Seeding a Simple Dream: Do No Harm
Pediatrician Donald Berwick left the bedside years ago, but he still cares very much for patients. For 15 years, the Institute for Healthcare Improvement, which he cofounded, has been a Johnny Appleseed for health change, roaming the nation to plant ideas that cut hospital deaths and complications. While IHI didn't invent most of these ideas, Berwick has become perhaps their most visible promoter. The most grandiose idea, which Berwick announced in late 2004, envisioned saving at least 100,000 lives over the following 18 months if enough hospitals agreed to employ a few low-cost measures such as raising the head of the beds of patients on ventilators to prevent pneumonia. Sure enough, when the final numbers were crunched, the campaign had saved an estimated 122,000 lives. Berwick talked with Avery Comarow, who directs U.S. News's "America's Best Hospitals" rankings, about making healthcare better and safer and how he found himself helping to lead the charge.
How did you land in this part of the medical universe?
The clearest answer is frustration. As early as I can remember in my medical training, I just was frustrated by how hard it was to get things done right and how little we knew. I think the other formative thing was the Kennedy School. I decided to get a master's degree in public policy along with medicine. That program was an amazing combination of political science, economics, quantitative methods, and really sophisticated systems theory. It just gave me a whole set of new tools.
Aren't all interns frustrated? Why did you react?
I don't know. But I remember one night in the emergency room, one patient after another rolling in with heart attacks, strokes, serious infections-and then the door of the emergency room flew open and there was a starry sky and a fresh breeze, and I came this close to just walking out. The pressure was so great.
Was there a tipping point when you decided you would look for solutions?
Probably 1986. I enrolled in a course with [the late management guru W. Edwards] Deming. The course was him talking for four days. I got increasingly uncomfortable because I thought it was pure drivel. The second morning I flew back home. That night I was very uncomfortable-sweating, tossing and turning, couldn't sleep. Suddenly I realized why I was so uncomfortable. Deming had presented a cogent, grounded theory that violated everything I'd been doing. My discomfort was not that he was so wrong but that he was so right.
What do hospital CEOs and trustees really think of you?
No one calls me up and says, "You're a jerk." In my heart, I think most of them think I'm unrealistic and don't understand the true world of management of institutions and organizations in a very hostile economic and political climate. They think I am a dreamer.
Whether you're talking to a big group or one person, you project a folksy intimacy. Is it something that you consciously developed?