Donald M. Berwick

Director, Centers for Medicare and Medicaid Services, Health and Human Services Department

(nih.gov)

Why He Matters

Berwick is famous in the health-care system for advocating its destruction.

An academic who has spent his career looking for ways to deliver care more efficiently and effectively, Berwick has been called a "revolutionary." He believes the structure of the health-care system encourages good people to make harmful medical errors and waste millions of dollars. If he could, he'd blow the whole thing up and start over.

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Corrections?

Background

At a Glance

Career History: President, Institute for Health-Care Improvement (since 1991); Clinical Professor of Pediatrics and Health Care Policy, Department of Pediatrics, Harvard Medical School; Professor of Health Policy and Management, Harvard School of Public Health
Birthday: 1946
Hometown: Moodus, Conn.
Alma Mater: Harvard College, B.A., 1968; Kennedy School of Government, Harvard University, M.P.P., 1972; Harvard Medical School, M.D., 1972

Spouse: Ann (Greenberg) Berwick
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Path to Power

Berwick grew up in a tiny Connecticut town called Moodus.

Berwick's father fit the classic image of an American doctor, an independent operator who made house calls to the entire town.

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Berwick respected his father, but feared him, too, according the the Boston Globe.

Berwick told the Globe about an incident in which his father, "interrupted by yet another patient phone call during dinner, thundered, 'Look, I'm the doctor. I'll decide when you get medicine!' and then slammed down the phone receiver so hard that it shattered."

In 1964, Berwick left Moodus for Harvard, where he stayed.

After earning a bachelor's degree from Harvard College in 1968, he earned a master's in public policy from Harvard's Kennedy School of Government and a medical degree from Harvard, both in 1972.

Berwick did a pediatrics residency at Children's Hospital in Boston. That's where he said he first learned how harmful good intentions can be.

"I was taking care of a boy who had cancer. He was dying. I got close to him," Berwick told the Boston Globe. "One day, he got more and more distressed. I gave him an increase of his sedative dose. I pushed in some medicine to try to make him more comfortable. I did something wrong. The medicine precipitated in his IV tube. I didn't know what was happening. He was more and more distressed, saying, `Please help!' Somewhere during this period, I realized that his parents were upstairs. They were resting. I said to someone, `Go get his parents.' By the time they got to the room, he was unconscious. And I remember the mother looked at me, and she said, `How could you not call us?'"

Quality Improvement

Berwick began his medical career as a pediatrician in the Harvard Community Health Plan, an HMO run by a businessman who had worked in advertising and cosmetics.

In 1983, the CEO created a position to measure quality of care, and he asked Berwick to take the job.

Berwick spent much of 1985 traveling around the country to learn about quality improvement from organizations like Gillette, Sheraton, Bell Labs and NASA.

One problem: rather than focusing on measuring quality, Berwick became fascinated by improving quality. "Don and I didn't see eye to eye on this," his boss, Thomas Pyle, told the Globe.

In 1987, Berwick and some like-minded friends got a grant to start the National Demonstration Project on Quality Improvement in Health Care, which brought their ideas about improving care to 21 health organizations "in the hopes of turning them into Toyotas that could revolutionize health care the way the Japanese carmaker had scared Detroit straight."

By 1989, Berwick had quit his HMO job to run courses on quality improvement.

In 1991, Berwick used grant money to start the Institute for Healthcare Improvement, a nonprofit group aimed at helping health-care systems improve patient care.

In 1997, President Bill Clinton appointed Berwick to the Advisory Commission on Consumer Protection and Quality in Healthcare.

From 1999 through 2001, he chaired the National Advisory Council at the HHS's Agency for Healthcare Research and Quality.

'Escape Fire'

In early 1999, Berwick's wife became ill with a mysterious ailment that left her barely able to walk. After three months, countless tests and two invasive medical treatments, her condition began to improve. But her illness was never diagnosed, and Berwick was left stunned by the incredible amount of waste in the system.

That December, Berwick spoke about the experience at his Institute for Healthcare Improvement's annual national forum.

The speech, called "Escape Fire," became an instant legend. In it, Berwick told the story of a Montana fireman in 1949. Trapped by a monstrous fire, he burned a small swath of forest to clear the immediate area of brush. When the larger fire stormed through, he was left untouched.

Though the "escape fire" was too innovative for other firemen who died that day, it soon changed the ways fires were fought. To Berwick, that innovative thinking was what the health-care system needed.

Obama Nomination

"Escape Fire" made Berwick something of a health-policy folk hero. He continued lecturing around the country while holding dual professorships at Harvard Medical School and the Harvard School of Public Health as well as running IHI.

In March 2010, President Obama announced his intention to nominate Berwick to head the Centers for Medicare and Medicaid Services, an organization that had been without a permanent leader since 2006.

The Issues

Berwick is hero to many in health policy for his revolutionary ideas on delivering quality care. Berwick's ideal for hospitals consists of five concepts: no needless death, no needless pain, no helplessness, no unwanted waits and no waste.

Steven C. Findlay of the Consumers Union called Berwick's nomination to CMS "spectacular" in the New York Times. "Don has been an intellectual force in health care for decades," he said. "He helped forge many ideas incorporated in the new health-care law."

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Shortly after his nomination was announced, media outlets including the Fox News Channel attacked comments Berwick made claiming race was a factor in American life expectancy.

Media Matter for America said Fox and other conservative-leaning outlets were "adding a new target to the right-wing media's witchhunt of President Obama's appointees." They referenced government statistics that supported the claim that African-Americans in the U.S. have a shorter life expectancy than whites.

Quality vs. Quantity

Like President Obama, Berwick is a proponent of cutting costs in health care. He's best known for advocating a new payment system in which doctors would be paid based on the outcome of the service they provide, not on how many services they provide.

This approach has been criticized by providers because outcomes can be tricky things to predict and vary widely based on patients.

Rationing

Republicans criticized Berwick's approach to cost-cutting, saying it was really a form of rationing care.

Republicans have long argued that certain provision in the 2010 health-care overhaul would allow the government to deny select procedures to patients in the names of cost-cutting. "Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care," said Sen. Pat Roberts (R-Kan).

A bevy of Berwick quotes touting his love of Britain's National Health Service didn't help matters. That organization's strict rationing of care allows them to deliver care inexpensively to all of Britain, but made the system a bogeyman for the right during U.S. health-care debates.

Berwick's hometown paper, The Boston Globe, came to his defense, saying Berwick found innovative ways to reduce costs and Republicans were "picking the wrong target."

Physician Discretion

Berwick believes the health-care system would be safer if physicians had fewer opportunities to make decisions. Instead, he believes they should follow scientifically-determined protocols.

"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety," Berwick told the Boston Globe in 2004. "Doctors will hate me for saying that."

Doctors' groups argue that each patient is unique and responds to treatments in a slightly different way. Therefore, forcing doctors to follow protocols would not only sterilize the doctor-patient relationship but also possibly harm patients.

Information Technology

In his cost-cutting efforts, Berwick supports using information technology to reduce costs and medical errors by condensing patients' paper charts into a single electronic record.

He and Obama's National Coordinator for Health Information Technology David Blumenthal were called a health-care IT "dream team."

The Network

At Harvard, Berwick worked with fellow health cost-cutter David Blumenthal, who was named Obama's National Coordinator for Health Information Technology. Working together, the two have been called a "dream team" for getting paper medical records into electronic form.

Berwick is one of many Harvardians to get a call from the Obama aministration. Fellow health policy wonk, economist David Cutler advises the OMB on health care.

Additional Resources