana-Farber Cancer Institute in Boston, Mass. where she spent three years in the roles of senior director of human resources and interim senior vice president of human resources for the Harvard Medical School-affiliated organization.  She also has worked for the May Institute in Randolph, Mass., Lifespan Healthcare Systems in Providence, R.I., The Housing Services Company in Boston, Mass. and Trans World Airlines.

Deloris has told me that living in the Baltimore area is “a wish come true.” She has an affinity for Maryland and has two brothers in the area. She is looking forward to moving to Baltimore. Please join me in welcoming Deloris.

1 comment:

  1. I appreciate Dr. Chessare’s tribute to Don Berwick. In the year Dr. Chessare was assigned to Dr. Berwick – 1982 – I had the privilege of receiving my first lessons on Quality from Dr. Donabedian as a student at the University of Michigan. I also attended this year’s IHI meeting in Orlando and was inspired by the Keynote speakers and innovative presenters. The final Keynote by Dr. Berwick was somewhat disillusioning because of his characterization of the “cynics” in Washington, but more motivational through the faith he puts in us healthcare providers to overcome all obstacles and challenges to provide the best experience for the people we serve. As a health care administer who formerly worked for a system in Baltimore and lives in the area, I’m excited to learn that a disciple of Don Berwick and leader of a well-respected medical center is bringing the Triple Aim to the region.
    Andy Cohen


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