Don Berwick :The Patient Centered Extremist Saturday, Apr 3 2010 

Over the last week, reports of President Obama nominating Don Berwick, CEO of the Institute of Health Care Improvement(IHI) to become the next Centers for Medicare and Medicaid Services (CMS) Administrator  have flooded the world media. The nomination has not been officially made.

I have had the unparalleled honor of sitting between Don Berwick  and Maureen Bisognano(COO IHI), for 4 of the last 7 months. I have come to know Don from up close.

Don Berwick’s Desk

The culture here at IHI is unlike any I have ever seen or experienced. The walls are either glass or non-existent. The doors to the COO and all Senior leaders, Maureen Bisognano, Jim Conway, Don Goldmann, Penny Carver, Joanne Healy, Frank Frederico, Carol Beasley, Pat Rutherford, Paul Hammett, are always open. In fact doors are barely noticeable.

The IHI staff consist of a little over 100 highly motivated, talented and very committed people.  When you enter IHI you are met by the incomparable Marva, who embodies the spirit of IHI with her smile.  I often say that I hit the good people lottery just having been chosen to be one of two George W. Merck Fellows for 2009-2010.

Then there is Don Berwick. I first met Don when I interviewed with him in October 2007. The next time I saw him was at the 2008 IHI National Forum. I introduced myself to him and not only did he remember me, he asked me how my daughter was doing! I now know that this is not unusual but common place.  Dr. Berwick is one of the most gracious, unassuming and driven persons anyone will ever encounter. Don treats all of the people that he encounters like they are family. His family is the world. Don is without pretension, without bluster, without arrogance, but he glows with a confidence and vision that ignites as few as 7 IHI fellows or a room crowded with thousands all hanging on his every motion and word. Yet, he seems to go out of his way to extend kindnesses and words of encouragement to all that he encounters.

On a recent visit home to Huntsville Alabama, I encountered Robert Centor MD Dean of the University of Alabama Birmingham School of Medicine Hunstville campus. Dr. Centor, an long time Don Berwick friend, said to me with a smile and a twinkle in his eye, ” Don Berwick is over the top”. What did he mean?  To me it means what Don has been saying for all of his career.. the IHI community will change the world and crucial to this effort is that we all become patient-centered extremists. If that scares you or makes you feel uncomfortable, then great! So, what does Don mean by being an extremist?

Read these excerpts from “Confessions of an Extremist” by Don Berwick:

An Extreme View
I freely admit to extremism in my opinion of what patient-centered care ought to mean. I find the extremism in a specific location: my own heart. I fear to become a patient. Partly, that fear comes from what I know about technical hazards and lack of reliability in care. But errors and unreliability are not the main reasons that I fear that inevitable day on which I will become a patient. For, in fighting them, I am aligned with the good hearts and fine skills of my technical caregivers, and I can use my own wit to stand guard against them.  What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hospital gown, homogenized, anonymous, powerless, no longer myself. It is the sound of a young nurse calling me, “Donald,” which is a name I never use—it’s “Don,” or, for him or her, “Dr. Berwick.” It is the voice of
the doctor saying, “We think…,” instead of, “I think…,” and thereby placing that small verbal wedge between himself as a person and myself as a person. It is the clerk who tells my wife to leave my room, or me to leave hers,without asking if we want to be apart. Last month, a close friend called a clinic for her mammogram report and was told, “You have to come here;we don’t give that information out on the telephone.” She said, “It’s OK, you can tell me.” They said, “No, we can’t do that.” Of course, they “can” do that. They choose not to, and their choice trumps hers: period. That’s what scares me: to be made helpless before my time, to be made
ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife’s hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep. Call it patient-centeredness, but, I suggest, this is the core: it is that property of care that welcomes me to assert my humanity and my individuality. If we be healers, then I suggest that that is not a route to the point; it is the point. -Don Berwick.

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A House Is Not A Home Saturday, Dec 12 2009 

The Institute for Health Care Improvement (IHI) fellows come to Boston/Cambridge in July each year and we remain here for one year. During that year several of the fellows are away from home and family.  We are at IHI under the supportive and watchful guidance of Don Goldmann, Maureen Bisognano, Don Berwick and a staff of over 100 of the most energetic, motivated intelligent staff imaginable.

We all just returned home from  a very successful 21st National Forum. The event went off seamlessly. Truly, with over 5000 attendees and another 18,000 on satellite, it took a village and a family to make it happen.

During this years Forum, we were all reminded that we are the ingredients in the foundation of the new patient centered home. The “we” includes physicians, nurses, dentists, public health professionals, administrators, students, patients and families.

This year, Don Berwick challenged us to think about what we want, what we really want and what we really really want. Don introduced the tragedy of the commons(Elinor Ostrom) and the supreme responsibility we have to protect the resources of this earth that we share, so that  future generations will not be left with ruins.  In true Berwickian style, he made an emotional plea that we learn to cooperate and coordinate our efforts so that we all can benefit, prosper and be able to enjoy what it is that we really really want. There is no room for free riders.

Following Don Berwick, the poet Sekou Andrews moved us to tears as he delivered his dramatic message of the mysteries of the heart. He shared his personal loss and described how the heart can be the center of wonderful symphonic love rhythms or it can be a malignant asynchronous killer that can break many hearts. Sekou left me realizing that there is no home where there is no love or heart.

Next up was social organizer and Harvard professor Marshall Ganz. Marshall helped organize voters in Mississippi in the 1960’s and later help organize farm workers with Cesar Chavez. He talked about how power can stifle and oppress but can be defeated. Even in the face of fear and despair David slew Goliath. He advised us to organize for the struggle that lies ahead as we build this new medical home.

The Forum ended with the in your face challenges presented by famed Princeton economist , Uwe Reinhardt. Uwe encapsulated the current health reform bill while he admonished us to understand that a house is not built in a few months. This new medical home will take years of construction. We are laying the foundation now. As we build we must use quality materials and state of the art construction techniques because this 21st century house requires new ideas, new technologies, advance thinking as its flooring, plumbing, wiring and fixtures. The roof has to be made to withstand heavy storms and strong winds. The IOM pillars will serve as its core support beams but this is just the house. It has to be a home that will be occupied by our family and this family has to create an  environment of justice, love, heart and soul. This house has to stand for the generations to come. It has to be the home that we really, really want.

After this home is completed,  we will have the greatest house warming party in the history of health care. The sign outside will read WELCOME ALL.

–Ron