Dr. Don Berwick to Healthcare Leaders: Don't Flunk the Moral Test

Several years ago, Don Berwick, MD, former acting administrator of CMS, and his family went on a 16-mile hike in the Castle Mountain trails in the Canadian Rockies. His youngest daughter, Becca, was lagging behind.

After several exchanges in which Dr. Berwick repeatedly told his daughter to walk faster, resulting in both tears and vomit, Becca finally said, "Daddy, telling me to walk faster doesn't make me walk any faster."

This is partially where healthcare is at right now, Dr. Berwick said in his keynote address at the Healthcare Financial Management Association's National Institute in Orlando, Fla. There is a lot of yelling in the environment about what should be done, but that won't necessarily help the situation. Instead, the healthcare industry must take initiative and change the system, especially to help those who are most vulnerable.

"We live in a civilized and wealthy country," Dr. Berwick said. "We should make healthcare a human right."

Dr. Berwick, also the co-founder of the Institute for Healthcare Improvement and now a gubernatorial candidate in Massachusetts, said there is a tremendous amount of waste in the U.S. healthcare system. He cited a study he conducted with Rand Corp. analyst Andrew Hackbarth, which found the U.S. healthcare system wastes roughly 34 percent of costs. In other words, $1 of every $3 in healthcare is flushed down the toilet.

"This isn't a government problem. Don't let anyone tell you that," Dr. Berwick said. "This affects every payer in the healthcare system."

The failure of the healthcare system stems from six main areas of waste, Dr. Berwick said: overtreatment, failures to coordinate care, failures in care delivery, excessive administrative costs, excessive healthcare prices and fraud and abuse.

This is where the Patient Protection Affordable Care Act — and even further progressive efforts — come in. Dr. Berwick touted the "Triple Aim," a concept coined by his IHI colleagues, John Whittington, MD, and Tom Nolan, PhD, that has since become the foundation of his career, even at CMS. The idea focuses around better care and better population health at lower costs, something he has already seen at other healthcare organizations.

For example, the Southcentral Foundation in Anchorage, Alaska, is built around its Nuka System of Care. Nuka is a team-based program in which clinicians, patients and community members ensure the health and wellness of each other through home care, an emphasis on prevention and a sturdy support system. Dr. Berwick also commended the Lean efforts of Denver Health and ThedaCare in Appleton, Wis.

These are the types of changes making a difference right now, Dr. Berwick said. For hospital and health system leaders who need the extra impetus to begin improvement measures, he recalled the words of former vice president Hubert Humphrey. When Dr. Berwick was at CMS, working in the HHS Hubert H. Humphrey Building, he often walked past this quote inscribed on a wall: "The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped."

If healthcare leaders do not have the courage to improve the system for those common goals, "we will flunk the moral test," Dr. Berwick said. Putting patients first, protecting the disadvantaged, starting improvements at scale, returning money and acting locally are essential to the system moving forward.

"You, as leaders of your organization and members of HFMA, you need to decide what you want to improve," Dr. Berwick said. "If we don't have you in the wheelhouse, the societal effects will be dramatic."

More Articles on Healthcare Leadership:

4 Leadership Lessons From One of Healthcare's Most Powerful Women
Defining a New Healthcare Conversation: Q&A With Former CMS Administrator Dr. Bruce Vladeck
Former HHS Secretary Dr. Donna Shalala: From Academia to the Healthcare Battleground

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