Live from IHI: What's the Fate of Healthcare?

He added some systems are making progress in recognizing and dealing with limited resources in providing care in their communities, such as Cedar Rapids, IA; Everett, WA; Tallahassee, FL, and La Crosse, WI.

At the meeting, Kavita Patel, who assists the president's senior advisor, Valerie Jarrett, at the White House, said current reform legislation does not specifically define quality or even how to measure it; this is likely to fall under the review of the healthcare organizations.

While Washington can write the rules, the odds of "re-form" will remain zero unless action is closer to home—or essentially closer to the providers of care. Berwick suggested some ideas to get started:

• Understand your "healthcare commons"—its limits and boundaries, who uses its resources, and who is served.
• Adopt a goal—such as over the next three years, reduce total resource consumption of your healthcare system by 10%. This would be achieved without rationing or exclusion of needed services.
• Develop it fast—"because there isn't much time left," he said. "Do not wait for external rules to be made or to change. Do it yourself."

"We can wait for the rules to be written by others and for the laws on tablets chiseled by others to rescue us—but those rules will be less wise than the ones we can write," he said. "It is a very tough choice: Get everything we can or respect everything we have been given."