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Dr. Donald Berwick – A Resource Guide

 Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, is known as a passionate advocate for improving the health care system. President Barack Obama’s choice of Berwick as head of the CMS, generated controversy. Some Republicans accuse him of favoring health care rationing — a charge Democrats dismiss as nonsense.  KHN’s Allison Fero assembled this resource guide.

Background | In His Own Words | Summaries of News Coverage

Who Is Donald Berwick?

Dr. Donald Berwick - A Resource Guide

Until his appointment to CMS, Berwick was president and CEO of the Institute for Healthcare Improvement.

An edited excerpt of his biography, from the IHI website:

Donald M. Berwick, MD, MPP, FRCP, is also Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, and Professor in the Department of Health Policy and Management at the Harvard School of Public Health. Dr. Berwick has served as vice chair of the US Preventive Services Task Force, the first “Independent Member” of the Board of Trustees of the American Hospital Association, and chair of the National Advisory Council of the Agency for Healthcare Research and Quality.

He is a recipient of numerous awards, including the 2002 American Hospital Association’s Award of Honor the 2007 William B. Graham Prize for Health Services Research, and the 2007 Heinz Award for Public Policy from the Heinz Family Foundation. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by the Queen of England in honor of his work with the British National Health Service. Dr. Berwick is author of numerous articles and the books Curing Health Care and Escape Fire.

Media Profiles

Who Runs Gov
: “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.”

CBS Evening News
: “Two years ago, he launched the 100,000 Lives Campaign. That’s the number of lives he hoped to save by getting hospitals to have standard operating procedures for the way they care for patients.”

“This includes hooking up a ventilator properly to eliminate the risk of pneumonia … Berwick says even something as simple as uniform hand-washing requirements would cut hospital infections in half” (Feb. 2007).

The Boston Globe : “Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care” (Jan. 4, 2004).

In His Own Words

Excerpts of Berwick’s speeches or writings, with links to the entire article or video.

Kaiser Health News, Checking In With Dr. Donald Berwick

Enlarge video

“Hospitals and health care systems are making phenomenal strides in quality and my optimism is very high. But the structures are still broken. We have fragmented payment systems and fragmented institutional boundaries. The enemy is fragmentation. We just don’t seem to form into the coalitions, the communities we need to make progress. Until we fix structures and finance it is going to be very hard to make fast progress” (Nov. 12, 2009)

New York Times Editorial, 10 Steps to Better Health Care
“There is a lot of troubling rhetoric being thrown around in the health care debate. But we don’t need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage. We must instead look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead” (Berwick was one of four authors, Aug. 12, 2009).

Institute for Healthcare Improvement Video, Defining Quality: Aiming for a Better Health Care System
“If you’re buying a car, there are dimensions of quality: safety, fuel efficiency, comfort, fun in driving, durability and so on. We’re used to that. But what are the dimensions of ‘goodness’ in health care?” (Oct. 2008).

Speech To Britain’s National Health Service KHN Transcript of Speech Excerpts
“Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … 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 wealth from the richer among us to the poorer and less fortunate. … Britain, you chose well. … Is the NHS perfect? Far from it, far from it. I know that as well as anyone in this room [but] the NHS has more evidence-based care, lower mortality rates for some major disease groups (especially cardiovascular diseases), you have lower waiting times for hospital, outpatient, and cancer care now, more staff and technologies are available, you have in many places better community-based mental health care, and you are starting to see falling rates of hospital infection” (July 1, 2008). NHS video of speech excerpts.

Full Text Of The Speech To Britain’s National Health Service A Transatlantic Review of the NHS at 60
“I am romantic about the NHS; I love it.  All I need to do to rediscover the romance is to look at health care in my own country” (July 1, 2008).

The Journal of the American Medical Association, The Science of Improvement
“Academic medicine has a major opportunity to support the redesign of health care systems; it ought to bear part of the burden for accelerating the pace, confidence, and pervasiveness of that change. Health care researchers who believe that their main role is to ride the brakes on change-to weigh evidence with impoverished tools, ill-fit for use-are not being as helpful as they need to be. ‘Where is the randomized trial?’ is, for many purposes, the right question, but for many others it is the wrong question, a myopic one. A better one is broader: ‘What is everyone learning?’ Asking the question that way will help clinicians and researchers see further in navigating toward improvement.” (Mar. 12, 2008).

Boston Globe Editorial, Dirty Words In Healthcare
“Managed healthcare was a great idea when it first emerged, before the term got hijacked by insurance companies that claimed to manage care but in many cases only managed money. The innovations that managed care and capitation made possible were good for almost everyone. Thousands of people avoided needless hospital visits; they got more appropriate, less expensive, better coordinated care in office settings” (Feb. 27, 2008).

British Medical Journal (via the U.S. National Institutes of Health), Steadying The NHS
“We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation. Yet, lately, it seems like a boxer on the ropes, not the champion it should be…. The NHS is not just a national treasure; it is a global treasure. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise” (July 10, 2006).

Newsweek Editorial, Keys to Safer Hospitals
“Here’s the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care. We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It’s surprising to learn that these standards aren’t already the norm–but the norms may finally be changing” (Dec. 12, 2005).

Health Affairs, ‘A Deficiency Of Will And Ambition’: A Conversation With Donald Berwick
“I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent. It’s certainly in double digits, and this has to be absolutely pasted onto the quality agenda. There is no difference between quality and efficiency . a lot of people make a lot of money on inefficiency-on production of things that have no value. So the minute you try to become truly efficient, you’re going to run into stakeholders who are going to tell you that you’re harming care, and the knee-jerk reactions of doctors and others will be to reinforce that idea”  (Jan. 12, 2005).

The New England Journal of Medicine, Errors Today and Errors Tomorrow  
“First, in local settings, our workforce largely remains blind to the enemy – patient injury. The invisibility of injuries to patients makes them seem trivial or infrequent. Until we find ways to make errors and injuries routinely visible in local health care settings, the national will to improve safety will be hard to translate into local intent. Second, even when hospitals find ways to notice the injuries to their patients, their theories of cause often remain scientifically Neanderthal. They cling to unsound but deeply entrenched beliefs” (June 2003).

Health Affairs, A User’s Manual For The Institute of Medicine’s “Quality Chasm” Report
“The report therefore suggests to any careful reader that whether we wish to tackle the problem of quality as payers, regulators, executives, managers, or clinicians, we will improve health care as it needs to be improved, either all together or not at all” (May/June 2002).

Dr. Donald Berwick - A Resource GuideEscape Fire: Lessons for the Future of Health Care
“This has been a tough year for my family, and especially for my wife, Ann, who last spring began developing symptoms of a rare and serious autoimmune spinal cord problem. this has been the formative experience for me overall in the past year The people work well, by and large, but the system often does not. Every hour of our care reminded me, and alerted Ann, about the enormous, costly, and painful gaps between what we got in our days of need, and what we needed. The experience did not actually surprise me, but it did shock me. Put in other terms, as a friend of mine said: Before this, I was concerned; now, I am radicalized” (First from a speech at the IHI National Forum, Dec. 9,1999;  later part of a Commonwealth Fund book with same title).  Watch the related video.

KHN Summaries Of News Coverage

GOP Prepares To Grill Berwick At Senate Hearing Next Week  
CMS administrator Donald Berwick is scheduled to testify before the Senate Finance Committee next Wednesday (11/11).

CMS Head Berwick Praises New Center For Medicare And Medicaid Innovation
Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, praised the new Center for Medicare and Medicaid Innovation, established by the federal health care law (10/20).

CMS Could Save Billions By Changing Payment, Delivery Methods 
News outlets address various Medicare and Mediciad issues including ways to save money for CMS and Medicare open enrollment season (10/18).

 Berwick Breaks Silence, Calling On Insurers To Join Pursuit Of ‘Shared Goals’  
In his first big speech as Obama’s top Medicare official, Donald Berwick called on insurers to join in a “full partnership” with his agency to achieve a health system with lower costs that doesn’t withhold care from anyone or risk harming patients (9/14). 

Berwick Planning Medicare Test Sites For New Health Care Models
The Boston Globe reports that while keeping a low public profile, Medicare chief Donald Berwick is working to “seed the US health care system with 100 to 300 sites to test new models of caring for patients” (9/6).

CMS: Seniors Will See Modest Increase In Medicare Drug Premiums But Improved Benefits
Seniors will see modest increase in Medicare drug premiums next year but benefits will also improve, federal health officials said Wednesday (8/19).

Critics Question Berwick’s Ties To Think Tank Donors
Donald Berwick, recently appointed as administrator of the Centers for Medicare and Medicaid Services without a Senate hearing, did not list donors, who contributed up to $5 million to the think tank he ran before his appointment, on his ethics forms (8/11).

Berwick Faces Continued Hostility From Senate
Dr. Donald Berwick, the new head of the Centers for Medicare & Medicaid Services, faces continued hostility in the Senate, The New York Times reports (7/27).

Obama Resubmits Berwick Nomination To Senate, Kagan Responds To Health Law Concerns
Just two weeks after President Obama bypassed Congress to set to work his pick to head the Centers for Medicare and Medicaid Services until the end of 2011, Obama again submitted the nomination of Dr. Donald Berwick to the Senate (7/20).

Sen. Roberts Lashes Out At Recess Appointment Of Berwick
Kansas Republican uses GOP’s weekly address to criticize President Barack Obama for “bypassing” the Senate. “Without a public confirmation hearing on Dr. Berwick’s nomination, the Senate and the American people do not have the opportunity to learn about the man who will control one third of all health care” (7/17).

Republicans Demand Hearing On CMS Head Berwick, Block Other Nominees
Senate Republicans are still angry that President Obama appointed Dr. Donald Berwick to head the Center for Medicare and Medicaid Services during the July Fourth recess (7/15).

Berwick Sworn In; First Public Health Event To Be Health IT Regs Unveiling 
Physician and Harvard professor Donald Berwick was sworn in to become the next administrator for the Centers for Medicare and Medicaid Services Monday (7/13).

Axelrod: Berwick Recess Appointment Intended To Avoid ‘Political Circus’
Senior White House adviser says Obama moved to appoint controversial doctor because “this nomination was going to be one that was going to be dragged on and on and on.” He said the administration felt it was “vital” to fill the position (7/12).

Obama Uses Recess Appointment To Install Berwick As Head Of Medicare, Medicaid
Berwick, a controversial nominee, will take the CMS position without going through the confirmation process (7/7).

Sebelius Defends Berwick For CMS Post
News outlets report on the criticism and defense of Donald Berwick, President Obama’s nominee to run the Centers for Medicare and Medicaid Services (6/4).

Sen. Kerry, White House Push Back On Berwick Criticism
After Republicans levied attacks on Donald Berwick, the physician and professor who is the president’;s nominee to lead the Medicare agency, Sen. John Kerry, D-Mass., came to the aide of his fellow Bay Stater (5/14).

GOP Launches Attacks On CMS Nominee Berwick
Republicans have begun attacking Donald Berwick, a doctor and Harvard professor nominated to head the Obama administration’s Medicare and Medicaid agency (5/13).

Berwick may face a difficult confirmation process in the Senate
News outlets continue to report on Donald Berwick, President Barack Obama’s nominee for administrator of the Centers for Medicare and Medicaid Services (4/21).

Berwick, Blumenthal May Form Dream Team At CMS 
New leadership at the Centers for Medicare and Medicaid Services may bring innovation, improve quality (4/6).

As CMS Nominee, Berwick Would Face Changes And Challenges
President Barack Obama is expected to soon nominate Dr. Donald M. Berwick, an expert on patient safety, to run Medicare and Medicaid, which will face enormous changes under new health law, news outlets reported (3/29).

Related Topics

Cost and Quality Medicaid Medicare The Health Law