Innovation and health care transformation

Pursuing the Triple Aim

A conversation with Don Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement (www.ihi.org)

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Dr. Berwick is a Harvard-­trained pediatrication with a passion for quality improvement. He has devoted much of his career to identifying innovations in health care delivery and bringing these efforts to a national scale. We talked with him about the importance of innovation on the new health care horizon.

Q: Throughout your career — most recently in leading the Centers for Medicare & Medicaid Services — you have been a prominent advocate for nationwide innovation in quality of care. Give us your report card on how the health care industry is doing in pursuing innovative approaches to care.

A: I'd say we get an "A" for innovation in biotechnology. And a "C" for innovation in delivery.

Innovation in the biotechnology world, creating better approaches to disease management, is health care's strong suit. It's one of the glories of this industry that we can now cure diseases that were fatal just a few decades ago. But when we look at the delivery system — how health technologies are getting to the patients who need them — we don't get a very good grade. Health care has been way behind in innovating its forms of delivery, and the industry is increasingly aware that its current models aren't adequate to meet our society's needs.

My father was a general practitioner in a small town in Connecticut for over 40 years. I daresay the processes he used in his office when he opened it in 1946 were not all that different from what they are now in 2013.

Health care was built in fragments because we take care of patients in pieces. We don't coordinate care and provide the levels of reliability that we could and should provide.

That's a design problem. So leaders who are interested in improving quality have to be leaders in designing the systems that deliver care. That's the biggest challenge of our day — how to design care without adding to the cost of delivery and without creating waste. The goals are framed by the Institute for Healthcare Improvement, the organization that I led for several years, as the Triple Aim: better care, better health and lower costs.

Leaders who are interested in improving quality have to be leaders in designing the systems that deliver care."

The good news is there's a solution: innovative redesign. And technically, it's possible. We have a growing number of examples of breakthroughs in care delivery. The greater challenge may be in spreading innovations so they become the standard.

Innovation and health care transformation
EY - Innovation and health care transformation

Q: How can health care leaders accelerate innovation in their organizations?

A: The framework I've used for years to guide organizational change is Will-­Ideas-­Execution. It was developed by my colleague Tom Nolan as a model for helping leaders provide resources to the workforce, enabling the organization to make changes, embrace them and thrive. You have to have the will to improve, you have to have ideas about alternatives to the status quo and then you have to make it real through execution. All three of these have to be arranged for by leaders; they are not automatic.

Innovation and health care transformation


EY - Innovation and health care transformation

Source: Adapted from the Institute for Healthcare Improvement Framework for Leadership for Improvement (Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-­Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: IHI; 2008. Available on www.IHI.org).

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