The president has just appointed the person who's going to oversee Medicare and Medicaid for the next few years—a daunting task, given that the programs are bleeding money and may have big changes in store. If you've been following health-care policy (and not just health-care politics), you may already know the new chief's name: Donald Berwick, president of the Institute for Healthcare Improvement (IHI), the influential Cambridge, Mass., think tank that advocates elegantly simple ways of making medicine better without making it more expensive. (In his spare time, he's also a pediatrician and health-policy professor at Harvard.) Berwick's appointment has a lot of people in the blogosphere excited. Here's why:
1. His name is synonymous with "reducing medical errors." In fact, he wrote about that in NEWSWEEK back in 2005. Hospitals could save perhaps as many as 100,000 lives, he said, by implementing a few simple reforms: keeping respirators sterile (lessening the chance of hospital-acquired pneumonia); doing the same for catheters and surgical sites (mostly by easy mechanisms, such as having doctors wash their hands more often); having rapid-response teams at the ready; giving reliable and consistent care to heart-attack patients; and making sure people actually get the medicines they’re prescribed. If all this sounds a bit obvious, that's the point: it's kind of amazing that hospitals weren't doing all of it before Berwick started telling them to.
2. He wants to make your hospital stay more pleasant. For Berwick, medicine is as much as about the patients as it is about the doctors—hence his philosophy of "patient-centered" medicine, described last year in Health Affairs. Berwick doesn't like being a patient, or at least he doesn't want "to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife's hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep." Hospitals, in other words, should give people dignity as well as medical care. Berwick has also advocated for better sharing of medical records, more smoothly coordinated care, and a model in which doctors are rewarded for outcomes rather than the number of procedures they perform.
3. He was once vice chair of the U.S. Preventive Services Task Force. This would be merely a line on his formidable résumé and not a news item, except that you've surely heard of the USPSTF: They're the people who put out the frenzy-provoking recommendation last fall that women under 50 shouldn't get annual mammograms. (Berwick wasn't on the committee at the time.) If Berwick's confirmation process gets ugly—and it surely will—someone may bring up his USPSTF affiliation as a sign that he's secretly planning to ration health care. Berwick, however, already has a response. According to The New York Times, "At his institute's annual conference in December, Dr. Berwick issued this challenge to health care providers: 'Over the next three years, reduce the total resource consumption of your health care system, no matter where you start, by 10 percent. Do that without a single instance of harm, without rationing effective care [emphasis ours], without excluding needed services for any population you serve.' "
4. He has concrete ideas about how hospitals can provide high-quality care without high costs. On the IHI Web site, you can find out what they are: the institute's "How Do They Do That?" project lays out 10 specific examples around the country of hospitals that provide the best care for the least money.
5. He probably knows what he's in for. "Talk is cheap; changing the culture of a hospital is hard," Berwick wrote for us in 2005. All you have to do is substitute "Washington" for "a hospital," and you have health-care reform in a single sentence. Good luck, Dr. Berwick: for all your sterling credentials, you're gonna need it.