Nursing Notes

December 30, 2011

Goodby, Don Berwick

Here’s an article from the Austin American Statesman written by my fellow nurse, Toni Ingles at Seton English: This is an image of Donald Berwick, w...Healthcare.  I’ve posted her articles before about the Texas whistleblower nurses and the trial.  This article is about the loss of Don Berwick.  Whether you liked him or not, this is a very good article and deserves to be read.  Enjoy the article.

Congress chewed him up and spit him out. Marilyn Tavenner will be a
good replacement for him. She is a nurse, has terrific experience and
is greatly admired by Don Berwick (and by me). Berwick’s immense
respect and confidence in her are demonstrated by his having tapped
her as his top deputy.


For the past 17 months I’ve watched through my fingers as Congress has
slowly eviscerated a gentle, brilliant, apolitical pediatrician and
Harvard professor — Don Berwick. It’s been painful, gut-wrenching and
depressing. Congress will finish him off today, when his resignation
as administrator of the Centers for Medicare & Medicaid Services takes

The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job
because his “triple aim” (his words) at health care was the same as
President Barack Obama’s reform goals: improving the patient
experience, improving population health and reducing costs — and
because Berwick had decades of experience successfully achieving those
goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute
for Healthcare Improvement, care has been redesigned and hospitals
trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health
care are identified, and IHI, often in partnership with the Robert
Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve
worked with people from the IHI and the RWJ foundation. In 2003, we
were chosen as one of 13 pilot sites to transform care at the bedside
in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license
and encouragement to develop and test methods to improve care. And
that we did. Many of the innovations Seton nurses designed are
practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and
families have become engaged in care; bedsores, patient falls,
infection and birth trauma have been drastically reduced;
communication during shift report has improved; multidisciplinary
rounds are made to enhance discharge planning, teamwork and safety;
patients are checked on hourly; response teams rush to a patient in
crisis before it’s too late; and patient and nurse/doctor satisfaction
and retention have dramatically improved. Hospital readmissions have

Through the transforming care project, in the perinatal area, birth
trauma has effectively been eliminated. Clinicians developed a bundle
of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In
2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb
government spending on health care. As part of the Affordable Care
Act, Berwick implemented financial incentives for doctors and
hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven,
accomplished and promising leader. Eager to demonstrate contempt for
the Affordable Care Act, Republican demagogues seized on Berwick as an
irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable
Care Act — encourage end-of-life discussions between doctor and
patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising
Britain’s health care system for covering all its people and reining
in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an
advocate of rationed care and socialized medicine. This, despite
Berwick’s insistence all along that the British system cannot be
copied here and that America’s system, having evolved around
insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you
begin to brand and unfairly define Berwick and the health care reform

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s
hope that she will be able to execute his goals. Congress will be more
comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience?
Yes. Has it improved population health? Yes. Has it reduced costs?

Have we missed an opportunity? Oh, and how.

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