The revolutionary
Donald Berwick says our nation’s world-class hospitals and doctors are delivering health care that is unsafe and unreliable. But his call to dismantle the system makes the medical establishment uneasy — especially since he used to be part of it.
By Neil Swidey, Globe Staff, 1/4/2004
… Every year, up to 98,000 people are believed to die in American hospitals because of medical mistakes. The studies that provided the basis for that chilling estimate were not Berwick’s, yet no one has done more to ensure that the findings remain at the top of the national health care agenda. And Berwick is committed to doing more than just sounding alarms. He believes health care can be dramatically improved if it takes to heart the systems-improvement work that has transformed other industries, and if it focuses on eliminating the danger, waste, confusion, and arrogance that are pulling medicine down. He and his institute are working with several hundred health care organizations, large and small, in an effort to post results that would back up his theories. The swelling ranks of Berwick’s acolytes speak of him in almost messianic terms. “Don Berwick should win the Nobel Prize for Medicine,” says Blair Sadler, who runs San Diego Children’s Hospital. “I think he has saved more lives than any doctor alive today.”
But the deeper Berwick has gotten into the problem over the last decade, the more radicalized he has become. At this point, mild-mannered, soft-spoken, self-effacing 57-year-old Don Berwick can best be described as a revolutionary. A lot of people say the current health care system is broken, but by that they mean the manner of financing it. Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care, no matter how many innovations its renowned doctors roll out, no matter how many awards they rack up. “They want to cure cancer,” Berwick says. “Well, how about curing health care?”
His conclusion: To save the health care system, it first needs to be blown up.
his is what health care would look like if Don Berwick ruled the world, rather than just traveled it:
When you wanted to see your doctor, you would call in the morning and get an appointment that afternoon. And it would start on time, not an hour and three outdated People magazines later.
You would maintain control of your medical record, rather than needing a subpoena just to get a peek at it.
Hospitals would have genuine one-stop registration, and every employee would be trained to have the customer-service touch of a Ritz-Carlton concierge. No one would ask you to wear one of those open-backed johnnies.
Waiting would be kept to a minimum, because the hospital will have embraced flow management, anticipating rather than just reacting. There would be no visiting hours in the intensive care unit, since any family member could visit at any time.
Medication errors — overdoses, allergic reactions, and other adverse responses — would be all but eliminated by the universal adoption of computerized drug-ordering systems. Hospitals would impose a zero-tolerance policy for workers failing to wash their hands, a move that could save upward of 10,000 lives a year.
Communication and patient-advocacy systems would put an end to horror stories like the one involving the 5-year-old boy who died at Children’s Hospital last year because each of his many doctors assumed another doctor was in charge.
Waste would be systematically reduced. Hospital performance would become so transparent that finding the best place to get an operation would be almost as easy as shopping for a new TV online.
And the treatment you receive from your doctors would be made far more effective by a system that gave them less discretion. Physician habit and ego would take a back seat to science in determining standardized courses of medical action. Berwick argues that in terms of improving safety, health care could learn a lot from aviation, where commercial pilots have much less discretion than they used to.