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US system may be next for health innovator

President to tap Harvard professor

Donald Berwick Donald Berwick
By Kay Lazar
Globe Staff / March 31, 2010
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Governments around the world have long sought Donald Berwick’s expertise to help solve stubborn health care problems — from hospital-acquired infections to medication errors.

The 63-year-old pediatrician and Harvard Medical School professor, once considered a rebel for his unconventional ideas about boosting quality care at less cost, is now facing a more daunting challenge:

Berwick is President Obama’s choice to run the nation’s largest health system, the Centers for Medicare and Medicaid Services. The agency and the nation’s health care system are about to undergo dramatic changes, and the Obama administration is under intense pressure to control costs. A White House spokesman confirmed the nomination, expected to be official soon.

Under the sweeping health overhaul Congress approved, Medicare will be scaled back more than $400 billion over 10 years, while Medicaid, a joint state and federally funded program, will extend health coverage to millions more poor people — its largest expansion ever.

The agency is one of the government’s largest, with 4,500 employees and an annual budget of $780 billion. It serves almost 102 million elderly, low-income, and disabled Americans.

Berwick has never run anything larger than his 110-employee Cambridge consulting firm and think tank and has never worked in Washington. But people who know him say he has the intellect and judgment to run the agency, which touches the lives of one in three Americans.

That is not to say his confirmation by the bitterly divided Senate will come easily. Berwick can expect to be pressed on how he will carry out the new law. Sparring over the controversial legislation, and how it will be implemented, may well be part of the proceedings.

Berwick has declined to be interviewed until his appointment is formally announced. But those who know him predict the respect he has earned in health care circles will help him survive the confirmation process.

“He has longstanding recognition for expertise and for not being a partisan individual, so I think that will assist him in his dealings with the Congress, both with the majority and hopefully the minority, as well,’’ said Gail Wilensky, an economist who ran Medicare and Medicaid from 1990 to 1992, during the first Bush administration. Since then, she has worked with Berwick on a number of health initiatives.

Bridging disparate personalities, politics, and egos is a strength of Berwick’s, say some who have watched his rise to guru-like status in the health care industry.

Dr. Paul Batalden, a Dartmouth Medical School professor and pediatrician who, with Berwick, cofounded the Cambridge-based Institute for Healthcare Improvement in 1991, puts it this way: “He has wonderful ideas, and he is able to help others see what those ideas mean in their daily lives.’’

Batalden recalled a meeting 10 years ago in the Pittsburgh headquarters of Alcoa, the once-wheezing steel manufacturer resuscitated when Paul O’Neill came aboard as chief executive. Berwick brought in a group of hospital CEOs to help them learn some of O’Neill’s secrets, and that’s when the Alcoa chief challenged the hospital executives to eliminate one of health care’s most frustrating problems: hospital-acquired infections.

“Everybody in the room tried to correct him and say that’s unrealistic, it can’t be done,’’ Batalden said. “But Don took that idea and made that happen in several hospitals in this country, because he helped people see it was possible.’’

Health care leaders from all over the globe have tapped Berwick’s nonprofit institute for guidance. President Clinton asked him to serve on an advisory commission on consumer protection and health care quality in the 1990s. Berwick’s resume also includes more than a passing brush with royalty: For his help in revamping Britain’s health care system, in 2005 he was made an honorary knight, the highest award given by the United Kingdom to noncitizens.

Berwick, a New York native and eldest son of a family doctor, is a pediatrician by training but a health policy specialist by passion. He earned a master’s degree in public policy at Harvard’s Kennedy School of Government in 1972, the same year he graduated from Harvard Medical School.

The transformation from physician to quality-of-care maestro started a decade later, when Berwick, then a pediatrician at Harvard Community Health Plan, was tapped for a new position aimed at measuring quality in the health organization. By 1985, Berwick was traveling around the country, meeting with leaders of other industries that had boosted their performance by revamping operations.

Lessons learned at places like Sheraton and Bell Labs became the seeds for Berwick’s institute. Over the years, the institute has launched campaigns that essentially guide hospitals in myriad ways to improve patient care, often by revamping internal communication systems.

Questions have been raised about some of the successes his institute cites, however. In 2006, two researchers published an article questioning results of the institute’s 100,000 Lives Campaign, which said it had averted about 122,000 hospital deaths, largely by preventing medication errors and infections in 3,100 institutions over 18 months.

The researchers said 14 percent of the hospitals did not submit their data, and that all of the data submitted were unaudited.

Also that year, Modern Healthcare, a respected journal, questioned the accounting of various funds at the institute. It also noted that in 2003, Berwick earned a “whopping $769,000 in total compensation, followed by $639,000 the next year, including $110,000 for lifetime health insurance.’’ The organization’s tax filings for fiscal 2008 show Berwick was paid $637,000.

Still, Berwick gets credit for the institute’s hard work.

“They involve hospital administrators, doctors, trustees, and nurses because they understand that you don’t get better unless everybody’s involved,’’ said Paul Levy, chief executive of Beth Israel Deaconess Medical Center, who hired the institute in 2002 to bolster patient care. “In the early days, he was not always well received by the medical profession, but he has been persistent and stuck with it and now is more likely to be paid attention to.’’

Kay Lazar can be reached at klazar@globe.com.

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