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Before he became a lightning rod for Republican criticisms, Berwick was a pediatrician. He earned his medical degree from Harvard picking up a master's degree in public policy at the same time and went to work at several hospitals in Boston. While still a young doctor, in 1979, Berwick began working for a health-maintenance organization (HMO) where he was put in charge of quality assurance. Searching for ways to measure doctor and hospital performance the U.S. health care system does shockingly little of this even today Berwick got interested in the ways large companies measured their production processes to become more efficient. He met with executives at Toyota, Bell Labs, GE and even NASA, eventually launching a nationwide demonstration project to teach health systems how to adopt some of the efficiency and quality practices common in nonhealth care sectors.
By 1991, Berwick had left the HMO to start the Institute for Healthcare Improvement (IHI), a nonprofit research firm dedicated to improving health care quality. He partnered with health systems in the U.S. and abroad to measure outcomes and institute systems to save money and reduce patient injuries and unnecessary deaths; along the way, he became a cult figure in the health-policy world with a reputation as an innovator.
He also became the country's leading proponent of patient-centered care. This notion may sound abstract, but Berwick has gained a following even among doctors for urging medical professionals to pay closer attention to what patients want. Ending limits on hospital visiting hours is a Berwick hallmark, as is open-access scheduling, which allows patients to get same-day appointments in doctors' offices.
Critics say he will bring a heartless, bottom-line sensibility to CMS, but the vast majority of Berwick's writings, speeches and policy work suggest exactly the opposite. In a May 2009 journal article titled "What Patient-Centered Should Mean: Confessions of an Extremist," Berwick wrote that the way hospitals currently treat patients makes him fear being a patient himself. "What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hospital gown, homogenized, anonymous, powerless, no longer myself."
Berwick also served on a panel that published an influential 1999 Institute of Medicine report that found that up to 98,000 Americans die unnecessarily every year due to preventable medical errors. In the report's wake, hospitals across the country contracted with Berwick's firm to figure out ways to improve their own statistics. Eventually, more than 3,000 hospitals joined an IHI campaign to share data about what worked and what didn't, as well as strategies to reduce infections and errors. The result, according to IHI, was 122,300 lives (and countless dollars) saved in just 18 months.
That's a lot, but there is still much room for improvement. A June study commissioned by the Society of Actuaries found that 1.5 million injuries caused by medical errors in 2008 led to $19.5 billion in wasteful spending.