Q&A: Don Berwick Reflects on Healthcare Reform, Part II
So, there is a gap between the improvement movement on the one hand, which has a lot of knowledge about using improvement to achieve cost reduction, and the responsible public policymakers and public servants who formulate regulations and laws.
And I have to say the same gap often exists between the improvement movement and the C-suite in medical organizations, hospitals and large systems. There is too much distance between the front office and the front line, and so executives can fail to appreciate quality as a business strategy, just as policy makers can fail to appreciate quality as a public policy strategy.
We're approaching a time when that gap should and will close, when people who identify themselves with quality improvement get to see themselves as potential leaders for solutions to the largest problems in healthcare, which include equity, justice, cost, and reliability. As that happens, the quality movement will really be moving into the big time.
I came out of the improvement movement. That's my original knowledge base; but I and many others are learning how to bring our knowledge into the political arena. That bridge needs to be built.
HLM: You said something last year that made me almost fall out of my chair. That the best healthcare reform legislation was campaign finance reform.
DB: Right. Right now, with $2.7 trillion in play, the status quo is very, very loud, and very well funded, and heavily connected to campaign finances, because lobbyists have earned entry into the politicians' doors. They speak loudly, and they do not always defend the interests of the poor.
The importance of making sure that medical treatment actually works, the toxicity of overtreatment, the need for better valuation of clinical practices—all of those things don't have the voice that the status quo has.
HLM: Which lobbyists are you referring to?
DB: Anyone whose job depends on the status quo, and for whom changes are painful. They would rather see things continue or even get more support for what they do.
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