First, Stop Doing Harm

It's a heady experience to attend the Quest for Excellence conference, which is held each year as a learning session based on the experiences of the newest winners of the Malcolm Baldrige National Quality Award.

The companies get to brag about all the things that they have done right, in areas like leadership, employee relations, customer service and information analysis. And it's hard not to get caught up in their enthusiasm. You walk out of the room feeling energized and determined to go back and do better.

But at this year's conference, the single most moving presentation was not delivered by one of the winners, and in fact it was not a quality success story at all. Instead the speech was an assessment of one of the most stubborn challenges that confront us--how to make our health care system more affordable, accessible and responsive to patient needs.

"We are doing harm, and we need to stop it," Donald M. Berwick, the president of the Institute for Healthcare Improvement, said in his address. His was not an academic dissection of the state of our medical system but rather a personal account of what happened after his wife, Ann, was diagnosed with an autoimmune spinal cord disease.

The good news is that she is on the road to recovery. But along the way there were frightening moments. While she was treated in some of the best hospitals in the world, "errors in her care were not rare, they were the norm," Berwick related. "I tell you from my personal knowledge: No day passed--not one--without a medication error."

What makes this all the worse is that Berwick is a medical doctor and a professor at Harvard Medical School. If he cannot secure safe and appropriate health care for a loved one, where does that leave the rest of us?

In his speech, Berwick offered a road map for how the medical profession can start to make sense of the problems it is causing and experiencing. But there is also an important role for the quality profession as a whole to play.

In dealing with our employers, elected representatives and health care providers, we should individually and collectively be making a stronger case for the use of quality in the medical system. It won't happen all at once, but if all those who have seen the power of quality at work begin to insist that the  health care system wake up to its possibilities, then perhaps we can move away from polarizing political debates and start to see some real solutions.

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  Miles Maguire

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