Donald Berwick: Curing the Healthcare System

How Dr. Donald Berwick and the Institute for Healthcare Improvement apply business best practices—from lean manufacturing to innovation

By Jessie Scanlon

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People go to the hospital to get well. Yet every year, some 15 million patients at U.S. hospitals are harmed—by surgical errors, bed sores, hospital-acquired infections, or other complications. Such avoidable conditions add tens of thousands of dollars to the cost of a patient's hospital stay, and an estimated 100,000 people die as a result, according to the Centers for Disease Control & Prevention.

These sobering facts were the inspiration behind the 5 Million Lives Campaign, a two-year initiative that urges hospitals to adopt 12 specific goals to avoid causing unnecessary harm. The campaign was launched in December 2006 by the Institute for Healthcare Improvement (IHI), a Cambridge (Mass.) nonprofit that was founded in 1991 by Dr. Donald Berwick, to apply business best practices —from lean manufacturing to innovation strategy—to health care.

"Other industries had long ago started managing for continual improvement in products, services, cost structures," says Dr. Berwick, who toured Bell Labs, NASA, and Toyota (TM) in the late '80s to see how those organizations approached quality control. "I soon realized that there was a need for this knowledge on a national level."

Leading Figure in Health-Care Innovation

IHI, which is funded through a combination of membership fees and foundation support, develops software tools to help health-care centers track their performance. It works with partner hospitals to test new methods, essentially running an industrywide innovation department. And it publishes case studies to help health-care providers improve their service and reduce costs at the same time. IHI now employs 118 people, and Dr. Berwick, as its founder, is widely respected as a leading figure in health-care innovation, able to synthesize and apply diverse management practices to an increasingly complex industry.

Consider the problem of how to move patients through a hospital efficiently, from patient admission to the emergency room through surgery and recovery to discharge. ERs in the U.S. are typically operating beyond their capacity, and hospitals often respond by expanding the ER to accommodate more patients. But this worsens the problem by bringing more patients into the system (who will ultimately need more operating rooms or in-patient beds) and adds to hospital costs because more patients end up "parked" in expensive ER beds as they wait to be transferred.

To solve the problem, IHI studied how hotels manage patient flow and found that the answer lay in eliminating unnecessary fluctuations in demand. For instance, hospitals might not be able to control when patients show up, but they can identify and schedule patients to be discharged, just as hotels have a check-out time. Thanks to these insights, published in IHI's 2003 report "Optimizing Flow," Kaiser Permanente doctors now do rounds at 11:30 a.m. to identify patients who can go home the next day and start the discharge process. This helps the staff prioritize patient visits in the morning, and helps housekeeping know when a room will be ready to turn over.

Spreading the World

Through IHI, Dr. Berwick has created an innovation network of hospitals to test new approaches, using a 90-day R&D process that IHI based on the practices of companies such as Procter & Gamble (PG) and 3M (MMM).

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