In this, the final article in our series on Quality Improvement (QI) heroes – we shine a spotlight on Dr Don Berwick, leading authority on QI in healthcare and founder of the Institute for Healthcare Improvement (IHI). Hailing from the US, he is recognised as a leading authority on healthcare quality and improvement. He’s had a massive input and influence in the internationally, sharing insights on outcomes, costs and quality of care across many countries.
Donald M. Berwick was born in 1946 and is recognised across the globe for his contribution to Quality Improvement in healthcare. He studied Medicine at Harvard and completed his medical residency in paediatrics at the Children's Hospital in Boston. He started work as a paediatrician at the Harvard Community Health Plan, where he went on to became its Vice President of Quality of Care Measurement in 1983. While working at the Harvard Community Health Plan, he developed an interest in the application of quality control in healthcare. He explored how other industries used quality control and developed these methods for usage within healthcare. A key focus of this work included studying how healthcare systems are managed and looking at and applying scientific and industrial methods and research to improve quality and save costs.
Dr Don Berwick also set up the National Demonstration Project of QI in health care in 1987 which helped people see the possibility of using these methods to improve quality in healthcare.
One of Dr Berwick’s key areas of interest is the desire to reduce medication errors in healthcare. His classic article ‘Reducing errors in medicine’ looks at the blame culture surrounding adverse events. It states: ‘When medical errors do surface, often with heart rending accounts of the suffering of the primary victims—the patients harmed—the reaction in medical settings is most commonly an attempt to fix blame and to punish someone.’ His theory is that this simply does not work. ‘If we truly want safer care, we will have to design safer care systems.’
Don Berwick has authored or co-authored more than 160 scientific articles and six books. He’s been described as someone who 'spearheaded the application of industrial approaches within a clinical environment. Influences on the development of clinical quality improvement include clinical audit, clinical guidelines, care pathways and clinical governance, with recent attempts to integrate these more closely with organisational issues.’
Creating new care models in the UK
Due to his pioneering work on QI in healthcare - and after having co-founded the Institute for Healthcare Improvement (more on that later) the NHS recognised Don Berwick as someone who could help improve and enhance models of care. He was hugely influential in leading and spearheading QI in the UK. In a 2008 paper, Dr Berwick said 'I am romantic about the National Health Service; I love it....The NHS is one of the astounding human endeavours of modern times.'
He was appointed to the post of NHS Patient Safety Tsar in 2013 and carried out a review of patient safety in the NHS via the then Prime Minister, David Cameron.
In 2015 he was appointed as an international visiting fellow to the Kings Fund to help support the Kings Fund’s aim to improve health and care in the NHS. This really interesting video sees Dr Berwick talking about his own experience of implementing new models of care and also his take on the NHS ‘five year forward view’.
He has also shared his knowledge and teaching in the UK via the IHI and in 2005 he was recognised for his work with the NHS, being appointed as an Honorary Knight Commander of the British Empire.
Aiming for a better healthcare system
Don Berwick’s life work is helping to create better healthcare systems. And he is passionate about sharing his knowledge and thinking. He has helped pioneer the phrase ‘the triple aim’ i.e. ‘the pursuit of three goals, namely: improving the experience of care, improving the health of populations, and reducing per capita costs.’
The IHI describe the Triple Aim framework as ‘the foundation for organizations and communities to successfully navigate the transition from a focus on health care to optimizing health for individuals and populations.’
Figure 1: The Triple Aim (Source)
Founding the IHI
Don Berwick co-founded the Institute for Healthcare Improvement (IHI) in 1991 with ‘a group of visionary individuals committed to redesigning health care into a system without errors, waste, delays, and unsustainable costs.’
The origins of the organisation can be traced back to the 1980s when work began on the US ‘National Demonstration Project on Quality Improvement in Health Care’ led Don Berwick.
It continues to be an inspiring organisation to this day, describing its ethos as: ‘Our Work Is Grounded in Science’. They run a programme of coaching to encourage QI in healthcare and to spread the word about quality, with a mission to ‘improve health and health care worldwide.’ It has influence across the globe, sharing improvement methods that have been used in manufacturing and applying them to healthcare. It runs a range of courses, coaching and summer schools and is a not for profit organisation. Read more about the IHI.
Don Berwick has won many awards, including the Heinz Award for Public Policy, the Award of Honour of the American Hospital Association, and the Gustav Leinhard Award from the Institute of Medicine.
“Hospitals and health care systems are making phenomenal strides in quality and my optimism is very high. But the structures are still broken. We have fragmented payment systems and fragmented institutional boundaries. The enemy is fragmentation. We just don’t seem to form into the coalitions, the communities we need to make progress. Until we fix structures and finance it is going to be very hard to make fast progress”
- Don Berwick