Dr. Donald Berwick, former administrator for the Centers for Medicare and Medicaid Services, addressed attendees at the Association of Perioperative Registered Nurses' 59th annual congress in New Orleans, Monday afternoon.
Berwick offered his insight on lessons he has picked up through his involvement with the health care sector.
He talked about the basics of quality, noting two points in particular. The first, according to Berwick, is core science. He stated that core science is not economics, but rather, system science -- the understanding of functioning of very complex systems and procedures as they interact with personnel. This should be the first law of improvement. "Every system is perfectly designed to achieve exactly the results it gets."
He used his old station wagon as an example -- it has a top speed and it's perfectly configured to hit that top speed. But if you don't like that top speed, a new system is needed. The concept, Berwick proposed, applies perfectly to health care.
He cited Japanese professor Noriaki Kano's inquiries about what quality is, for lesson two. The three aspects of his questioning broke into three "Kanos". Kano 1 quality improvements are about defect reductions. Kano 2 improvements cover reducing costs. Kano 3 improvements deal with innovations.
One of the more surprising findings he shared with the audience was about the research done by Steven Jencks and the Centers for Disease Control and Prevention. According to Jencks, the highest health care expenditure states have the lowest quality of care, and the lowest expenditure states have the highest quality of care. In other words, although our health care programs are, in his opinion, in trouble, good care isn't tied to the most spending, so there should be some optimism about being able to provide quality health care to more Americans even with budget cuts looming. But it will take commitment from those on the front line to make it happen.
