Editor’s Note: ‘Let’s Improve Our Way Out of This Mess’
Even at times of highest stress and acrimony during the recent political campaign, there were pockets of optimism within the medical community about our ability to solve the country’s healthcare problems. I’ve written about this refreshing and unexpected optimism before, following last year’s IHI National Forum. I ran into it again recently, not surprisingly, with Don Berwick, MD, who was the closing keynote speaker at the Pega Collaborative Healthcare Summit in Boston last month.
Berwick began by describing the environment and challenges he faced in July 2010, when he left his position as CEO and president of the Institute for Healthcare Improvement, having been “recess” appointed by President Obama to be head of the Centers for Medicare & Medicaid Services (CMS). The controversy and vitriol with which many in Washington greeted Berwick have been reported widely. His term at CMS ended at the end of 2011 when the recess appointment ran out with no prospect that the Senate would consider a further appointment. Since then, Berwick has traveled extensively, encouraging everyone to recognize that the healthcare challenge is difficult but by no means impossible to solve. In fact, the solutions at this point are well known and well tested.
In Washington, Berwick faced our national healthcare challenges, with responsibility for implementing the Affordable Care Act and providing healthcare (through Medicare and Medicaid) to one out of three people in the United States while facing a budget crisis and broken politics daily. At first, he wondered how to proceed:
My position at the sharp end of all this was a very wild ride, very exciting; not always pleasant, but always interesting. I had to get my bearings.…I’m a pediatrician, I ran a nonprofit for 20 years, and now I’m pulled into the White House four times a week, dealing with the congress… in a fraught environment, dealing with a very intense part of our economy. How do I get out of this… alive? My tendency was to go to what I know. What I know is quality improvement. Thirty years of my career has been about to make things better, anything better.
In addition to expertise and years of experience with improvement science, Berwick sees evidence of successful quality improvement, at least in pockets, across the country. In the rest of his talk at the Pega Healthcare Summit, Berwick shared success stories that demonstrate improvement in key areas: teamwork, Lean transformation, technology innovation, workforce and scope of practice expansion, and patient-centered design. Through these stories, he expressed confidence that we already know “how to improve our way out of this mess.” Our attempts to deal with the “mess”—an inefficient and ineffective delivery system, which is bolstered by counter-productive reimbursement schemes and often results in inconsistent access, poor outcomes (especially for chronic conditions), and a disaffected workforce—too often amount to reactionary cost cutting that makes the mess worse, certainly in the short run. Improving our way out of this mess is more likely to be successful in both the short and long term.
More of Berwick’s current thoughts on our healthcare challenges and solutions are available in a WIHI audio program available here.