Berwick Pushes for Quality

He cited the example of the fragmented car—one that would use the best of every vehicle—such as the brakes from a Jaguar, the door from a Volvo, the fuel system from a Camaro, or the suspension of a BMW. 

But instead of the best car in the world, it would be a car that wouldn't work because the parts don't fit together. "A car isn't just a collection of parts; it is a system of interacting parts.  That's why cars need designs, and that's why healthcare needs design, too," Berwick said. "'Everyone does their best" is a bad plan. The right plan is, 'Everyone does their best together.'"

Community-based prevention. Rather than wait for problems, actions should be taken to prevent them, Berwick said. That means addressing the causes of illness where they lie—in communities—by looking at daily habits, social supports, and everyday choices.

Moving in these directions will not work with a "top-down, national project," he said. Instead, any successful redesign of healthcare will be a community-by-community task. "That's technically and morally correct, because, in the end, each local community—and only each local community—has the knowledge and skills to define and deliver what is locally right."

America is "seriously underinvested" in using what is known about preventing illnesses such as heart disease, asthma, and depression, he said. "Prevention, if we get serious about it, is a big, big bargain."

So will this quality vision honed over years of working with healthcare providers work? "None of this will be easy." Berwick admitted. "All of us will have to change the way we do business. And there's plenty of work ahead."