Episode #104: Reframing Healthcare – A Moral Imperative, with Dr. Don Berwick

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I’m delighted to welcome back to this podcast Dr. Don Berwick – one of the leading authorities on healthcare quality & improvement over the past few decades.  

Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. His body of work & contributions to the field of healthcare quality & safety are unparalleled, including two classics: the 1999 IOM report, ‘To Err is Human’ and the 2001 IOM report, ‘Crossing the Quality Chasm’. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British individuals, in recognition of his work with the British National Health Service.

To say that Dr. Berwick brings a seasoned perspective on the current state of our healthcare system and the challenges we face as a nation is, to put it mildly, an understatement. What distinguishes Dr. Berwick even more than his record of accomplishment or his brilliant mind is his tireless reminders of the ethical responsibility we have to attend to the health of the American public – especially for those of us who are providers, administrators, policy makers, health insurance companies, as well as pharmaceutical and device manufacturers. A relevant quote from one of Dr. Berwick’s recent articles underscores this responsibility;  “Fate will not create the new normal; choices will.”

In this episode, we’ll cover a range of topics, including the following:

  • Dr. Berwick’s recent article, Choices for the “New Normal” – which is a call-to-action and a leadership roadmap outlining crucial choices in six critical domains that will play a significant role in determining the future of healthcare delivery.
  • Inequality and Inequity –  the relative lack of social support services provided in the US as compared to other developed nations; which Dr. Berwick describes as “the most notable wake-up call”.
  • An ethical reframing of the social determinants of health, described in his recent article, The Moral Determinants of Health; along with some shocking statistics on inequities related to poverty, hunger, homelessness, social isolation, and the uninsured.
  • The tragic and insidious institutional racism that is embedded in our healthcare delivery system, as well as in other institutions such as our criminal justice system.
  • A critical reframing of healthcare that Dr Berwick refers to as “What Matters to You Medicine”; which he suggests should disrupt and replace the legacy “What’s the Matter With You” paradigm.

Dr. Berwick is one of the greatest healthcare humanitarians and transformational leaders of our era. He is the quintessential example of empathic ethical leadership. We need more leaders like this in and around healthcare. Dr. Berwick’s recent publications are seminal. In these articles, he courageously cuts to the stark realities of our healthcare system. He not only lays bare the truth for all to see but also outlines the crucial leadership choices of our time. And even beyond that, he lays out a pathway for positive action. Dr. Berwick writes, speaks & acts with intellectual integrity, academic rigor, and with a disarmingly insightful and honest authenticity – as well as with a powerful voice based in morals and compassion. At times, it’s unsettling, uncomfortable and inconvenient. Make no mistake about it, Dr. Berwick’s message is not an academic treatise. It is a call for ethical action.

Until next time,
Be safe and be well.

Zeev E. Neuwirth, MD