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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June 13, 2011

Inglis: Efficiency can make health care better and cheaper

Kathleen Sebelius

Image via Wikipedia

Here is an article that ran in our Austin Statesman and was contributed by Toni Ingles, RN.  She is a very funny lady that I have emailed back and forth before and I am proud to list her among my associates and friends.  The article is about the visit of Health and Human Services Secretary Kathleen Sebelius to the Seton Hospitals to see the innovation and changes made by nurses that impact the bottom line.

While this article lacks the humor I have come to associate with Toni’s work, it is still right on target which is also her trademark.  I am proud to be a Seton nurse and I would like to share here some of our successes.


Toni Inglis, Regular Contributor

Published: 7:14 p.m. Tuesday, May 10, 2011

There’s a little history leading up to Health and Human Services Secretary Kathleen Sebelius’ visit to Austin last week. It began in 1999, the year that health care across America woke up.

Sebelius’ visit coincided with the 12th anniversary of a report by the Institute of Medicine that upward of 100,000 people die in any given year from medical errors in hospitals. As if the 1999 data weren’t bad enough, a prestigious study published last month indicated that the number might be 10 times that much, with one-third of patients incurring illness or injury while in the hospital.

The Centers for Medicare & Medicaid Services’ stark, dark data show that the agency spent $4.4 billion in 2009 on care for patients harmed in hospitals and another $26 billion on patients who were readmitted within 30 days.

Enter the Patient Protection and Affordable Care Act. Its cumbersome name denotes what it is intended to do — protect patients, hold providers accountable and make health care affordable. The law intentionally left the job of cutting costs to the professional clinicians in the field.

The first year focused on insurance company reform. The second year zeroes in on clinical practice. That’s where the talents of President Barack Obama’s pick to head CMS, Dr. Donald Berwick, come in.

Berwick founded the Institute for Healthcare Improvement and over two decades enlisted thousands of hospitals worldwide to test and identify best practices for patient safety and to ensure their broadest possible adoption.

Sebelius has visited several sites that adopted Berwick’s model. She visited a hospital in Seattle for preventing patient falls and bed sores and a community in Ohio for preventing infection in children.

She visited ICUs in Michigan that used a simple checklist famously chronicled in “The Checklist Manifesto” written by a cancer surgeon at Johns Hopkins, Atul Gawande. Given the enormous potential for human error in such complex care, adopting a checklist including the simplest things like hand washing and donning sterile gloves, turned out to be enormously effective. In the first year, the Michigan hospitals reduced infections by two-thirds, saving 1,500 lives.

Sebelius came to Austin to learn about the Seton Family of Hospitals’ successes in patient safety. She learned of the nurse-led initiative that virtually eliminated bed sores, ranking Seton first internationally. She learned how major reductions in infections were achieved. She learned how University Medical Center Brackenridge achieves the national standard of restoring circulation in 90 minutes after an acute heart attack — 100 percent of the time.

The biggest draw for Sebelius, however, was to see how Seton dropped its birth injury rate to zero. Partnering with IHI, Seton nurses and doctors developed a bundling of best practices for obstetricians: no elective induced births before 39 weeks gestation and limited use of the drug oxytocin to shorten labor and of vacuum extraction of the baby.

Of interest to Sebelius was the saving in government spending by preventing birth trauma. In 2003, when the safety initiative began, Seton billed Medicaid $500,000. In 2009, Medicaid was not billed at all.

During her visit, Sebelius introduced Partnership for Patients, an initiative begun last month with Berwick’s design. The $1 billion government investment targets hospitals to help them learn about and implement proven methods to improve care. The partnership is expected to avoid millions of unnecessary medical injuries and complications and thousands of deaths. It is also expected to reduce Medicare costs by $50 billion over the next decade.

Her visit also coincided with the release of a federal rule to take effect in 2013. It will reward better-performing hospitals with commensurately higher incentive payments. Government will reverse economic incentives from quantity to quality of care.

Berwick, a recess appointment, might not be long for public office. He has been a target of political criticism and is not expected to win Senate confirmation to remain in his seat past 2011. Hopefully, his legacy of innovation for patient safety will continue. Through public office, his model to change the way health care is delivered represents the government’s first serious attempt to address patient safety.

Given the number of deaths, health care needs to view itself as an industry just as complex and high-risk as the airline and nuclear energy industries — both of which use checklists.

If corporations producing commodities like TVs, microwaves and cars can make better products and save money by eliminating waste and increasing efficiency, so can health care. Most Americans can afford a TV, but no uninsured American can afford health care.

Inglis is a neonatal intensive care nurse at the Seton Family of Hospitals and editor of ‘Seton Nursing News.’





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