Berwick Outlines Sweeping 7-Step Campaign for the Quality Movement

The IHI president emeritus wants healthcare providers to reach beyond the hospital walls and embrace the 'moral determinants of health.'

ORLANDO – Patient safety guru Donald Berwick, MD, is urging healthcare providers to take quality, access, and equity of care a step further and embrace a sweeping, global movement that grounds care delivery on moral convictions.

"At last, I think we're starting to recognize the inescapable importance of the social determinants of health," Berwick said here Wednesday at the keynote address of the 31st Institute for Healthcare Improvement National Forum.

"But now we need to go one very hard step further. We need to call out, not just the social determinants of health, but also the moral determinants of health, because without that we are not going to find the will to act," he said.

To the rousing applause of thousands of forum attendees, the IHI president emeritus and senior fellow used the dais to propose "a new campaign for our quality movement, founded on a shared commitment to act on what really matters to the people of our nation, to all the people of the world, boundaries, notwithstanding."

Berwick urged healthcare providers to embrace his unabashedly progressive agenda that looks beyond their own immediate needs and margin pressures, and actively confronts the root causes of the vast social and moral issues that ultimately affect the health of humanity, such as a lack of access to food, shelter, healthcare, and hope.

"The campaign that I would envision would consist of those actions, those goals, those investments that that moral compass points to," he said. "They are what we must work on or must choose to work on if we're going to be true to that moral core. Our project then becomes to improve the social determinants of health that our moral determinants illuminate."

Berwick outlined seven steps to make it happen.

1. Commit to human rights: "First, declare a commitment to achieve U.S. ratification of key human rights treaties," he said. "The U.S. technically has ratified the Universal Declaration of Human Rights, but we have not ratified subsequent covenants or treaties, especially pertaining to the right to health and healthcare. We need to join the global human rights community formally and now."
    
2. Push for universal coverage: "Second, make healthcare unequivocally a human right in this nation," he said. "At this moment this country still has 30 million people without health insurance. It is time to end that cruel embarrassment. This quality movement should stand foursquare, vocally for universal health coverage in the United States of America now."
    
3. Combat climate change: "Third, we need to restore American leadership to the fight to reverse climate change," he said. "The evidence is overwhelming. Our nation is not doing its job to reverse that imminent tragedy. It may be too late I fear, but we have to try. Neither healthcare nor the quality movement can responsibly be a bystander."
    
4. Back criminal justice reform: "Fourth, please let's achieve radical reform in our nation's criminal justice system," he said. "We have more people in prison per capita in this nation than any other nation on Earth, except Russia. ... The people who are incarcerated are overwhelmingly people of color by a factor of six or eight. This is the cruelest form of racism in our nation in our time. It is as erosive of health and well-being for entire generations as the most toxic bacteria or the most sinister cancer. We have to fix it."
    
5. Encourage inclusive immigration policies: "Fifth, we've got to end policies of exclusion and achieve meaningful immigration reform in this nation," he said. "I have had it up to here with cruelty at our borders."
    
6. Take poverty head-on: "Sixth, we need to end hunger and homelessness in America," he said. "That ought to offend every sensibility of a civilized and compassionate people; the claim that our rich nation cannot assure food and clothing and shelter to absolutely everyone. ... that claim is insane. And let me be clear, this absolutely requires a big dose of redistribution of wealth in America. It means once and for all ending the practice of blaming people who are less fortunate."
    
7. Defend civil institutions: "Finally, seventh, we need to restore order and dignity and equity toward democratic institutions," he said. "Most of all, assure the right of every single person's vote to count equally. ... When the institutions no longer serve mercy and compassion and health and shared well-being the rules must change. I believe deeply that America's project and democracy, however fragile however sometimes wandering or maddening it can become, it's still the best route to the communities that we want."