From The WBUR Archives: A Health Care Knight

President Obama will soon nominate Donald Berwick, a Harvard professor, pediatrician and the CEO of the Cambridge-based Institute for Healthcare Improvement, to oversee Medicare and Medicaid, according to administration sources.

As the newly enacted health care overhaul increases the power and responsibilities associated with the oversight position, WBUR turns to its archives for past coverage of the local doctor.

Below, WBUR's Martha Bebinger featured Dr. Berwick on Aug. 15, 2005 after he was knighted by Queen Elizabeth II for his work with the British National Health Service.

Dr. Donald Berwick (Courtesy)
Dr. Donald Berwick (Courtesy)

BOSTON — He's not a household name like Jimmy Carter, Colin Powell or Bob Hope, and his impact on society may be more subtle than that of Ronald Regan or Steven Spielberg. But Newton doctor Donald Berwick is joining their ranks as an Honorary Knight Commander of the British Empire.

Dr. Berwick is a man on a mission, and while he is polite and savvy, he is also impatient with the state of health care in America.

"If we know that there are hospitals that can reduce mortality or can save lives by not allowing infections to occur someplace, why don’t we do it everyplace?" Dr. Berwick asks. "The gaps are too big to live with — it’s unconscionable how far we are from the quality we ought to have."

Dr. Berwick and his staff of 70 crusade for better and more cost effective care out of the Institute for Healthcare Improvement (IHI), which he helped found in 1991. The organization's work caught the attention of the United Kingdom's National Health Service, and when the Labour Party and Tony Blair took power in 1997, Dr. Berwick was the only foreign member appointed to a board that created a new NHS plan.

Richard Smith, a former editor of the British Medical Journal, now runs a division of United Healthcare. Smith said the board adopted many of Dr. Berwick's ideas for reducing hospital infections, medication errors, patient waiting times and waste in the system.

"His contributions to the NHS have been formidable," Smith said.

Smith credits Dr. Berwick with helping to persuade the NHS not to impose top-down changes. He said Dr. Berwick convinced the board that to encourage better work, simply telling people to do things better wouldn't be enough.

"It’s unconscionable how far we are from the quality we ought to have.”

"You need processes and you need to inspire people and lead them and give them freedom to innovate and change," Smith said. "Don was very, very instrumental in making that happen because he had the ear and respect of very influential people, not only within the NHS, but politically."


The official ceremony, when Dr. Berwick becomes a knight, will take place sometime later this year. Because he isn't British, he won't bow for the tap of a sword on each shoulder and won't command the title, "Sir." He will get a gold medal with a pink rose and gray ribbon that he can wear to ceremonies, such as the Queen's birthday.

Dr. Berwick said he's deeply grateful for the honor, and that he's rolling with the punches.

"I've heard more knight jokes in the last few months than I thought existed," he said. An example?

"Here's one from the kid across the street from me: Two knights are sitting in a pub. The first knight says, 'Sir G. just sent me a letter saying we should go on a quest for the Holy Grail. He got word from Sir L. Will you sign your name to this and send it on to the other knights?' And the second knight responds, 'No, I have chain mail.' That's the quality of the joke I'm getting, every day!"

James Mongan, the CEO at Partners HealthCare, has worked with Dr. Berwick at the National Institute of Medicine. Mongan said two reports Dr. Berwick helped produce for the IOM were watershed events for the medical community.

"For many, many years before these reports, people focused a lot on quality and took safety for granted," Mongan said. "They would say they had the best example, say, in Kansas City, but it was because they had the best heart surgeon or the most advanced equipment. Don forced a focus on safety on its own feet, in addition to concerns about quality."

These days, Dr. Berwick's IHI is spearheading a campaign to reduce hospital patient deaths by 100,000 per year. So far, 2,500 hospitals have agreed to dozens of changes, such as bar coded patient bracelets, tilting the bed for those on a ventilator to prevent pneumonia, and making sure heart failure patients get beta-blockers.

But Dr. Berwick is still frustrated by what he sees as a lot of nods of agreement that don't always translate into changes in the United States — compared to the United Kingdom, where his ideas got traction, particularly among health care leaders.

"When I'm in the U.K., as opposed to the U.S., there's somebody to talk to — it's a central system that's centrally funded," he said. "I feel like there's somebody on the other side of the table saying, 'How shall we change, how shall we do it?' When here in the U.S., we have close to 6,000 hospitals, which means we have to address the problem 6,000 times."

He added: "It’s a very hard and fragmented problem and pace is slow."

"If, as a country, we could wake up and give up this belief that more is better, we would have a rational supply of care. There are answers, they're just not answers we're willing to swallow yet as a country."

Dr. Berwick believes a national American health plan would improve care and reduce costs, but he knows that politicians and most of his colleagues say that a single-payer health care system is a non-starter here. They argue that Americans with health insurance won't go for limits on where or when they can get care.

Dr. Berwick points to a 2003 Dartmouth College study that says the best quality care is in areas with a minimum number of hospitals, labs and doctors.

"If, as a country, we could wake up and give up this belief that more is better, we would have a rational supply of care, exactly where we need it, and not be wasting on oversupply," he said. "There are answers, they're just not answers we're willing to swallow yet as a country."

But Dr. Berwick is optimistic that patients and employers will get tired of paying more for what he says is inadequate care and warm to the idea of adopting a more streamlined health care system.

Until then, he says he sees health care in the U.S. on a collision course — unless the current fragmented system is consolidated and coordinated into a more integrated system. In the meantime, Dr. Berwick continues to push strategies for improvement.

"We gotta' get to some of the insurers," he said. "They know they need to change, and this is the bridge. We know we’ve proved the quality in spades."

This program aired on April 6, 2010. The audio for this program is not available.


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