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Catching Up With Don Berwick: Where Quality Improvement Is Going, and How Young People Are Leading the Way

Mary Caffrey
The former CMS administrator, who coined the term the Triple Aim, spoke about what he sees ahead in technology and how uncertainty is affecting the healthcare quality movement.
Last month, The American Journal of Managed Care® spent time with former CMS Administrator Don Berwick, MD, MPP, the president emeritus and senior fellow at the Institute for Healthcare Improvement (IHI), when he spoke at the Patient-Centered Summit hosted by Horizon Blue Cross Blue Shield of New Jersey. Berwick is best known as the champion of the triple aim—the idea that remaking America’s healthcare system requires the pursuit of 3 goals: improving the experience of care, improving the health of populations, and reducing per capita costs.

Berwick criticized what he called efforts to undermine the Affordable Care Act (ACA); the conversation took place a week before President Donald Trump canceled cost-sharing reductions. However, Berwick brightened when he spoke of what he sees and hears in his work at IHI and during conversations with fellow champions of better care, particularly young leaders who will build the system of the future.

IHI and Berwick host a National Forum on Quality Improvement in Orlando, Florida, in December, which he said brings 2000 groups together to discuss the best new strategies. Below are excerpts from the interview with Berwick:

AJMC®: What projects excite you today?
The most exciting one is called the IHI Leadership Alliance.  We thought if we made a call out to the country for organizations, hospitals, physician groups, and health systems that want to achieve the Triple Aim, they might learn more together than separately. There’s now upwards of 30 organizations that meet regularly, virtually and in-person. It’s in its fourth year. They pick projects to learn together how to achieve better care and lower costs, or refocus on community care and wellbeing.

My favorite project they did recently was on cost reduction—we called it “Breaking the Rules for Better Care.”1 Twenty-four of the organizations polled patients and staff to identify rules that appeared to impede care—these were silly, obstructive rules that could changed. We had over 350 rules nominated by the 24 organizations—and most turned out to be not regulations or laws, they were just habits. There were 4 categories: (1) habits; (2) administrative rules that could be changed; (3) myths, which were misinterpretations of statutes; and (4) statutes and regulations. So, over 80% of the “rules,” were, in fact, not actually rules or regulations.

Another project I love is the IHI Open School, which is about 8 years old. We had demand from young people who wanted to learn about quality, error reduction, and patient safety, but weren’t learning it in medical school or nursing school. So, we started IHI Open School, which is a computer environment in which young people—at no cost—can take courses, start local chapters, and engage in international projects. Right now, there’s about 550,000 young people all over the world networked together in the open school. They’ve downloaded more than 3 million courses. There are over 800 chapters in 80 countries. This is an international movement. We have another element of the open school called ICAN, which is an action project, in which young people can pick projects they want to do, such as population health.

When we originally did it, we knew there was a gap. We polled about 1700 students in all health professions—medicine, nursing, health administration, industrial engineering, pharmacy, respiratory therapy—and we asked them: do you want to learn how to change your care? And 85% said, “Yes.” Are you learning in your current school? And 85% said, “No.” Then we said, we’ll do one of two things, we’ll start different virtual schools—one for medicine, one for nursing, one for pharmacy—or we’ll just do one across all professions. Overwhelming the response was, we want to learn to work together. So, this is a highly multidisciplinary program. And I love it. I am sure the younger professionals are ready for the triple aim. Those of us who were trained in a different era—we elders—it’s our job is to make it possible.

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