Another Blow to Health Reform?

The head of the Centers for Medicare and Medicaid Services (CMS), Don Berwick, announced he would step down from his post on Wednesday.  Berwick was a temporary 18 month appointment who Obama hoped would stay on longer.  The San Francisco Chronicle reports

The point man for carrying out President Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Don Berwick aimed to improve healthcare quality in Medicare.  Many individuals, however, have tried to improve the quality of care provided to Medicare enrollees.  Why would might Berwick’s efforts have been any more successful than his predecessors?  John McDonough of Health Stew notes that Berwick has a legacy of promoting quality improvement across a variety of healthcare organizations.

In 1989, Berwick wrote a seminal article for the New England Journal of Medicine called “Continuous Improvement as an Ideal in Health Care,” and set off an intellectual revolution in American, and eventually, global medicine. Prior to Berwick, “quality” had been linked with the word “assurance” with the cavalier and false assumption that quality already existed, and all that was needed was adequate policing to root out “bad apples.” Every hospital was required to have a “quality assurance” department that looked out for quality; everybody else just did their jobs.

More than anyone, Berwick changed the word from “assurance” to “improvement” with new assumptions: quality must be an essential part of everyone’s job; no matter how good or how bad you think you and your organization are, every day, you have multiple opportunities to improve; and the key to quality improvement (QI) is the elimination of errors and waste, along with the empowerment of workers. Berwick did more than just establish an idea, he created an organization, the Institute for Healthcare Improvement (IHI), to advance and actualize it. Under his leadership, IHI has become the worldwide home for QI through training, teaching, learning, collaborating, advocating, and more.

Berwick also ran into trouble for using the ‘r’ word.  Specifically, in an interview with a biotechnology journal in 2009, he said, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

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