Back in the 1980s, Berwick was a pediatrician at the Kenmore Center of the Harvard Community Health Plan in Boston, and in charge of "quality assurance" for the plan. His intellectual curiosity led him to wonder how non-medical parts of U.S. society addressed quality, a heretical notion in the snobby, clubby world of organized U.S. medicine.
In his search, Berwick stumbled onto a fast moving and worldwide intellectual revolution in industry and manufacturing. A key thought leader was another former heretic named W. Edwards Deming who taught the Japanese in the 1950s and the US in the 1970s and '80s that the path to economic success required a relentless focus on customer satisfaction and quality improvement, and that better quality -- doing the right thing and doing it right -- was a way to save money by eliminating rework. The term of art was "total quality management."
In 1989, Berwick wrote a seminal article for the New England Journal of Medicine called "Continuous Improvement as an Ideal in Health Care," and set off an intellectual revolution in American, and eventually, global medicine. Prior to Berwick, "quality" had been linked with the word "assurance" with the cavalier and false assumption that quality already existed, and all that was needed was adequate policing to root out "bad apples." Every hospital was required to have a "quality assurance" department that looked out for quality; everybody else just did their jobs.
More than anyone, Berwick changed the word from "assurance" to "improvement" with new assumptions: quality must be an essential part of everyone's job; no matter how good or how bad you think you and your organization are, every day, you have multiple opportunities to improve; and the key to quality improvement (QI) is the elimination of errors and waste, along with the empowerment of workers. Berwick did more than just establish an idea, he created an organization, the Institute for Healthcare Improvement (IHI), to advance and actualize it. Under his leadership, IHI has become the worldwide home for QI through training, teaching, learning, collaborating, advocating, and more. [...]
That insight led Berwick to shift his focus to health system change. Still at IHI, he became centrally involved in two landmark reports from the Institute of Medicine, To Err Is Human in 1998 (affirming for the first time that at least 100,000 Americans lose their lives every year due to medical errors) and Crossing the Quality Chasm in 2001 (defining the scope and breadth of quality deficiencies in the US health system and charting a path toward improvement). In 2003, focusing on his wife's life threatening illness, he wrote his own personal account of exposure to poor quality, Escape Fire.
At IHI, Berwick developed the national 100,000 Lives Campaign which organized hospitals across the nation in an unprecedented way to undertake a series of QI measures to save that number of lives through systemic, coordinated quality improvement. (While the campaign generated sizable momentum, the final result is disputed.) More campaigns followed, including the Triple Aim campaign to improve patient care, cut health care costs, and fix population health needs. Berwick brought the Triple Aim to CMS, though the lawyers demanded a name adjustment to "Three Part Aim." The CMS-HHS Partnership for Patients is now working to reduce hospital acquired infections and complications.
