Healthcare Reform: Call for Revolution Goes Mainstream



There is hardly a day that goes by that I don’t receive an email or read an item in a newsgroup about someone who has had problems with our heathcare system. The striking thing about these notes is the shock people have about being harmed and the aloneness they feel like a wolf howling in the wilderness. However, they are not alone and they should read Don Berwick’s new book, “Escape Fire: Designs for the Future of Health Care.” There are other wolves out there howling.

Healthcare leaders are well aware of the problem and have been given a mandate to do something about it by the Institute of Medicine initial patient safety report, “To Err is Human.” Medical errors are conservatively the third leading cause of death in the United States and that includes only inpatient medical errors in hospitals. Healthcare leaders are also aware that nothing of substance has yet been done about it, as noted by the Washington Post Editorial, “A Medical Enron.”

When change will not happen peacefully, you need a revolution, and Dr. Berwick, Harvard Professor of Clinical Pediatrics and Healthcare Policy and CEO of The Institute for Healthcare Improvement is emerging as one of the leading revolutionaries. The book is his collected keynotes speeches at the National Forum on Quality Improvement in Health Care from 1992-2004. It starts off with “Kevin Speaks” given in 1992.

Kevin had most of his small intestine removed at the age of 2 and at 15, Dr. Berwick asked him to write down three things that especially pleased him about healthcare system in the life of a child with chronic illness. He also asked Kevin to provide a score of the percent of time these things occurred.

Care is best when:

1. They tell you what’s going on right away. 35%

2. You get the same answer from everyone. 30%

3. They don’t make you scared. 40%

The system got failing grades in 1992 and it is not much better now, maybe worse. So Berwick said in 1992:

In the storm of the health care crisis–the variations on “pay or play” or the “Canadian option” or “managed competition”; in the various debates about rationing and protocols and incentive compensation, and even about TQM–it is so easy–frighteningly easy–to forget why we trouble ourselves in the first place. It is so easy–frighteningly easy–to become trapped in the sterile thesis that our institutions must survive simply because they must survive, or that our true, deep purpose is to gain and preserve market share in a vacant terrain of others whose purpose is precisely the same. It is easy to believe that our habits of work are somehow valid and worth defending in isolation from the reason that work exists in the first place.

But the work is not there in the first place. The work is second. In the first place there is Kevin. “Tell me what you know right away,” he asks. “Comfort me, answer me, do not make me wait or waste my time. Try not to frighten me,” he asks. And unspoken, because he is so frightened, is the most important request of all; “To the very best of your ability, help me live and grow.” We are not there to survive. We are there to help Kevin survive.

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