Here are the 11 monsters Berwick has identified. Some are held within institutional culture, those in policy and law, and those in practice, that Berwick told the healthcare industry it must slay.
1. Instill confidence in science as a basis for action. Doctors and hospitals have triumphed in connecting medical decisions to science, and treat patients "according to facts, not according to myths or habits…But it's an incomplete triumph because we don't do it…We continue to allow quite senseless unscientific variation in practice to masquerade as autonomy."
And what comes from that is a confused public, and now it's become a suspicious public…made suspicious by politics, by exploitive accusations that scientific thought is elitist…a way to deny people what they need. We say science, we say evidence-based medicine, and the public hears 'rationing."
2. Use our global brains. While at CMS, Berwick says, he was told to never mention another country. "If you do, you'll take a cheap, demagogic shot from someone who questions your loyalty or says you're a socialist…
"But being different isn't a bad thing. What's missing is a chance to learn from our differences. Penicillin was discovered in Paddington, London, and now cures pneumonia in Peoria."
3. Learn from large systems. Somehow, American healthcare's thought leaders must learn how to improve care by experimenting with change in real time clinical environments, not by researching or adopting what happened in the past. But they haven't sufficiently developed, nor have they widely accepted, new investigatory approaches and they will have to get over that.
4. Name the excess. America spends 40% more on healthcare than it needs to. And that has been pushed by the argument that patients need more. "These claims are goodhearted…But it has been nearly impossible to claim what in our nation has become true, which is enough is enough. The particular monster here is very big and very scary. It's the scariest one."