Donald Berwick
Encyclopedia
Donald M. Berwick is the outgoing Administrator of the Centers for Medicare & Medicaid Services (CMS)
. Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI) a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama
appointed Dr. Berwick to serve as the Administrator of CMS through a recess appointment; on November 23, 2011, the White House announced that he would be leaving his position on December 2.
Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine
and comparative effectiveness research to improve the tradeoff among quality, safety and costs. Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile
infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.
Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor, and his favorable statements about the British health care system. They quote Berwick as saying, “The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open.” They point to statements such as, “Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
Supporters contend rationing already is done by insurance companies and Berwick simply wants transparency and accountability in medical decisions.
. Berwick graduated with a B.A.
from Harvard College
, and received an M.P.P.
from John F. Kennedy School of Government
at Harvard University
and an M.D.
from Harvard Medical School
. He completed his medical residency in pediatrics at Children's Hospital Boston
.
Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement. In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings. From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI.
Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School
and Professor of Health Policy and Management at the Harvard School of Public Health
. He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston
, and a Consultant in Pediatrics at Massachusetts General Hospital
.
Based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. IHI’s work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.
IHI's vision for health care is an adaptation from the Institute of Medicine
's six improvement aims for the health care system – care that is safe, effective, patient-centered, timely, efficient, and equitable:
Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).
An editorial wrote that his policy ideas could cut health care costs. Conservatives criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.
Berwick advocates cutting health costs by adopting some of the approaches of Great Britain’s National Health Services (NHS) and its National Institute for Health and Clinical Excellence
(NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS, as guidance for local authorities to decide what to cover. Mark McClellan
, who served in the Bush administration, also advocated adopting some of NICE's methods.
Conservative critics claim, "NICE decides which healthcare people will get and which they won’t." Philip Klein in The American Spectator
dubbed him “Obama’s Rationing Man.” The chairman of NICE called these statements "outrageous lies."
Senator John F. Kerry defended Dr. Berwick against “phony assertions” and accused Republicans
of using an “attack machine [to] make his nomination a distorted referendum on reform.”
Dr. Berwick was installed by recess appointment
on July 7, 2010 before confirmation hearings were scheduled by the Democratic
-controlled Senate committee. Dr. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Dr. Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter broke along partisan lines as all were Republicans.
The quote "What can you do by next Tuesday?" is frequently credited to Berwick but seems to have been coined by the authors of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians, which they wrote under the IHI aegis.
Blog posts
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
. Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI) a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
appointed Dr. Berwick to serve as the Administrator of CMS through a recess appointment; on November 23, 2011, the White House announced that he would be leaving his position on December 2.
Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
and comparative effectiveness research to improve the tradeoff among quality, safety and costs. Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.
Berwick's critics have cited his statements about the need for health care to redistribute resources from the rich to the poor, and his favorable statements about the British health care system. They quote Berwick as saying, “The decision is not whether or not we will ration care - the decision is whether we will ration with our eyes open.” They point to statements such as, “Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
Supporters contend rationing already is done by insurance companies and Berwick simply wants transparency and accountability in medical decisions.
Biography
Berwick graduated from Nathan Hale-Ray High School in Moodus, ConnecticutMoodus, Connecticut
Moodus is a census-designated place in East Haddam, a town in Middlesex County, Connecticut, United States. The population was 1,263 at the 2000 census.-Geography:...
. Berwick graduated with a B.A.
Bachelor of Arts
A Bachelor of Arts , from the Latin artium baccalaureus, is a bachelor's degree awarded for an undergraduate course or program in either the liberal arts, the sciences, or both...
from Harvard College
Harvard College
Harvard College, in Cambridge, Massachusetts, is one of two schools within Harvard University granting undergraduate degrees...
, and received an M.P.P.
Master of Public Policy
The Master of Public Policy , one of several public policy degrees, is a master's level professional degree that provides training in policy analysis and program evaluation at public policy schools. The MPP program places a focus on the systematic analysis of issues related to public policy and the...
from John F. Kennedy School of Government
John F. Kennedy School of Government
The John F. Kennedy School of Government at Harvard University is a public policy and public administration school, and one of Harvard's graduate and professional schools...
at Harvard University
Harvard University
Harvard University is a private Ivy League university located in Cambridge, Massachusetts, United States, established in 1636 by the Massachusetts legislature. Harvard is the oldest institution of higher learning in the United States and the first corporation chartered in the country...
and an M.D.
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
from Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
. He completed his medical residency in pediatrics at Children's Hospital Boston
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
.
Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement. In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings. From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI.
Berwick is Clinical Professor of Pediatrics and Health Care Policy in the Department of Pediatrics at the Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
and Professor of Health Policy and Management at the Harvard School of Public Health
Harvard School of Public Health
The Harvard School of Public Health is one of the professional graduate schools of Harvard University, located in the Longwood Area of the Boston, Massachusetts neighborhood of Mission Hill, which is next to Harvard Medical School. HSPH is considered a significant school focusing on health in the...
. He is also a pediatrician, Adjunct Staff in the Department of Medicine at Children's Hospital Boston
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
, and a Consultant in Pediatrics at Massachusetts General Hospital
Massachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
.
Based in Cambridge, Massachusetts, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. Employing a staff of approximately 100 people and maintaining partnerships with hundreds of faculty members, IHI offers programs that aim to improve the lives of patients, the health of communities, and the satisfaction of the health care workforce. IHI’s work is funded primarily through fee-based programs and services, and also through the support of foundations, companies, and individuals. IHI provides program scholarships, research and development, professional education, and initiatives in developing countries.
IHI's vision for health care is an adaptation from the Institute of Medicine
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
's six improvement aims for the health care system – care that is safe, effective, patient-centered, timely, efficient, and equitable:
- No Needless Deaths
- No Needless Pain or Suffering
- No Helplessness in Those Served or Serving
- No Unwanted Waiting
- No Waste
- No One Left Out
Berwick has published over 129 articles in professional journals on health care policy, decision analysis, technology assessment, and health care quality management. He is the co-author of several books, including Cholesterol, Children, and Heart Disease: an Analysis of Alternatives (1980), Curing Health Care (1990), and New Rules: Regulation, Markets and the Quality of American Health Care (1996).
Nomination and controversy
On April 19, 2010, Dr. Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid, which oversees the two federal programs.An editorial wrote that his policy ideas could cut health care costs. Conservatives criticized Berwick, based on comments he made about health care being, by definition, redistribution of wealth, rationing care with "our eyes open" and complete lives system.
Berwick advocates cutting health costs by adopting some of the approaches of Great Britain’s National Health Services (NHS) and its National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence is a special health authority of the English National Health Service , serving both English NHS and the Welsh NHS...
(NICE). NICE evaluates the costs and effectiveness of medical therapy that is covered by the NHS, as guidance for local authorities to decide what to cover. Mark McClellan
Mark McClellan
Mark Barr McClellan is currently the Director of the Engelberg Center for Health Care Reform, Senior Fellow in Economic Studies and Leonard D. Schaeffer Director's Chair in Health Policy Studies at the Brookings Institution in Washington, DC. McClellan served as Commissioner of the United States...
, who served in the Bush administration, also advocated adopting some of NICE's methods.
Conservative critics claim, "NICE decides which healthcare people will get and which they won’t." Philip Klein in The American Spectator
The American Spectator
The American Spectator is a conservative U.S. monthly magazine covering news and politics, edited by R. Emmett Tyrrell Jr. and published by the non-profit American Spectator Foundation. From its founding in 1967 until the late 1980s, the small-circulation magazine featured the writings of authors...
dubbed him “Obama’s Rationing Man.” The chairman of NICE called these statements "outrageous lies."
Senator John F. Kerry defended Dr. Berwick against “phony assertions” and accused Republicans
Republican Party (United States)
The Republican Party is one of the two major contemporary political parties in the United States, along with the Democratic Party. Founded by anti-slavery expansion activists in 1854, it is often called the GOP . The party's platform generally reflects American conservatism in the U.S...
of using an “attack machine [to] make his nomination a distorted referendum on reform.”
Dr. Berwick was installed by recess appointment
Recess appointment
A recess appointment is the appointment, by the President of the United States, of a senior federal official while the U.S. Senate is in recess. The U.S. Constitution requires that the most senior federal officers must be confirmed by the Senate before assuming office, but while the Senate is in...
on July 7, 2010 before confirmation hearings were scheduled by the Democratic
Democratic Party (United States)
The Democratic Party is one of two major contemporary political parties in the United States, along with the Republican Party. The party's socially liberal and progressive platform is largely considered center-left in the U.S. political spectrum. The party has the lengthiest record of continuous...
-controlled Senate committee. Dr. Berwick could thus serve until the summer of 2011 without a Senate approval. The White House had talked up the possibility of a re-nomination through the fall of 2010; on January 26, 2011, the President re-nominated Dr. Berwick. On March 4, 2011, 42 U.S. Senators wrote the White House and asked for the nomination to be withdrawn. The signers of the letter broke along partisan lines as all were Republicans.
Awards and honors
- Ernest A. Codman Award, 1999
- Alfred I. DuPont Award for excellence in children’s healthcare, 2001
- American Hospital Association, "Award of Honor", 2002
- Fellow of the Royal College of Physicians in London, 2004
- Honorary Knight Commander of the Most Excellent Order of the British EmpireOrder of the British EmpireThe Most Excellent Order of the British Empire is an order of chivalry established on 4 June 1917 by George V of the United Kingdom. The Order comprises five classes in civil and military divisions...
, 2005 - Purpose Prize for "enlisting wide-scale cooperation and scientifically-proven protocols to help hospitals improve care and save more than 100,000 lives," 2007
- The 13th Annual Heinz AwardHeinz AwardThe Heinz Award is an award currently given annually to ten honorees by the Heinz Family Foundation. The Heinz Awards recognize outstanding individuals for their contributions in the five areas of: Arts and Humanities, the Environment, the Human Condition, Public Policy, and Technology, the Economy...
for Public Policy, 2007
Quotations
- "Some is not a number. Soon is not a time." (slogan for IHI's completed 100K Lives Campaign, now slogan for IHI's 5 Million Lives Campaign in progress)
- "We are guests in our patients’ lives; and we are their hosts when they come to us. Why should they, or we, expect anything less than the graciousness expected by guests and from hosts at their very best. Service is quality."
- "We are not hosts in our organizations so much as we are guests in our patients’ lives."
- "Some say that doctors and patients should now be partners in care. Not so, I think. In my view, we doctors are not our patients' partners; we are guests in our patients' lives. We are not hosts. We are not priests in a cathedral of technology."
- "You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker and that any health care funding plan that is just, equitable, civilized and humane must, MUST redistribute wealthRedistribution (economics)Redistribution of wealth is the transfer of income, wealth or property from some individuals to others caused by a social mechanism such as taxation, monetary policies, welfare, nationalization, charity, divorce or tort law. Most often it refers to progressive redistribution, from the rich to the...
from the richer among us to the poorer and the less fortunate. Excellent health care is, by definition, redistributional."
The quote "What can you do by next Tuesday?" is frequently credited to Berwick but seems to have been coined by the authors of Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians, which they wrote under the IHI aegis.
Selected publications
- Berwick DM, Cretin S, Keeler EB. Cholesterol, children, and heart disease: an analysis of alternatives. New York: Oxford University Press, 1980. ISBN 0-19-502669-1.
- Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC. Preferences for health outcomes. Comparison of assessment methods. Med Decis Making. 1984;4(3):315-29. PMID 6335216.
- Berwick DM, Weinstein MC. What do patients value? Willingness to pay for ultrasound in normal pregnancy. Med Care. 1985 Jul;23(7):881-93. PMID 3925259.
- Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL. Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis. Arch Gen Psychiatry. 1987 Jun;44(6):550-5. PMID 3579501.
- Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989 Jan 5;320(1):53-6. PMID 2909878.
- Perrin JM, Homer CJ, Berwick DM, Woolf AD, Freeman JL, Wennberg JE. Variations in rates of hospitalization of children in three urban communities. N Engl J Med. 1989 May 4;320(18):1183-7. PMID 2710191.
- Berwick DM, Godfrey AB, Roessner J. Curing health care: new strategies for quality improvement. A report on the National Demonstration Project on Quality Improvement in Health Care. San Francisco: Jossey-Bass, 1990. ISBN 1-55542-294-2.
- Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991 Feb;29(2):169-76. PMID 1881269.
- Berwick DM. A primer on leading the improvement of systems. BMJ. 1996 Mar 9;312(7031):619-22. PMID 8595340.
- Berwick DM. Quality of health care. Part 5: Payment by capitation and the quality of care. N Engl J Med. 1996 Oct 17;335(16):1227-31. PMID 8815948.
- Brennan TA, Berwick DM. New rules: regulation, markets, and the quality of American health care. San Francisco: Jossey-Bass, 1996. ISBN 0-7879-0149-0.
- Berwick DM. Developing and testing changes in delivery of care. Ann Intern Med. 1998 Apr 15;128(8):651-6. PMID 9537939.
- Leape LL, Berwick DM. Safe health care: are we up to it? BMJ. 2000 Mar 18;320(7237):725-6. PMID 10720335.
- Berwick DM. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood). 2002 May-Jun;21(3):80-90. PMID 12026006.
- Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002 Jul 24-31;288(4):501-7. PMID 12132984.
- Berwick DM. Disseminating innovations in health care. JAMA. 2003 Apr 16;289(15):1969-75. PMID 12697800.
- Berwick DM, Jain SH. "The Basis for Quality Care in Prepaid Group Practice," in Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice. Alain C. Enthoven & Laura A. Tollen eds. San Francisco: Jossey-Bass, 2004.
- Berwick DM. Escape fire. Designs for the future of health care. San Francisco: Jossey-Bass, 2004. ISBN 978-0-7879-7217-2.
- Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA. 2005 May 18;293(19):2384-90. PMID 15900009.
- Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006 Jan 18;295(3):324-7. PMID 16418469.
- Berwick DM. The science of improvement. JAMA. 2008 Mar 12;299(10):1182-4. PMID 18334694.
- Berwick, DM, Jain SH, and Porter ME. "Clinical Registries: The Opportunity For The Nation." Health Affairs Blogs, May 2011.
External links
- Institute for Health Care Improvement
- Dr. Berwick at Harvard Medical SchoolHarvard Medical SchoolHarvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
- Donald Berwick at the Institute of Medicine of the National Academies
- Money-Driven Medicine a documentary featuring Dr. Donald Berwick based on the book by Maggie Mahar
Blog posts
- Who Is Don Berwick and What Will He Mean for Reform?, Maggie Mahar, TheHealthCareBlog, March 30, 2010. Blog post citing WP:RS sources favorable to Berwick
- Obama Nominee Donald Berwick’s Radical Agenda, Ben Domenech, RedState.com, May 12, 2010. Blog post citing WP:RS sources unfavorable to Berwick
- In a Surprise Move, Administration Appoints Berwick to Head CMS By Maggie Mahar, TheHealthCareBlog, July 2010. Analysis of White House decision to appoint Berwick to top job in CMS, favorable to Berwick.