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?
I grew up in a really small town, Moodus, Conn. I don't think when I walked down Main Street there was anybody I saw whose name I didn't know. That shaped me. I really do feel this unrealistic sense of knowing people. It's really weird. I have this experience flying-when I look down and I see the farms of Kansas below me, I have this little bit of surprise that I don't know everybody's name.
Effective leaders know their deficiencies. How do you address yours?
I don't feel like a leader, so it's very hard for me to project myself into that situation. But inattention to detail is my biggest defect. I'm always leaning forward into something new. I can create a mess. Luckily, I have people who are willing to create the detail around the idea or, if they're really smart, know which ideas to ignore.
The second defect is more personal uncertainty than you would probably believe. Every time I put an idea out, despite my enthusiasm, I'm very, very unsure about whether it's OK or not. And the third is that I want everyone to like me, and yet I'm aware that when you're pushing for change, that isn't always going to happen. To be more effective as a leader, I would probably want to thicken my skin.
Do you think there's less good leadership today than there once was?
Yes, I do. I don't know why, but people are getting their compass from their polling data and from their concern about what will be thought, or staying in power, and, man, I don't think that's leadership. I just think you've got to say: We are going here. If you're wrong and nobody follows you, that's OK.
How do you create a sense of mission in the people who work for you?
You're implying I show up in the room and say, "Today I'm going to inspire people." That's not how it goes with me. But I've learned about projecting optimism. Hope. There is a way out here. We can do this. Anything's possible. I really do believe this.
Have you made missteps that just made you put on the brakes and tell yourself, "I screwed up"?
The screw-ups that eat at me are when I have been inadvertently disrespectful of someone. I know points in a speech or in a meeting where I've hurt somebody with inappropriate humor or being insensitive or inattentive. [But] the biggest mistake I made that still eats at me is scoring a basket for the wrong team. I once did that in a basketball game. Oh, my God.
How do you organize your working day?
Badly right now. My day is largely reactive. I try to get dug out all day long, as if one could ever get dug out. The one thing I do is I negotiate with my assistants to establish what I call writing days. On writing days, I go to the public library in my town. I always go to the same carrel, and I sit there at 9 or 9:30, and I won't get up except to go to the bathroom until 5:30 or 6.
You have talked about how helpless you felt when someone close to you was hospitalized-even as a physician, you couldn't protect her from medication errors. Have things changed?
There would be no difference today. The average hospital is not yet committed from the boardroom and the executive level to the kind of order-of-magnitude changes and the level of safety and reliability that would make the experience of the patient fundamentally different. I wish I could say otherwise.
But thousands of hospitals have enlisted in at least one of your initiatives.
It's the difference between the first step and a completed journey. The real result will be when you can go to an American hospital and have confidence that you will not be hurt.
Will that happen eventually?
I used to think it would be in my lifetime. Now I'm not so sure.
Your days must be long and hectic. At the end of the day, can you still function?
It depends whether I'm traveling. Travel is absolutely exhausting to me-the airplanes and security lines and hotels and the inefficiency of moving my body around the country or the world. If I'm not traveling, I have energy to spare. Do you know the New York Review of Books? I'm addicted. I mean, if you say OK, Don, here's a half-hour you never expected to have. What do you want to do with it? I would die for that magazine and just read the next article in it.
This story appears in the October 30, 2006 print edition of U.S. News & World Report.