October 30, 2009
Health care reform may do more harm than good unless attention is paid to improving health “systems,” according to Donald Berwick, president and CEO of the Institute for Healthcare Improvement and professor in the HSPH Department of Health Policy and Management, who gave the annual Dr. Herbert Sherman Memorial Lecture on October 13 in the Kresge cafeteria. The event was sponsored by the Office of the Dean.
“The idea of a system is neither a frill nor a fine point if we are to get reform right,” said Berwick. “It lies at the very center of the scientific and political challenges that stand between us and the care we seek. With a proper understanding of systems, authentic health care redesign is feasible and socially productive. Without that understanding, ‘reform’ will likely do more harm than good.”
Berwick said that paying attention to each individual part of the nation’s health care system — cost, quality and coverage — will not be enough if all the parts do not work together to produce an intended result. “The performance of a system — its achievement of its aims — depends as much on the interactions among elements as on the elements themselves,” he said.
He lamented the fact that, during their training, medical students rarely train with nurses and that often different departments within a hospital jealously guard their own resources and rarely meet to identify how they might work together to provide the best possible care for patients.
“Health care reform without attention to the nature and nurture of health care as a system is doomed,” Berwick said. “It will at best simply feed the beast, pouring precious resources into the overdevelopment of parts and never attending to the whole — that is care as our patients, their families and their communities experience it.”
In its groundbreaking report, Crossing the Quality Chasm, Berwick noted that the Institute of Medicine designated six aims for improvement. These included: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.