Dr. Don Berwick: 5 big missteps on the patient safety journey

While the patient safety movement has made great strides since the late 1990s, the healthcare industry has veered off the path in a few ways during the journey, according to Don Berwick, MD.


Dr. Berwick, the former CMS administrator and current senior fellow at the Institute for Healthcare Improvement, spoke to a crowd at the 19th Annual National Patient Safety Foundation Patient Safety Congress Thursday. During the speech he highlighted some missteps in the approach that the patient safety community has taken throughout its improvement journey.

Five of those mistakes are highlighted below.

  1. Money has become more important than safety. Dr. Berwick noted most hospital board members and executives are increasingly concerned about cost reduction and staying in the black than they are about patient safety.

    Indeed, quality and safety didn't even crack the top five concerns of hospital executives who participated in the Advisory Board Company's 2017 Annual Health Care CEO Survey.

  2. Believing the illusion that the industry has achieved patient safety. "We will never be done," Dr. Berwick said of the patient safety movement. He called the concept of looking at safety improvement as a box-checking exercise with a defined ending point "lethal" to future patients.

  1. Thinking incentives will improve safety. Nearly all healthcare workers come to work every day wanting to well, Dr. Berwick said. That makes the incentive theory to patient safety improvement ineffective; as incentives come from the place of believing workers want to do something wrong and they need an incentive to do the right thing. "Until we … give up [the] incentive orientation to safety, we won't make progress."

  1. Too many metrics. Healthcare has "glutted [itself] with metrics," Dr. Berwick said to applause from the audience. "We have got to go on a diet." He stressed the importance of identifying the most critical metrics and measuring just those, and not more.

  1. Separating the quality and safety movements. At some point in the movement, quality and safety got placed in separate dimensions, which Dr. Berwick called "a mistake." He applauded the merger between the Institute for Healthcare Improvement and NPSF as a way of reuniting the two endeavors. "We don't have resources to waste on tribalism," he said.

Editor's note: This article was updated May 24 to correct the name of the Institute for Healthcare Improvement. A previous version of this article incorrectly referred to IHI as the Institute for Patient Safety. We regret the error.

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