Physician, patient involvement critical for solving healthcare crisis

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CHICAGO–The professional community must take an active involvement in solving the U.S. healthcare crisis or a solution will be thrust upon them, according to Donald M. Berwick, who delivered the annual Simon Dack Lecture at the American College of Cardiology (ACC) Scientific Sessions on Sunday.

“You’re either at the table or you’re on the menu,” he observed.

Berwick, president and CEO of Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), is also clinical professor of pediatrics and healthcare policy at Harvard Medical School and serves on the Institute of Medicine governing council.

“We are struggling as a nation trying to move what is possible into what is standard,” he said. “We’re trying to make the best care, everyone’s care. And that can’t be done in a set of individual, separate initiatives. It’s not about autonomy anymore; it’s not about individual heroism – it’s about us doing this together and deciding that the improvement of care on behalf of our public should be at the strategic center of everything that’s done.”

Berwick noted that the U.S. spends twice as much on healthcare as other industrialized nations yet ranks lower on many significant measures, such as mortality and outcomes, than countries spending half as much.

“That’s not too happy a story,” he observed. “We have an audacious system able to produce technical miracles but apparently missing some level of performance at the system level. It’s disturbing.”

Berwick said the primary aim of the IHI is to help accelerate change in healthcare by cultivating promising concepts for improving patient care and turning those ideas into action. The IHI has five measureable goals that guide its work:

1. No needless deaths
2. No needless pain or suffering
3. No helplessness in those served or serving
4. No unwanted waiting
5. No waste

“Every system is perfectly designed to achieve exactly the results it gets,” Berwick said. “We need to design systems based on human frailty.”

This design concept takes into account that humans are imperfect and creates systems that can eliminate medical errors.

Berwick cited the 100,000 lives campaign as an example of healthcare professional involvement in creating such a successful system.

This campaign, begun in 2006, sought to save 100,000 lives by deploying rapid response teams at the first sign of patient decline; deliver reliable, evidence-based care for acute myocardial infarction; prevent adverse drug reactions; prevent central-line infections; prevent surgical site infections; and prevent ventilator-associated pneumonia. These six changes, adopted by more than 2,800 hospitals, achieved the goal of the campaign, Berwick said.

The IHI has since created the 5 million lives campaign, a voluntary initiative with more than 3,700 hospitals enrolled to protect patients from 5 million incidents of medical harm between December 2006 and December 2008. (More information about the initiative is available on the IHI website at:

Berwick is convinced that reform led by the greatest stakeholders in the system, healthcare professionals and patients, will provide the best solution to the healthcare crisis. The transition to such a system will not be easy he cautioned.

“The transition state is painful,” he said. “Every stakeholder in America would have to put something on the table in order to reach population-based care at the level we could technically. Will the professional-based community arise to lead this? Or will it simply be one of the stakeholders so frightened of that transition state that we don’t appear to get there from here? That’s the question you face now.”

ACC president, James T. Dove, MD, echoed Berwick’s call to action for healthcare reform led by clinical professionals in his address during the session.

“If we don’t do it, someone else will and it won’t be good,” he stated.