Reviving Healthcare

Abstract:If confirmed by the Senate later this summer, Dr. Don Berwick will become the head of the Centers for Medicare and Medicaid Services (CMS). Working with his colleagues in the quality field, Berwick has advanced ideas that are now central to current thinking about health care reform in the U.S. His leadership in the Institute for Healthcare Improvement and the Triple Aim has spread quality improvement and best practices throughout the …

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I feel like a union member instead of an ASQ member. The ASQ leadership is pushing LEFT i.e. Berwick and Social Responsibility while I want neither. Like most on the LEFT, they are using my money to do it. Get back to Quality.
--Russ, 08-10-2011

Berwick is a cog in the Statist far left machine. If he is successful, it will be a very bad day for the American People.
--G. Miles, 06-06-2011

No question that the healthcare system can be improved to provide better quality at less cost.

"The most basic question is not what is best, but who shall decide what is best." - Thomas Sowell

--Tim Clark, 07-31-2010

The March 2010 QP features a tribute to the late Russell Ackoff, noted professor (Wharton School of Business), pioneer in operations research and tireless advocate of systems thinking. Any quick search of the web will yield Russell Ackoff's take on the U.S. healthcare system. Here's a representative comment: "The healthcare system of the United States is not a healthcare system; it is a sickness- and disability-care system. ... Conversion of the current system to a healthcare system would require a fundamental redesign."
--Joe, 07-28-2010

It's worth the effort to watch Dr. Berwick's Deming Lecture at the 2008 Joint Statistical Meetings. You can find it online at
--Joe, 07-27-2010

The main question here (I think) is should ASQ (the proponent of quality) take a partisan approach to the question of healthcare reform? NO.

Quality methodologies, tools and processes have a place in everyone's organization and as a tool in everyone's skillset. I do not know the right answer for healthcare reform, but Americans don't have access to a consistent quality of healthcare. Americans have access to excellent healthcare resources when patients have enough resources.

Several have mentioned the articles lack of data. Check out some statistics. Infant mortality calculated as infant deaths per 1,000 live births is often used as an indicator of the level of health. The 2010 U.S. infant mortality rate is higher than that of other nations: Japan, China, France, Germany, Switzerland, Israel, United Kingdom, Canada and Greece to name a few.
--Elizabeth, 07-20-2010

I've been a fan of Dr. Berwick for years for his insights for improving healthcare quality. But he has outed himself as a political hack, interested in using his position as head of CMS for social change, wealth redistribution and rationing, instead of devoting himself and his department to improving quality. It appears "death panels" were not as imaginary as portrayed.

I find QP articles highly informative, but this one was incredibly biased. To be fair, Dr. Berwick should have been shown as a long-time quality heavyweight with many controversial views, with an exhortation to him to follow the proven path of applying a systems approach to healthcare delivery.

I've started taking a hard line of discontinuing long-standing memberships of organizations who venture out of their area of expertise and into the political arena; AARP was the first to go for selling out its members for a political payoff. If ASQ continues down the same road, it will be sadly added to the list.

Sign me: a disgruntled healthcare worker with dashed hopes.
--Larry, 07-20-2010

The issue for me is ASQ's endorsement of a political party's nominee. Melinda's post addresses my concerns on advocacy.

Politics is a suboptimal, zero-sum game. Improving healthcare requires the most optimal (nonpartisan) of approaches. Plus one for the Progressive Democrats on the Berwick appointment. If the Republicans gain the majority in the House this November, they can choose not to fund healthcare reform - plus one for the Republicans -- zero-sum for the American people. Why does ASQ choose to be part of this neverending game? Changing and improving the system has to be supported from the system/process owners, e.g., We the People, through successful application of quality principles and approaches.

Regarding William's post on the decisions to retain or cancel membership and Deming's admonition that one point out of limit is not a cause to panic - an ASQ policy that allows endorsement of political appointees would represent more than one point.

My decision to renew membership gets more difficult every year. Joined in 1991, senior member, a CQA, past section chair, am a published Quality Press book author. Decision point for me regarding continued membership will be the quality of response, if any, by ASQ leadership regarding the issues and concerns identified in the replies to this article.
--Tim Clark, 07-15-2010

A puff piece. No critical analysis of what some unintended consequences may be for the triple aim. #1 Aim states "a population is the unit of concern". I don't know about you, but for me, each individual should be the unit of concern, not some computer collected 'group'. That's a key difference. Americans, contrary to the U.K., have always been more obsessed with good food and good healthcare. It's who we are.

Where is the consensus for this article and the ASQ leadership's public position? That a majority of members would support the ASQ public stated position seems quite presumptuous. Why didn't ASQ follow what it preaches about: communication, consensus, connectivity, teamwork, satisfying customers, (not having them - us the members - caught off-guard) and so forth.

My triple aim?

1. This letter of protest.
2. A request that the ASQ leadership recalibrate itself and offer a retraction, front page apology to the ASQ membership.
3. Sadly teetering on the edge of terminating my membership after 30 plus years.
--Don,7-15-10, 07-15-2010

Food for thought:

Do I totally agree with Dr. Berwick? NO! Do I totally disagree with Dr. Berwick? NO!

I think we will have to wait to see what actions he is able to take and then monitor the outcomes. He has promoted some good change in healthcare and appears to be able to get some things done. Some of his comments floating around on the internet bother me, but I was not there to hear the whole presentation. As far as redistribution of wealth, we have that now with people going to the ER for care and not paying. Those of us with insurance or pay taxes pay the tab.

We have a lot of room for improvement when it comes to the quality of care. Where we actually stack up is not as critical (unless at either end of the scale) as the fact that we recognize there are problems and they need fixing. I am not in favor of the current healthcare bill passed by Congress. I don't think it is reform of the care, but reform of who pays when and to who. Will young, healthy people get insurance? Probably not, if they can pay less than $1000 a year penalty instead of $4000-$6000 a year premiums. With preexisting conditions gone, they will wait until sick and then get insurance. When well, they will drop the insurance again. So that will put only the sick into the paying pool.

There is too much lacking in the bill when it comes to details of how the steps will be accomplished. Maybe Dr. Berwick will include some of his quality-of-care and cost-reduction ideas into those holes in the bill. I don't know how, but we definitely need healthcare reform, and it should have included tort reform to minimize defensive medicine costs.
--Mickey Christensen, 07-13-2010

Berwick has done great work in the space of healthcare provider quality improvement. That is an assertion that is very difficult to dispute. Healthcare reform, unfortunately, has its primary focus on healthcare insurance reform, which is a change in financial services and structure much more than it is a change in how healthcare is practiced.

He is not qualified as an insurance expert, yet his primary role will be the oversight of insurers. This article had nothing to say about the financial services that insurance companies offer and how they contribute to the overall healthcare system, largely because the person ASQ recommended has little knowledge in the industry he will now oversee.

Quality expertise is critical, but so is industry expertise, and this recommendation is analogous to recommending an expert in chip fabrication to lead the nuclear regulatory commission because nuclear energy production depends on the availability of ASICs. A quality expert in one challenging domain is not necessarily qualified as a regulator of another.
--Mat, 07-13-2010

I have worked in the auto industry and healthcare for several years. I have attended IHI Conferences and am able to evaluate this article under several considerations. It is my belief that in general, most folks in healthcare do not understand "industry" and vise versa. The enthusiasm with the appointment of Dr. Berwick is understandable if you are in healthcare. His politics generally take a back seat to the perceived improvements IHI has made throughout hospitals.

Having been in both fields, I found this article disappointing, political and not evidenced based. I am disappointed in Dr. Berwick's political left-ness and the fact that there apparently will be no debate. I believe that ASQ may have made a mistake with this article, but I am not about to disenfranchise myself from ASQ as yet. Deming says that one point out of limit is not a cause to panic.

Hospitals will get better with or without Dr. Berwick. There are many other, more effective organizations promoting improvement in healthcare that healthcare quality professionals should research.
--William Redinger, 07-12-2010

From the cover page of QP: "Don Berwick aims to transform U.S. healthcare with a systems solution."

A system includes all the stakeholders. Interests from these stakeholders would have been represented in confirmation hearings that were circumvented. Compounding the issue is an administration that passed healthcare reform that surveys indicate the majority of Americans oppose. The issue of repealing all or most of the healthcare reform will likely be among the key issues in the upcoming 2010 and 2012 elections.

The endorsement that needs to be made and that was reinforced in the article was how specific application of the quality principles and approaches are more important than ever in improving the healthcare system. A quality approach by definition, is nonpartisan and nonpolitical.

Healthcare is just one component of our political system that was designed to decentralize and balance power. The successful application of the quality technology requires the continuous improvement of the entire system and not just one component. Successful application would result in the need for less government and not more.

One person or one political party is not going to create an optimal healthcare system. Is ASQ's endorsement of a political party's nominee ever in the best interests of the country, the profession and its membership?

Tim Clark
--Tim Clark, 07-11-2010

Agree with all comments above. Very disappointing, all pro & no con. I want to read data-driven discussions. I do not want ASQ making political, one-sided arguments that have flavor of propaganda.
--Ted, 07-11-2010

I am extremely dismayed ASQ has chosen to endorse Don Berwick and that they printed an article, "Reviving Healthcare," in the July 2010 Quality Progress magazine that applauds Dr. Berwick's nomination to lead the Centers for Medicare and Medicaid Services and his Triple Aim plan. I do not need to expound on the controversy surrounding his nomination or views, as they are well publicized on TV, the internet, etc.
Quality and quality improvement should be non-political. There is no reason that quality improvement in healthcare or any other industry cannot be discussed without involving or supporting some social or political agenda. ASQ's statement about their "advocacy" activities states, "ASQ plays a key role in providing reliable information on quality-related matters to legislators, policy makers and the media. We advocate activities and legislation that promote quality in all walks of life." This statement does not include advocating for or against any particular political viewpoint. I believe ASQ's recent activities regarding the government healthcare initiatives have crossed the line of providing "reliable information on quality-related matters" to promoting a particular political viewpoint.
As a result, it is with regret that I will no longer continue my ASQ membership. I hold two certifications (CQA, CQPA) and have found our local meetings both educational and fun. However, I cannot continue to support ASQ's political involvement. To truly promote quality, ASQ should be a leading example of an apolitical "membership organization devoted to quality."
In Liberty,
Former ASQ Member
--Melinda, 07-10-2010

I am shocked by other members' comments. The most systematic study of healthcare quality in the United States by the RAND Corporation found a defect rate of 45% (NEJM 2003: 349:1866-1868). By any objective standard, we have a high-cost, low-quality healthcare industry. Donald Berwick has been the single-most effective leader in bringing the ASQ quality improvement tools into healthcare. We are lucky Berwick was willing to go into public service. Outside of elective politics, Republican and Democrat healthcare leaders (quoted in this article) are on the same page on what needs to change in our healthcare system. Let's hope that the realm of elective politics can learn some bipartisanship on healthcare.
--Michael, 07-10-2010

I have yet to read any dissension from actual medical professionals. The Institute for Healthcare Improvement (IHI), under Don Berwick's leadership, has been an instrumental resource for many of the top-ranked hospitals and medical organizations in the United States. If you have a family member who survived a complex surgery or procedure without complications or an infection, many of you can thank Berwick and the IHI. It's that simple. By the way, the previous administration used the same method for avoiding confirmation hearings for federal judge court appointments. It's not a new "left wing" strategy or conspiracy.
--Jim, 07-09-2010

Good article, but I am afraid that Berwick's recent appointment by Obama while Congress was away is a sure sign that the President's "agenda" will be a far left approach toward making our healthcare system the center of the new U.S. socialist movement.
--Michael C. Piacenza, 07-09-2010

I am definitely not happy to see ASQ endorse Berwick. He is so radical that quality isn't even a possibility with this man. Obviously, you have failed to research this man. Shame on you.
--Diane, 07-09-2010

My 20-plus years in quality have reinforced the belief that generally you have to do the hard things to get it right. There is no shortcut to success. Berwick is an extremist who espouses redistribution of income to level the playing field. Sorry, but that isn't getting it right; it is a shortcut that cannot be sustained.

Shame on ASQ for endorsing this controversial appointment! If President Obama had a true commitment to change, then the nomination would have been sent to Congress.

I am a senior member of ASQ and a CQE. This endorsement came at an unfortunate time: my annual dues were just paid. If ASQ is going to get into the business of politics, then I will be ending my affiliation at the end of June 2011.

--Fred, 07-09-2010

Prior to this article, I had not realized that ASQ had taken any kind of position on Berwick. I find this quite disconcerting and will be looking at ASQ's stance on other issues of this ilk before renewing my membership.
--Jeff, 07-09-2010

This is soft propaganda. There is no evaluation of the downside of what Dr. Berwick would do. Dr. Berwick seems to have his heart in the right place, but to appoint him without Senate confirmation was just another example of the heavy handed approach of the current administration. Berwick's comments and philosophy should be fully aired before the American people.
--Frank Spaccarotella, 07-09-2010

I have voiced my disagreement on Berwick and ASQ's endorsement of him to my Region 14 and ASQ as a whole. I will be dropping everything with ASQ except what I have to to keep my certifications. Obama was so afraid of the American people's reaction to Berwick's radical ideas that he is sneaking around Senate confirmation. This man is a radical that will not be trying to Kaizen the system but to do a radical overhaul before we can kick him out. We have the best healthcare. Yes, we need some improvements, but NOT A OVERHAUL!!!!!!!!!!!!!!!!!!
--Pamela Young, 07-09-2010

I found this article to be lacking in specific data and therefore inappropriate for a data-driven organization like ASQ to publish. There is multiple use of vague generalities unsupported by data and facts. ASQ should refrain from politics and stick to data.
--Tim , 07-08-2010

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