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Dr Don Berwick Highlights the Lessons From AF4Q

In a series of video interviews, Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement, discussed the lessons learned from the Aligning Forces for Quality initiative.
Donald M. Berwick, MD, MPP, president emeritus and senior fellow of the Institute for Healthcare Improvement, served as the guest editor for The American Journal of Managed Care's supplement on research emerging from the Aligning Forces for Quality (AF4Q) initiative. In a series of video interviews, he discussed the lessons of AF4Q regarding alignment in the United States healthcare system, consumer engagement in healthcare, and evaluating social experiments on improving healthcare, among other topics.




Transcript (slightly modified)
A central problem with the US healthcare system is misalignment: we reward individual acts and not overall acts of wellness. What have we learned about fixing this problem from AF4Q?

We built a healthcare system in fragments, and the fragments are not aligned for what the Institute for Healthcare Improvement calls the triple aim—better care, better health, lower costs.

For example, it makes a lot of sense in society to put efforts into preventing illness, and yet the reward systems for hospitals reward being full. We say we value primary care as a foundation for keeping people healthy and thriving, but money shifts to technocratic care. We say we value mental health, but we don’t support mental health.

And it is very difficult to manage toward health and well-being when things aren’t aligned. That’s the brilliance of Aligning Forces for Quality. It took a number of levers, and it said, “Let’s get all these levers lined up, so that healthcare providers and communities can really work together toward a common aim with that kind of alignment.”

What we learned from Aligning Forces for Quality is that it’s hard—it’s very hard.

Some of what the premises were behind Aligning Forces for Quality, like the importance of transparency, turned out to be hard to execute. We can say we want to be transparent, but that requires consumers and healthcare providers to truly be interested in that. One of the lessons learned is that it’s hard to maintain their attention, and a real commitment.

It was a great effort, to try to get the signals aligned. It taught us how hard it’s going to be get all the forces working in the same direction.



 
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