Podcast appearances and mentions of don berwick

We're back with new stories, new voices, and a renewed commitment to spotlighting nurse-led innovation. As SEE YOU NOW celebrates 5 years of sharing the bold ideas and groundbreaking work of nurses, we're looking ahead to the next chapter and amplifying the ways nurses are leading transformative change in healthcare.  In upcoming episodes, we'll explore patient safety with Don Berwick and Patricia McGaffigan, tackle access and workforce challenges, dig into mental health innovation, continue our AI in Play series, and more.   Subscribe, share, and stay tuned—because when we support nurses, we advance better health for all.   

This episode is a collaboration with Doctors for America."This issue has been affecting my sleep. I'm not sleeping and I'm a pretty good sleeper, so this must be bothering me."In this powerful special episode of the Pursuit of Health podcast, Dr. Eric Fethke collaborates with Doctors for America to sound the alarm about the proposed $880 billion in Medicaid cuts over ten years - a cut larger than the program's entire annual budget.Using the fictional Smith family as a case study, Dr. Fethke illustrates how Medicaid is essential for everyday Americans: from a farm manager with a green card, to a mother pursuing nursing education, a son in addiction recovery, a pregnant wife with diabetes, and a grandmother with early Alzheimer's.Dr. Fethke explains that Medicaid serves as a crucial lifeline, supporting rural hospitals, covering 1 in 4 children, and providing essential care for the elderly, disabled, and those with chronic conditions. The episode features insights from Dr. Don Berwick, former head of CMS, who warns against "blaming the poor" for healthcare system issues."Medicaid is the largest single health insurance provider in the country. It's bigger than Medicare, and most people don't know that. Even doctors... 26% of all Americans receive health care through Medicaid."---As a special thank-you to our listeners, DFA is offering 35% off your first year of membership! Just use the code PURSUIT at checkout to take advantage of this exclusive offer.To learn more about DFA and how you can get involved, visit www.doctorsforamerica.org. You'll also find all the details and links in our show notes.https://docs.google.com/document/d/1O1ApRxGzx2cxvxWFI_kMXP6GOvUfcJngmSZHS4IkqL0/edit?usp=sharingFollow me on Instagram and Facebook @ericfethkemd and checkout my website at www.EricFethkeMD.com. My brand new book, The Privilege of Caring, is out now on Amazon! https://www.amazon.com/dp/B0CP6H6QN4

Welcome to Season 6 Episode 1 of the podcast. This season we will explore the overarching theme of hope as something we intentionally co-create through great strategy and action. I am incredibly honoured to be joined but not one but two "giants" in healthcare clinical leadership, Dr Don Berwick President Emeritus and Senior Fellow at at the Institute for Health Improvement and also special guest co-host Professor Catherine Crock Chair and Founder of the Hush Foundation. ( More complete bios in episode)       In this powerful conversation we again use Marshall Ganz's perfect story arc of self, us and now to explore Dr Berwick's own story and journey of healthcare improvement, we discuss how important it is not do this work alone and organise and bring others will us. We learn that there is method in mobilisation as beautifully demonstrated by the success of the 100, 000 lives campaign. Leadership remains the pervasive theme throughout and the call to action extends to all of us in healthcare but particularly to the highest levels of leadership to courage and kindness, to dare greatly, get rid of stupid stuff, deeply listen and engage clinicians and patients and be prepared to change mind and direction with new and involving information. Whilst a short podcast conversation cannot do full justice to the wealth of combined knowledge and wisdom of these two senior clinical leaders, I know you, like I, will gain so much from this one and I encourage you to explore more of the resources we discuss linked below. "If I have seen further it is by standing on the shoulder of giants"Sir Isaac Newton Links, References and Recommended Reads :https://www.ihi.orghttps://cms.megaphone.fm/channel/ihiturnonthelightsLink to IHI Dr Don Berwick and Dr Jessica Berwick ]https://youtu.be/kxZl8Kc0-S0?si=iWOdRAmt_rFuCGWN The Moral determinants of health Berwick DM. The Moral Determinants of Health. JAMA. 2020;324(3):225–226. doi:10.1001/jama.2020.11129 Dr Don Berwick and Prof Amy Edmondson IHI Patient Safety Conference 2024https://youtu.be/akLEl9XOA28?si=kMYRwtFo77B7HkU0The Hush Foundation https://www.hush.org.au People, Power Change Marshall Ganz https://www.hks.harvard.edu/publications/people-power-change-organizing-democratic-renewal Sir Michael Marmot The Health Gap https://www.bloomsbury.com/au/health-gap-9781408857977/ The Mind Full Medic Podcast is proudly sponsored by the MBA NSW-ACT Find out more about their service or donate today at www.mbansw.org.auDisclaimer: The content in this podcast is not intended to constitute or be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional. Moreover views expressed here are our own and do not necessarily reflect those of our employers or other official organisations.

A panel with Dr. Don Berwick, Tanya Sanderson and Ron HowrigonToday, Dr. Fethke calls on three previous guests to share their thoughts, insights, and solutions in the light of the UHC incident, a tragic murder that highlighted the scale of public anger at the state of our healthcare system.With our panel drawing from their vast collective experience at clinical, administrative and federal level, this episode serves as a vital resource for understanding how we got here, why the situation is so dire, and what we need to do to fix it.From insurance companies to pharmaceuticals, medical professionals to hospitals, the government and most importantly the public: it's time to move forward constructively, reforming American healthcare for the better.Follow me on Instagram and Facebook @ericfethkemd and checkout my website at www.EricFethkeMD.com. My brand new book, The Privilege of Caring, is out now on Amazon! https://www.amazon.com/dp/B0CP6H6QN4

The Best of The Next Gen Cast: Celebrating Eight Years of Next Gen programmesIn this special episode of The Next GenCast, we celebrate the Next Gen's 8-year anniversary by revisiting the highlights from the five most downloaded podcast episodes.Get ready to hear from truly inspiring leaders on a range of topics, from the conversations which have resonated the most with our listeners over the years:4 mins- Oliver Burkeman on Time Management15 mins- Don Berwick on Joy in Work24 mins- Sarah Jane Marsh on Work-Life Balance31 mins- Jeremy Hunt on Leadership and Politics38 mins- Laura Neilsen on Tackling Health Inequalities*Links to the full episodes:Oliver BurkemanDon BerwickSarah Jane MarshJeremy HuntLaura NeilsonThank you to everyone who has listened, subscribed and shared the podcast, as well as giving us your thoughts on what resonates - it has been wonderful to hear how much you're enjoying it. Hosted on Acast. See acast.com/privacy for more information.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Don Berwick of the Institute for Healthcare Improvement about his paper as part of the Vital Directions for Health and Health Care: Priorities for 2025 package that proposes strategies for how health care in the US could be transformed.Order the February 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

Join host Andrew Stotz for a lively conversation with Cliff Norman and Dave Williams, two of the authors of "Quality as an Organizational Strategy." They share stories of Dr. Deming, insights from working with businesses over the years, and the five activities the book is based on. TRANSCRIPT 0:00:02.2 Andrew Stotz: My name is Andrew Stotz, and I'll be your host as we dive deeper into the teachings of Dr. W. Edwards Deming. Today, we have a fantastic opportunity to learn more about a recent book that's been published called "Quality as an Organizational Strategy". And I'd like to welcome Cliff Norman and Dave Williams on the show, two of the three authors. Welcome, guys.   0:00:27.1 Cliff Norman: Thank you. Glad to be here.   0:00:29.4 Dave Williams: Yeah, thanks for having us.   0:00:31.9 Andrew Stotz: Yeah, I've been looking forward to this for a while. I was on LinkedIn originally, and somebody posted it. I don't remember who, the book came out. And I immediately ordered it because I thought to myself, wait, wait, wait a minute. This plugs a gap. And I just wanna start off by going back to Dr. Deming's first Point, which was create constancy of purpose towards improvement of product and service with the aim to become competitive and stay in business and to provide jobs. And all along, as anybody that learned the 14 Points, they knew that this was the concept of the strategy is to continue to improve the product and service in the eyes of the client and in your business. But there was a lot missing. And I felt like your book has started really to fill that gap. So maybe I'll ask Cliff, if you could just explain kind of where does this book come from and why are you bringing it out now?   0:01:34.5 Cliff Norman: That's a really good question, Andrew. The book was originally for the use of both our clients only. So it came into being, the ideas came out of the Deming four day seminar where Dr. Tom Nolan, Ron Moen and Lloyd Provost, Jerry Langley would be working with Dr. Deming. And then at the end of four days, the people who some of who are our clients would come up to us and said, he gave us the theory, but we don't have any methods. And so they took it very seriously and took Dr. Deming's idea of production viewed as a system. And from that, they developed the methods that we're going to discuss called the five activities. And all of our work with this was completely behind the wall of our clients. We didn't advertise. So the only people who became clients were people who would seek us out. So this has been behind the stage since about 1990. And the reason to bring it out now is to make it available beyond our client base. And Dave, I want you to go ahead and add to that because you're the ones that insisted that this get done. So add to that if you would.   [laughter]   0:02:53.0 Dave Williams: Well, thanks, Cliff. Actually, I often joke at Cliff. So one thing to know, Cliff and Lloyd and I all had a home base of Austin, Texas. And I met them about 15 years ago when I was in my own journey of, I had been a chief quality officer of an ambulance system and was interested in much of the work that API, Associates of Process Improvement, had been doing with folks in the healthcare sector. And I reached out to Cliff and Lloyd because they were in Austin and they were kind enough, as they have been over many years, to welcome me to have coffee and talk about what I was trying to learn and where my interests were and to learn from their work. And over the last 15 years, I've had a great benefit of learning from the experience and methods that API has been using with organizations around the world, built on the shoulders of the theories from Dr. Deming. And one of those that was in the Improvement Guide, one of the foundational texts that we use a lot in improvement project work that API wrote was, if you go into the back, there is a chapter, and Cliff, correct me if I'm wrong, I think it's chapter 13 in this current edition on creating value.   0:04:34.3 Dave Williams: In there, there was some description of kind of a structure or a system of activities that would be used to pursue qualities and organizational strategy. I later learned that this was built on a guide that was used that had been sort of semi self-published to be able to use with clients. And the more that I dove into it, the more that I really valued the way in which it had been framed, but also how, as you mentioned at the start, it provided methods in a place where I felt like there was a gap in what I saw in organizations that I was working with or that I had been involved in. And so back in 2020, when things were shut down initially during the beginning of the pandemic, I approached Lloyd and Cliff and I said, I'd love to help in any way that I can to try to bring this work forward and modernize it. And I say modernize it, not necessarily in terms of changing it, but updating the material from its last update into today's context and examples and make it available for folks through traditional bookstores and other venues.   0:05:58.9 Andrew Stotz: And I have that The Improvement Guide, which is also a very impressive book that helps us to think about how are we improving. And as you said, the, that chapter that you were talking about, 13, I believe it was, yeah, making the improvement of value a business strategy and talking about that. So, Cliff, could you just go back in time for those people that don't know you in the Deming world, I'm sure most people do, but for those people that don't know, maybe you could just talk about your first interactions with Dr. Deming and the teachings of that and what sparked your interest and also what made you think, okay, I wanna keep expanding on this.   0:06:40.0 Cliff Norman: Yeah. So I was raised in Southern California and of course, like many others, I'm rather horrified by what's going on out there right now with fires. That's an area I was raised in. And so I moved to Texas in '79, went to work for Halliburton. And they had an NBC White Paper called, "If Japan Can, Why Can't We?", and our CEO, Mr. Purvis Thrash, he saw that. And I was working in the quality area at that time. And he asked me to go to one of Deming's seminars that was held in Crystal City, actually February of 1982. And I got down there early and got a place up front. And they sent along with me an RD manager to keep an eye on me, 'cause I was newly from California into Texas. And so anyway, we're both sitting there. And so I forgot something. So I ran up stairs in the Sheraton Crystal City Hotel there. And I was coming down and lo and behold, next floor down, Dr. Deming gets on and two ladies are holding him up. And they get in the elevator there and he sees this George Washington University badge and he kind of comes over, even while the elevator was going down and picks it up and looks it up real close to his face. And then he just backs up and leans, holds onto the railing and he says, Mr. Norman, what I'm getting ready to tell you today will haunt you for the rest of your life.   0:08:11.8 Cliff Norman: And that came true. And of course, I was 29 at the time and was a certified quality engineer and knew all things about the science of quality. And I couldn't imagine what he would tell me that would haunt me for the rest of my life, but it did. And then the next thing he told me, he said, as young as you are, if you're not learning from somebody that you're working for, you ought to think about getting a new boss. And that's some of the best advice I've ever gotten. I mean, the hanging around smart people is a great thing to do. And I've been gifted with that with API. And so that's how I met him. And then, of course, when I joined API, I ended up going to several seminars to support Lloyd Provost and Tom Nolan and Ron Moen and Jerry as the various seminars were given. And Ron Moen, who unfortunately passed away about three years ago, he did 88 of those four day seminars, and he was just like a walking encyclopedia for me. So anytime I had questions on Deming, I could just, he's a phone call away, and I truly miss that right now.   0:09:20.5 Cliff Norman: So when Dave has questions or where this reference come from or whatever, and I got to go do a lot of work, where Ron, he could just recall that for me. So I miss that desperately, but we were busy at that time, by the time I joined API was in '88. And right away, I was introduced to what they had drafted out in terms of the five activities, which is the foundation of the book, along with understanding the science of improvement and the chain reaction that Dr. Deming introduced us to. So the science of improvement is what Dr. Deming called the System of Profound Knowledge. So I was already introduced to all that and was applying that within Halliburton. But QBS, as we called it then, Qualities of Business Strategy was brand new. I mean, it was hot off the press. And right away, I took it and started working with my clients with it. And we were literally walking on the bridge as we were building it. And the lady I'm married to right now, Jane Norman, she was working at Conagra, which is like a $15 billion poultry company that's part of Conagra overall, which is most of the food in your grocery store, about 75% of it. And she did one of the first system linkages that we ever did.   0:10:44.5 Cliff Norman: And since then, she's worked at like four other companies as a VP or COO, and has always applied these ideas. And so a lot of this in the book examples and so forth, comes from her actual application work. And when we'd worked together, she had often introduced me, this is my husband, Cliff, he and his partners, they write books, but some of us actually have to go to work. And then eventually she wrote a book with me with Dr. Maccabee, who is also very closely associated with Dr. Deming. So now she's a co-author. So I was hoping that would stop that, but again, we depend on her for a lot of the examples and contributions and the rest of it that show up in the book. So I hope that answers your question.   0:11:28.2 Andrew Stotz: Yeah, and for people like myself and some of our listeners who have heard Dr. Deming speak and really gotten into his teachings, it makes sense, this is going to haunt you because I always say that, what I read originally... I was 24 when I went to my first Deming seminar. And I went to two two-day seminars and it... My brain was open, I was ready, I didn't have anything really in it about, any fixed methods or anything. So, for me, it just blew my mind, some of the things that he was talking about, like thinking about things in a system I didn't think about that I thought that the way we got to do is narrow things down and get this really tight focus and many other things that I heard. And also as a young, young guy, I was in this room with, I don't know, 500 older gentlemen and ladies, and I sat in the front row and so I would see him kind of call them on the carpet and I would be looking back like, oh, wow, I never saw anybody talk to senior management like that and I was kind of surprised. But for those people that really haven't had any of that experience they're new to Deming, what is it that haunts you? What is... Can you describe what he meant when he was saying that?   0:12:42.9 Cliff Norman: I gotta just add to what you just said because it's such a profound experience. And when you're 29, if most of us, we think we're pretty good shape by that time, the brain's fully developed by age 25, judgment being the last function that develops. And so you're pretty well on your way and then to walk in and have somebody who's 81 years old, start introducing you to things you've never even thought about. The idea of the Chain Reaction that what I was taught as a certified quality engineer through ASQ is I need to do enough inspection, but I didn't need to do too much 'cause I didn't want to raise costs too much. And Dr. Deming brought me up on stage and he said, well, show me that card again. So I had a 105D card, it's up to G now or something. And he said, "well, how does this work?" And I said, "well, it tells me how many samples I got to get." And he says, "you know who invented that." And I said, "no, sir, I thought God did." He said, "no, I know the people that did it. They did it to put people like you out of business. Sit down, young man, you've got a lot to learn." And I thought, wow, and here you are in front of 500 people and this is a public flogging by any stretch.   0:13:56.1 Cliff Norman: And it just went on from there. And so a few years later, I'm up in Valley Forge and I'm working at a class with Lloyd and Tom Nolan and a guy named, I never met before named Jim Imboden. And he's just knock-down brilliant, but they're all working at General Motors at that time. And a lot of the book "Planned Experimentation" came out of their work at Ford and GM and Pontiac and the rest of it. And I mean, it's just an amazing contribution, but I go to dinner with Jim that night. And Jim looks at me across the table and he says, Cliff, how did you feel the day you found out you didn't know anything about business economics or anything else? I said, "you mean the first day of the Deming seminar?" He said, "that's what I'm talking about." And that just... That's how profound that experience is. Because all of a sudden you find out you can improve quality and lower costs at the same time. I'm sorry, most people weren't taught that. They certainly weren't taught that in business school. And so it was a whole transformation in thinking and just the idea of a system. Most of what's going on in the system is related to the system and the way it's constructed. And unfortunately, for most organizations, it's hidden.   0:15:04.2 Cliff Norman: They don't even see it. So when things happen, the first thing that happens is the blame flame. I had a VP I worked for and he'd pulled out his org chart when something went bad and he'd circle. He said, this is old Earl's bailiwick right here. So Cliff, go over and see Earl and I want you to straighten him out. Well, that's how most of it runs. And so the blame flame just takes off. And if you pull the systems map out there and if he had to circle where it showed up, he'd see there were a lot of friends around that that were contributing. And we start to understand the complexity of the issue. But without that view, and Deming insisted on, then you're back to the blame flame.   0:15:45.1 Andrew Stotz: Yeah. And Dave, I see a lot of books on the back on your shelf there about quality and productivity and team and many different things. But maybe you could give us a little background on kind of how how you, besides how you got onto this project and all that. But just where did you come from originally and how did you stumble into the Deming world?   0:16:08.9 Dave Williams: Sure. Well, sadly, I didn't have the pleasure of getting to sit in on a four-day workshop. Deming died in 1993. And at that time, I was working on an ambulance as a street paramedic and going to college to study ambulance system design and how to manage ambulance systems, which was a part of public safety that had sort of grown, especially in the United States in the '60s. And by the time I was joining, it was about 30 years into becoming more of a formalized profession. And I found my way to Austin, Texas, trying to find one of the more professionalized systems to work in and was, worked here as a paramedic for a few years. And then decided I wanted to learn more and started a graduate program. And one of the courses that was taught in the graduate program, this is a graduate program on ambulance management, was on quality. And it was taught by a gentleman who had written a, a guide for ambulance leaders in the United States that was based on the principles and methods of quality that was happening at this time. And it pieced together a number of different common tools and methods like Pareto charts and cause-and-effect diagrams and things like that.   0:17:33.1 Dave Williams: And it mentioned the different leaders like Deming and Juran and Crosby and others. And so that was my first exposure to many of these ideas. And because I was studying a particular type of healthcare delivery system and I was a person who was practicing within it and I was learning about these ideas that the way that you improve a system or make improvement is by changing the system. I was really intrigued and it just worked out at the time. One of the first roles, leadership roles that emerged in my organization was to be the Chief Quality Officer for the organization. And at the time, there were 20 applicants within my organization, but I was the only one that knew anything about any of the foundations of quality improvements. Everybody else applied and showed their understanding of quality from a lived experience perspective or what their own personal definitions of quality were, which was mostly around inspection and quality assurance. I had, and this won't surprise Cliff, but I had a nerdy response that was loaded with references and came from all these different things that I had been exposed to. And they took a chance on me because I was the only one that seemed to have some sense of the background. And I started working and doing...   0:19:10.1 Dave Williams: Improvement within this ambulance system as the kind of the dedicated leader who was supposed to make these changes. And I think one of the things that I learned really quickly is that frequently how improvement efforts were brought to my attention was because there was a problem that I, had been identified, a failure or an error usually attributed to an individual as Cliff pointed out, somebody did something and they were the unfortunate person who happened to kind of raise this issue to others. And if I investigated it all, I often found that there were 20 other people that made the same error, but he was, he or she was the only one that got caught. And so therefore they were called to my office to confess. And when I started to study and look at these different issues, every time I looked at something even though I might be able to attribute the, first instance to a person, I found 20 or more instances where the system would've allowed or did allow somebody else to make a similar error.   0:20:12.6 Dave Williams: We just didn't find it. And it got... And it became somewhat fascinating to me because my colleagues were very much from a, if you work hard and just do your job and just follow the policy then good quality will occur. And nobody seemed to spend any time trying to figure out how to create systems that produce good results or figure out how to look at a system and change it and get better results. And so most of my experience was coming from these, when something bubbled up, I would then get it, and then I'd use some systems thinking and some methods and all of a sudden unpack that there was a lot of variation going on and a lot of errors that could happen, and that the system was built to get results worse than we even knew.   0:21:00.7 Dave Williams: And it was through that journey that I ended up actually becoming involved with the Institute for Healthcare Improvement and learning about what was being done in the healthcare sector, which API at the time were the key advisors to Dr. Don Berwick and the leadership at IHI. And so much of the methodology was there. And actually, that's how I found my way to Cliff. I happened to be at a conference for the Institute for Healthcare Improvement, and there was an advertisement for a program called the Improvement Advisor Professional Development Program, which was an improvement like practitioner project level program that had been developed by API that had been adapted to IHI, and I noticed that Cliff and Lloyd were the faculty, and that they were in my hometown. And that's how I reached out to them and said, hey can we have coffee? And Cliff said, yes. And so...   0:21:53.1 Andrew Stotz: And what was that, what year was that roughly?   0:22:00.3 Dave Williams: That would've been back in 2002 or 2003, somewhere in that vicinity.   0:22:02.0 Andrew Stotz: Hmm. Okay.   0:22:06.8 Dave Williams: Maybe a little bit later.   0:22:06.9 Andrew Stotz: I just for those people that are new to the topic and listening in I always give an example. When I worked at Pepsi... I graduated in 1989 from university with a degree in finance. And I went to work at Pepsi in manufacturing and warehouse in Los Angeles at the Torrance Factory originally, and then in Buena Park. But I remember that my boss told me, he saw that I could work computers at that time, and so I was making charts and graphs just for fun to look at stuff. And he said, yeah, you should go to a one of these Deming seminars. And so he sent me to the one in... At George Washington University back in 1990, I think it was. And but what was happening is we had about a hundred trucks we wanted to get out through a particular gate that we had every single morning. And the longer it took to get those trucks out the longer they're gonna be on LA traffic and on LA roads, so if we can get 'em out at 5:00 AM, fantastic. If we get 'em out at 7:00, we're in trouble. And so they asked me to look at this and I did a lot of studying of it and I was coming for like 4:00 in the morning I'd go up to the roof of the building and I'd look down and watch what was happening. And then finally I'd interview everybody. And then finally the truck drivers just said, look, the loaders mess it up so I gotta open my truck every morning and count everything on it. And I thought, oh, okay.   0:23:23.7 Andrew Stotz: So I'll go to the loaders. And I go, why are you guys messing this up? And then the loaders was like, I didn't mess it up. We didn't have the production run because the production people changed the schedule, and so we didn't have what the guy needed. And so, and oh, yeah, there was a mistake because the production people put the product in the wrong spot, and therefore, I got confused and I put the wrong stuff on by accident. And then I went to the production people and they said, well, no, it's not us. It's the salespeople. They keep putting all this pressure on us to put this through right now, and it's messing up our whole system. And that was the first time in my life where I realized, okay, it's a system. There's interconnected parts here that are interacting, and I had to go back into the system to fix, but the end result was I was able to get a hundred trucks through this gate in about 45 minutes instead of two hours, what we had done before.   0:24:18.8 Andrew Stotz: But it required a huge amount of work of going back and looking at the whole system. So the idea of looking at the science of improvement, as you mentioned, and the System of Profound Knowledge, it's... There's a whole process. Now, I wanna ask the question for the person who gets this book and they dig into it, it's not a small book. I've written some books, but all of 'em are small because I'm just, maybe I just can't get to this point. But this book is a big book, and it's got about 300... More than 300 pages. What's the promise? What are they gonna get from digging into this book? What are they gonna take away? What are they gonna be able to bring to their life and their business that they couldn't have done without really going deeper into this material?   0:24:57.7 Cliff Norman: Dave, go ahead.   0:25:01.4 Dave Williams: Well, I was gonna joke by saying they're gonna get hard work and only half because this is just the theory in the book and many of the... And sort of examples of the method. But we're in the process of preparing a field guide which is a much deeper companion guide loaded with exercises and examples of and more of the methods. So the original guide that that API had developed was actually about an eight... Well, I don't know how many pages it was, but it was a thick three inch binder. This, what you have there is us refining the content part that explains the theory and kind of gets you going. And then we moved all of the exercises and things to the field guide for people that really wanna get serious about it.   0:26:00.3 Dave Williams: And the reason I say hard work is that the one thing that you won't get, and you should probably pass it if this book if you're on Amazon, is you're not gonna get an easy answer. This is, as a matter of fact, one of the things that emerged in our early conversations about was this project worth it? Is to say that this is hard work. It's work that a very few number of leaders who or leadership teams that really want to learn and work hard and get results are gonna embark on. But for those, and many of our clients, I think are representative of that, of those people that say, gosh, I've been working really hard, and I feel like we could do better. I feel like I could make a bigger impact, or I could serve more customers or clients.   0:26:44.0 Dave Williams: And but I am... And I'm in intrigued or inspired or gotten to a certain point with improvement science on my own, but I want to figure out how to be more systematic and more global and holistic at that approach. Then that's what QOS is about. It builds on the shoulders of the other books that you mentioned, like The Improvement Guide which we talked about as being a great book about improvement, and improvement specifically in the context of a project. And other books like The Healthcare Data Guide and the Planned Experimentation, which are also about methods, healthcare Data Guide being about Shewhart charts, and Planned Experimentation being about factorial design. This book is about taking what Cliff described earlier as that... I always say it's that that diagram that people put on a slide and never talk about from Deming of production views as a system and saying, well, how would we do this if this is the model for adopting quality as strategy, what are the methods that help us to do this?   0:28:01.3 Dave Williams: And this book breaks that down into five activities that are built on the shoulders of profound knowledge, built on the shoulders of the science of improvement and provide a structure to be able to initially develop a system, a systems view of your organization, and then build on that by using that system to continually operate and improve that organization over time. So the book describes the activities. The book describes some of the things that go into getting started, including being becoming good at doing results-driven improvement, building a learning system, focusing in on the things that matter to your organization. And then working towards building the structure that you can improve upon. The book creates that foundation. It provides examples from clients and from people that we've worked with so that you can see what the theory looks like in practice get, kind of get a flavor for that. And we hope it builds on the shoulders of other work that I mentioned in the other books that compliment it and provides a starting point for teams that are interested in taking that journey.   0:29:26.5 Andrew Stotz: And Cliff, from your perspective, if somebody had no, I mean, I think, I think the Deming community's gonna really dive in and they're gonna know a lot of this stuff, but is gonna help them take it to the next level. But for someone who never had any real experience with Deming or anything like that, and they stumble upon this interview, this discussion, they hear about this book, can they get started right away with what's in this book? Or do they have to go back to foundations?   0:29:49.6 Cliff Norman: No, I think that can definitely get started. There's a lot of learning as you know, Andrew, from going through the four-day to understand things. And I think we've done a pretty good job of integrating what Dr. Deming taught us, as well as going with the methods. And one of the things people would tell him in his four-day seminars is, Dr. Deming, you've given us the theory, but we have no method here. And he said, well, if I have to give you the method, then you'll have to send me your check too. So he expected us to be smart enough to develop the methods. And the API folks did a really good job of translating that into what we call the five activities. So those five activities are to understand the purpose of the organization.   0:30:35.6 Cliff Norman: And a lot of people when they write a purpose, they'll put something up there but it's usually we love all our people. We love our customers even more. If only they didn't spend so much, and we'll come out with something like that and there'll be some pablum that they'll throw up on the wall. Well, this actually has some structure to it to get to Deming's ideas. And the first thing is let's try to understand what business we're in and what need we're serving in society that drives customers to us. So that word is used not need coming from customers, but what is it that drives them to us so we can understand that? And then the second part of that purpose needs to define the mainstay, the core processes, the delivery systems that relate directly to customers. And just those two ideas alone, just in the first activity of purpose, most people haven't thought about those ideas.   0:31:27.8 Cliff Norman: And can somebody pick up this book and do that? Yes. And that will answer a big challenge from Dr. Deming. Most people don't even know what business they're in, haven't even thought about it. And so that we... That question gets answered here, I think, very thoroughly. In this second activity, which is viewing the organization as a system contains two components that's viewing the organization as a system. And that's difficult to do, and a lot of people really don't see the need for it. Jane Norman reminded Dave and I on a call we did last week, that when you talk about a systems map with people, just ask 'em how do they know what's going on inside other organizations, other departments within their organization? How do they know that? And most of us are so siloed.   0:32:11.2 Cliff Norman: Somebody over here is doing the best job they can in department X, and meanwhile, department Y doesn't know anything about it. And then three months later the improvement shows up and all of a sudden there's problems now in department Y. Well, somebody who's focused on the organization as a system and sees how those processes are related when somebody comes to a management meeting said, well, we've just made a change here, and this is gonna show up over here in about three months, and you need to be prepared for that. Andrew, that conversation never takes place. So the idea of having the systems map and this book can help you get started on that. The second book that Dave was just talking about, there are more replete examples in there. I mean, we've got six case studies from clients in there than the practitioners and people who actually are gonna be doing this work.   0:33:01.7 Cliff Norman: That's gonna be absolutely... They're gonna need that field guide. And I think that's where Dave was coming from. The third activity is the information activity, how are we learning from outside the organization and how do we get feedback and research into the development of new products and services and the rest of it? And so we provided a system there. In fact, Dave took a lead on that chapter, and we've got several inputs there that have to be defined. And people just thinking through that and understanding that is huge. When Dr. Deming went to Japan in 1950, he was there to do the census to see how many Japanese were left after World War II. And then he got an invitation to come and talk to the top 50 industrialists. And he started asking questions and people from the Bank of Tokyo over there and all the rest of it.   0:33:52.4 Cliff Norman: And Dr. Deming says, well, do you have any problems? And they said, what do you mean? He says, well, do customers call up and complain? And he said, yes. And he says, well, do you have any data? And he said, no. He says, but if they complain, we give them a Geisha calendar. And then Dr. Deming says, well, how many Geisha calendars have you given out? So it's like, in 1991, I'm sitting here talking to a food company and I asked him, I said, well, you get customer complaints? Oh yeah. Do you have any data on it? No, but we give 'em a cookbook. I said, well, how many cookbooks are you giving out? So I was right back to where Deming was in 1950, so having the information activity, that third activity critical so that we're being proactive with it and not just reactive.   0:34:43.7 Cliff Norman: And so I think people can read through that and say, well, what are we doing right now? Well, I guess we're not doing this and move on. Then the fourth activity is absolutely critical. This is where you know that you've arrived, because now you're going to integrate not only the plan to operate, but a plan to improve. That becomes the business plan. For most people in business plan they do a strategy, and then they have a bunch of sub strategies, and they vote on what's important, and they do some other things, and then a year later they come back and revisit it. Well, what happens here is there's some strategic objectives that are laid out, and then immediately it comes down to, okay, what's gonna be designed and redesigned in this system? Which processes, products and services are gonna be designed? 'Cause we can all see it now, Andrew.   0:35:31.6 Andrew Stotz: Mm.   0:35:31.6 Cliff Norman: We can, it's right in front of us. So it's really easy to see at this point, and now we can start to prioritize and make that happen on purpose. As an example when Jane was a vice president at Conagra, they came up with five strategic objectives. Then they made a bunch of promises to corporate about what they were gonna do and when they were going to achieve it. When she laid out the systems map for them, they were horrified that over 30% of the processes that they needed to be having precooked meat didn't even exist. They were gonna have to be designed. And so Jane and I sat there and looking at 'em and said, well, if you'd had this map before you made the promises, would you have made those promises? No, no, we're in trouble right now. I gotta go back to the CEO of the holding company and tell 'em we're not gonna make it.   0:36:22.4 Cliff Norman: But there's a whole bunch of people that sit around in goal settings. We're gonna do this by when and have no idea about what they're talking about. So that's a little bit dangerous here. And then the fifth activity, it's probably the most important. And where I want people to start, I actually want 'em to start on the fifth activity, which is managing individual improvement activities, team activities. And what I mean by that is, nothing can hold you up from starting today on making an improvement and use the model for improvement. The three basic questions, you can write that on an envelope and apply it to a project and start right away. Because learning the habit of improvement, and when you identify, and this is typical in the planning process, again, a chapter that Dave took a lead on in the planning chapter.   0:37:03.8 Cliff Norman: When you lay that out, you're gonna come up with three to five strategic objectives, but that's gonna produce anywhere between 15 and 20 improvement efforts. And when people start three improvement efforts, and they see how difficult that is to traffic through an organization, particularly if you have a systems map, makes it a lot easier. If you don't have that, then there's all sorts of things that happen to you.   0:37:21.3 Andrew Stotz: Hmm.   0:37:22.8 Cliff Norman: But the, the idea of that all coming together is critical. And where you... Where that really shows up for the reader here is in chapter one. So Lloyd Provost took a lead on chapter one. If you read chapter one, you got a pretty good idea of what's gonna happen in the rest of the book. But more importantly, in that book, in chapter one, there's a survey at the end. And every time we give this out to people, they feel real bad.   0:37:48.1 Cliff Norman: And well, Cliff, any, on a scale of one to 10, we only came up with a four. Well, what I would tell 'em is, if you can come up with a four, you're pretty good. And those fundamentals have to be in place. In other words, the management needs to trust each other. There are certain things that have to be in place before you can even think about skating backwards here. And quality as an organizational strategy is all about skating backwards. The people who don't have the fundamentals can't even start to think about that.   0:38:15.0 Cliff Norman: So that survey and the gap between where they are at a four and where they're going to be at a 10, we've integrated throughout the whole book. So as you're reading through the whole book, you're seeing that gap, and then you have a good plan forward as to what do I need to do to get to be a six, an eight, and what do I need to do to finally arrive at a 10? Dave, why don't you add to what I just said there, and I gotta turn on a light here, I think.   0:38:39.2 Dave Williams: Well, I think one of the things that, and Cliff has probably been the one that has helped me appreciate this to the biggest degree is the role in which improvement plays in quality as an organizational strategy. So, I mean, I think in general, in our world, improvement is seen as kind of like a given, but in our case, what we've found is that many times people are not working on the things right in front of them or the problems in which they have, that they are on the hook... I like to say, are on the hook to get accomplished right now. And like Cliff mentioned, many of my clients when I engage with them, I say, well, what have you promised this year? And they'll give me a list and I'll say, well, okay, what are you working on to improve? And they'll be working on projects that are not related to that list of things that they've got to affect. And so usually that's a first pivot is to say, well, let's think about what are the things that you're working on or should be working on that are either designing or redesigning your system to achieve these strategic objectives.   0:39:48.8 Dave Williams: And the reason to put the attention on that fifth activity and get people working on improvement, there's a good chance that the improvement capability within the organization currently isn't to the level that you need it, where you can get results-driven projects happening at a clip that will enable you to chip away at 20 projects versus four in a year. And that it's not well integrated into the leadership, into the support structures that you have. In addition, if you're trying to use improvement on things that you're on the hook for, and Cliff noted, especially if you've got a system map while you're on that journey, you're gonna start to pick up on where the disconnects are. Similar to your example, Andrew, where you were describing your experience working backwards in the process, you're going to start to recognize, oh, I'm working on this, but it's linked to these other things. Or in order for me to do this, I need that. Or... And so that amplifies the project to be kind of just a vehicle to appreciate other things that are interconnected, that are important in improving our work together.   0:41:05.1 Dave Williams: And so I think that that's a critical piece. I mean, I sometimes describe it as the disappointment that people have when they open QOS because they want to have a new method or a new thing to work on. I said, well, there's a lot new in here. And at the same time, we want to build on the shoulders of the fundamentals. We want to build it because it's the fundamentals that are going to be able for you to activate the things that are necessary in order for you to skate backwards, like Cliff was describing earlier.   0:41:36.2 Cliff Norman: I got to add to what Dave was saying because this actually happened to me with a... I'm not going to mention the name of the company, but it's a high-tech companies worldwide. And we got up, a good friend of mine, Bruce Bowles, and we were introducing the idea of quality as an organizational strategy. And one of the guys in the front row, he says, Cliff, this just sounds like common sense, why aren't we all doing this? I said, that's a real good question. Let me put that in the parking lot here. So I put it up on a flip chart. And so we went through the idea of... We were working on Shewhart control charts. And so we showed him one of those. And at the end of all that, he raised his hand and I said, yeah, he says, Cliff, this is hard. I said, well, let me put that up here. This is hard. Then we went through the systems map and he says, look, this is hard. By the end of the two days, it was, this is hard, this is hard, this is hard, this is hard. This goes back to what Dave was saying earlier about once you open this page, there's some work that takes off, but more importantly, there's something new to learn here.   0:42:40.3 Cliff Norman: And that's frustrating to people, especially when they've got to quit doing what they've done in the past. It's what Deming says, you got to give up on the guilt and you got to move forward and transform your own thinking. So there's something here for the management to do. And if they're not willing to do that work, then this is probably not a good thing for them. Just go back to the blame flame and circling org charts and that kind of stuff and then wonder why we're losing money.   0:43:11.8 Andrew Stotz: Yeah, and I think that that's one of the things that we see in the Deming community is that, why are people doing it the way they are, dividing things up and doing KPIs and saying, you take care of that. And we're gonna optimize by focusing on each... We see how that all kind of falls apart.   0:43:27.9 Cliff Norman: It all falls through reductionism.   0:43:29.8 Andrew Stotz: [laughter] Yeah.   0:43:32.5 Cliff Norman: It doesn't understand the system, yeah.   0:43:32.5 Andrew Stotz: Yeah, so what I want to do now is I was just thinking about a book on my shelf called "Competitive Strategy" by Michael Porter. And there's a whole field of study in the area of strategy for businesses. Now you guys use, and you explain a little bit about the way you come up with... Why you come up with organization rather than let's say company as an example. But let's just talk about strategy for a moment. Generally we're taught in business school that there's two main strategies. One is a differentiation strategy. I like to teach my students like Starbucks. It's very differentiated from the old model. And you can have a low cost strategy, which is like McDonald's, where it's all about operational efficiency.   0:44:18.4 Andrew Stotz: And those are two different strategies that can get to the same goal, which is to build a strong and sustainable business that's making a good profit for the employees to get paid well and for shareholders. And so for somebody that understands some of the foundations of typical strategy, it's hard for them to think, wait, wait, wait, what? You're just talking about just better quality is the strategy? How should they frame this concept of quality as a strategy in relation to what we've been taught about low cost and differentiation and other types of strategy? How do we think about this book in relation to that?   0:45:03.2 Cliff Norman: When Deming wrote his book, his very first one of the four "Out of the Crisis", which was the whole idea about quality and competitive position. But he was kind of answering that. And at that time, what we had is we had three companies in the United States that were going at each other, Ford, GM, and Chrysler. And they'd call each other up, well, what are you doing this year? Oh, we're making cars that don't work. Sometimes they break down. That's why we have Mr. Goodwrench to repair them. That's an extra revenue source for us. As one of the executives that are challenged, a colleague of mine, he said, you don't realize how much money we're gonna lose here taking the repair business out because we make a lot of money out of repair. So making cars that don't work has been a good revenue stream for us. Well, all that works out great, until somebody shows up like Toyota that has a car that works and doesn't need to be repaired by Mr. Goodwrench all the time.   0:45:58.8 Cliff Norman: So the mind shift there, and what Dr. Deming was saying is that he was focused on the competition's already licked. And I don't think Porter's thought about that very much, not to be overly critical, because I'm an admirer of his, but the idea of focusing on the need and why is that customer coming to us so that we make a journey, and the Japanese call that being in the Gemba, being in the presence with the customers as they use the product or service and doing the research and the rest of it. And then coming back and then redesign that product or service so that it not only grabs the current customer, but we start thinking about customers that are not even our customers and innovate and actually come up with a design that actually brings new customers to us through products and services that we haven't thought about yet. So if I show you three products just to make a picture of it, we often show like an abacus, which was a hand calculating machine about BC. Then there's a slide rule that came out about the same year that Columbus discovered America. And that was good till about 1968.   0:47:06.0 Cliff Norman: And then the calculator, the handheld calculator came out. Well the need for all three of those products is to do handheld calculations. So we've had that need since BC. Now in 1967, K&E Calculator was making that slide rule, which I used in junior high school. If you'd have come up to me and said, Cliff, what do you need in the way of a better slide rule? I said, well can you get me a holster for it? 'Cause I don't like having to stick me in the face. I put it in my pocket and it sticks me in the face. And if you can give me a holster for that, that would be my view of that. I wasn't about to come up with the TI calculator. That wasn't gonna happen. Not from Cliff. It's gonna come from an engineer at TI. Now, K&E Calculator, if they'd been doing research in the marketplace and saying, is there something that can totally disrupt us going on here? Rather than just looking at figuring out a way to make the K&E slide rule better, they might've discovered that.   0:48:07.0 Cliff Norman: Most people don't do that. They just go back. They just lose their business. And it was interesting in '67, their annual report put out, what's the world gonna look like 100 years from now? So they had dome cities, they had cars flying, they had all sorts of things going on that were great innovations, but they didn't have the TI calculator in there, along with the HP calculator. And that wiped out their business. And so if people understand the need, and that's what Dr. Deming is getting at, he says, they really haven't thought about what business they're in. So why are the customers coming to us? He says, no customer ever asked for pneumatic tire. No customer ever asked for a microwave oven. That came from people with knowledge that were looking at how the customers are using the current products and services and say, now, is there technology innovation going on that we can actually do a better job of providing a better match in the future?   0:48:56.9 Andrew Stotz: And can you explain why you use the word need as opposed to want?   0:49:06.5 Cliff Norman: That's a good question. The idea is that there's a need that's constant in society. So that need of having to do handheld calculations or needing healthcare or to pay bills, that need is constant throughout civilization. And so if I want something that's interesting, that might be the match. That might be something to do with some features what I'm offering and so forth. I'd like to have this, I'd like to have that. But the need and the way we're using that is it doesn't come from customers. It's what drives customers to us. And it's always been there. It's always been there. Need for transportation, for example. Whether you're walking or driving a bicycle or a car or a plane.   0:49:53.6 Andrew Stotz: And Dave, how would you answer the same question when you think about a person running a business and they've had many strategy meetings in their business, they've set their corporate strategy of what we're doing, where we're going and that type of thing. And maybe they've picked, we're gonna be a low cost producer. Thailand's an interesting one because Thailand had a ability to be low cost producers in the past. And then China came along and became the ultimate low cost producer. And all of a sudden, Thai companies had a harder time getting the economies of scale and the like. And now the Chinese manufacturers are just really coming into Thailand, into the Thai market. And now it's like, for a Thai company to become a low cost leader is almost impossible given the scale that China and the skills that they have in that. And so therefore, they're looking at things like I've got to figure out how to get a better brand. I've got to figure out how to differentiate and that type of thing. How does this... How could this help a place like that and a management team that is struggling and stuck and is looking for answers?   0:51:07.0 Dave Williams: Well, I go back to what Cliff said about that many organizations don't pause to ask, why do they exist? What is the need of which they are trying to fulfill? Much of my background involved working in the service industry, initially with public safety and ambulance systems and fire systems, and then later in healthcare and in education. And in many of those environments, especially in places where in public systems where they've been built and they may have existed for a long time, when you ask them about what are they trying to accomplish as an organization or what is it that they... The need that they're trying to fulfill? Typically, they're gonna come back to you with requests or desires or wants or sort of characteristics or outcomes that people say they expect, but they don't pause to ask, like, well, what is the actual thing of which I'm trying to tackle? And Cliff mentioned like, and we actually, I should mention in the book, we have a list of different strategies, different types of strategies, all the different ones that you mentioned, like price and raw material or distribution style or platform or technology.   0:52:30.9 Dave Williams: There's different types of strategies, and the one that we are focusing in on is quality. But I think it's important for people to ask the question. Cliff mentioned transportation. There's a number of different great examples, actually, I think in transportation, where you could look at that as being an ongoing need as Cliff mentioned from the days when there was no technology and we were all on foot to our current day. Transportation has been a need that existed and many different things over time have been created from bicycles, probably one of the most efficient technologies to transport somebody, wheels and carts. And now, and you were referencing, we've made reference to the car industry. It's a fascinating experience going on of the car world and gas versus electric, high technology versus not, autonomous vehicles. There's, and all of them are trying to ask the question of, are there different ways in which I might be able to leverage technology to achieve this need of getting from point A to point B and be more useful and potentially disrupt in the marketplace? And so I think the critical thing initially is to go back and ask and learn and appreciate what is that need?   0:53:58.6 Dave Williams: And then think about your own products and services in relation to that. And I think we include four questions in the book to be able to kind of think about the need. And one of those questions is also, what are other ways in which you could fulfill that need? What are other ways that somebody could get transportation or do learning or to help sort of break you away from just thinking about your own product as well? And that's useful because it's super tied to the system question, right? Of, well, this is the need that we're trying to fulfill and these are the products and services that are matching that need. Then the system that we have is about, we need to build that and design that in order to produce, not only produce the products and services that match that need, but also continually improve that system to either improve those products and services or add or subtract products and services to keep matching the need and keep being competitive or keep being relevant. And maybe if it's not in a competitive environment where you're gonna go out of business, at least be relevant in terms of the city service or community service, government service that continues to be there to match the need of the constituents. So I think it's a really important piece.   0:55:17.0 Dave Williams: It's that North star of saying, providing a direction for everything else. And going back to your original comment or question about strategy, and many times people jump to a strategy or strategies or, and those might be more around particular objectives or outcomes that they're trying to get to. It may not actually be about the method or the approach like cost or technology that they may not even think that way. They may be more thinking about a plan. And I really encourage people to be clear about what they're trying to accomplish and then start to ask, well, how's the system built for that? And later we can bring a process that'll help us learn about our system and learn about closing that gap.   0:56:05.1 Cliff Norman: Yeah. Just what I'd add to that, Andrew, because you mentioned China, a few other countries, but I think the days are coming to an end fairly quickly where somebody can say, oh, we can go to this country. They have low wages, we'll put our plant there and all that. There's a lot of pushback on that, particularly in the United States. And if that's your strategy, that hadn't required a lot of thinking to say the least. But in 1966, over 50% of the countries in the world were, let me rephrase that, over 50% of the population of the world lived in extreme poverty. So there were a lot of targets to pick out where you want to put your manufacturing. And in 2017, and you and Dave were probably like myself, I didn't see this hit the news, but that figure had been reduced from over 50% down to 9%. And all you have to do is just, and I worked in China a lot, they're becoming very affluent. And as they become very affluent, that means wages are going up and all the things that we want to see throughout the world. And I think that's happening on a grand scale right now, but you're also getting a lot of pushback from people when they see the middle class in their own country, like here in the United States, destroyed, and say, I think we've had enough of this. And I think you're gonna see that after January. You're gonna see that take off on steroids.   0:57:31.7 Cliff Norman: And that's gonna happen, and I think throughout the world, people are demanding more, there's gonna have to be more energy, every time a baby is born, the footprints gets bigger for more energy and all the rest of it. So it's gonna be interesting, and I think we are going into an age for the planet where people as Dr. Deming promised that they'd be able to live materially better, and the whole essence of this book is to focus on the quality of the organization and the design and redesign of a system to a better job of matching the need and cause that chain reaction to go off. When Jane and I went over to work in Sweden, Sven Oloff who ran three hospitals and 62 dental clinics there and also managed the cultural activities and young shipping. He said, Cliff, I report to 81 politicians. I don't wanna have to go to them to put a bond on an election to get more money for my healthcare system, I wanna use Dr. Deming's chain reaction here to improve care to the patients in my county and also reduce our costs. A whole bunch of people that don't even believe that's possible in healthcare.   0:58:39.9 Cliff Norman: But that's what Sven Oloff said that's what you're here for. And that's what we proceeded to do, they launched about 350 projects to do just that, and one of their doctors, Dr. Motz [?], he's amazing. We taught him a systems map, I came back two months later, and he had them in his hospital on display. And I said, Motz, how did you do this? He said well Cliff, I'm an endocrinologist by education as a doctor, of course, that's a person who understands internal systems in the body. So he said the systems approach was a natural for me. But I'd like to say it was that easy for everybody else, that systems map idea and as you know, being in the Deming seminar, that's quite a challenge to move from viewing the organization as an org chart, which has been around since Moses father-in-law told him, you need to break up the work here a little bit, and the tens of tens reporting to each other, and then of course, the Romans took that to a grander scale, and so a centurion soldier had 100 other soldiers reporting to him. So we've had org charts long and our federal government took that to a whole new level.   0:59:46.1 Cliff Norman: But the idea is switching off the org chart from biblical times to actually getting it up to Burt [?] about 1935 and understanding a system that's kind of a nose bleed in terms of how much we're traveling there to get us into the 21st century here.   1:00:04.0 Andrew Stotz: And I left Ohio, I grew up outside of Cleveland, and I left Ohio in about 1985, roughly. And it was still a working class, Cleveland had a huge number of jobs and there was factories and all that, and then I went to California, and then I moved to Thailand in 1992. So when I go back to Ohio now, many years later, decades later, it's like a hollowed out place, and I think about what you're saying is... And what's going on in the world right now is that I think there's a desire in America to bring back manufacturing to bring back production and all of that, and that's a very, very hard challenge, particularly if it's gone for a while and the skill sets aren't there, maybe the education system isn't there, I talk a lot with John Dues here on the show about the what's happening in education and it's terrifying.   1:01:05.9 Andrew Stotz: So how could this be... Book be a guide for helping people that are saying, we've got to revitalize American production and manufacturing and some of these foundational businesses and not just services, which are great. How can this book be a guide?   1:01:25.8 Dave Williams: One thing I would say that I think is interesting about our times, many times when I reflect on some of the examples that you just provided, I think about how changes were made in systems without thinking about the whole system together. And there may have been changes at various times that we're pursuing particular strategies or particular approaches, so it may have been the low-cost strategy, it may have been to disrupt a marketplace. And oftentimes, they don't think about... When somebody's pursuing one particular view, they may miss other views that are important to have an holistic perspective. One of the things that I appreciate about QoS in the methods and overall as a holistic view of looking at organizations that it's asking us to really think initially about that North Star, what we're trying to do, our purpose, and what are the tenants. What are the things that are important us, the values...   1:02:38.7 Dave Williams: That are important to us in pursuing that particular purpose? And in doing that, really thinking about how does the system work as it is today, and if we make changes, how does it move in alignment with the values that we have and in the direction that we wanna go? And appreciating, I would say, part of the value of the scientific thinking that is in the Science of Improvement is that it encourages you to try to see what happens and appreciate not only what happens in relation to the direction you're trying to go, but also the... Have a balanced view of looking at the collateral effects of things that you do, and I think that systems do is really important there. So I think from that perspective, the quality as an organizational strategy brings a holistic picture into these organizations, or at least...   1:03:45.1 Dave Williams: To be paying attention to the system that you have, maybe the direction you wanna go, and what happens as you... What are your predictions and what do you see when you study the results of making changes in the direction of the vision that you have. And I think that's at a high level that is one of the ways that I think about it. Cliff, how would you add on there?   1:04:09.1 Cliff Norman: Your question made me think of something that happened about two years ago, Jane and I got a call from a lady that worked for her in one of the chicken plants, and she said, Jane, I had to call you because I need to order some of those Shewhart charts. But what happened today, you should have been here and Jane said, what... She said, Remember that 10 year thing we buried in the ground that we're gonna open up in 10 years, and she said, yeah, said, well, we opened it up today, and the new plant manager was here, and those Shewhart charts came out, and he looked at the costs on them. He said, you were operating at this level? She said, yeah, routinely. And he said what happened? He said, well, they had new management come in and they got rid of the charts, that's the first thing they did, and then gradually they try to manage things like they normally did, and then they forgot everything that we had learned. And that's kind of where we are right now.   1:05:11.0 Cliff Norman: So just think of that a decade goes by, and it just as Dr. Deming said, there's nothing worse than the mobility of management, it's like getting AIDS in the system. And they basically destroyed their ability to run a low-cost operation in an industry that runs on 1 or 2%. And when you watch that happen and understand that we still have food companies in this country, and we have to start there and start looking at the system anew and start thinking about how it can actually cause that chain reaction to take off, and that comes from focusing on quality of the system. And then as Dr. Deming says, anybody that's ever worked for a living knows why costs go down with two words less rework, but instead of people will put in extra departments to handle the rework. Next thing they start building departments to handle...   1:06:01.8 Cliff Norman: The stuff that's not working because the system they don't understand. So that was a... What do they call those things, Dave, where they put them in the ground and pull him out?   1:06:11.0 Dave Williams: Time capsule.   1:06:13.4 Andrew Stotz: Time capsule yeah.   1:06:13.5 Cliff Norman: Yeah. Time capsule. The a 10-year time capsule.   1:06:19.2 Andrew Stotz: It's a great, great story. And a great idea. We had a company in Thailand a very large company that the CEO of it came upon the idea of the teachings of Dr. Deming and over time, as he implemented it in his company, the Japanese Union of Scientists have their prize and his company won that prize and then he had about 10 subsidiary companies that also were doing it and they also won over time. And so Thailand is actually is the second largest recipient of the Japanese Deming Award outside of India. But he left and he retired and another guy took over, a very bright guy and all that, but he threw most of that out and focused on newer methods like KPIs and things like that. And just at the end of last year, maybe six months ago, they reported a pretty significant loss, and I was kind of made me think how we can spend all this time getting the Deming teachings into our business, and then one little change in management and it's done.   1:07:26.9 Andrew Stotz: And that made me think, oh, well, that's the value of the book, in the sense that it's about building the concept of quality as a core part of strategy as opposed to just a tool or a way of thinking that could go out of the company as soon as someone else comes in. Go ahead, Dave.   1:07:41.9 Dave Williams: I was gonna say, Andrew, you raise a point, I think it's really, really important and Cliff mentioned this in terms of the problem of mobility of management. One thing that I don't know that we outline probably in dark enough ink in the book is the critically important piece of leadership, building the structures and the capability. I know we talk a little bit about it, but doing it in a way that both builds up the people that you have... So Cliff emphasiz

Six years ago, Fixing Healthcare launched as a “podcast with a plan to fix American healthcare.” After more than 150 episodes—spanning three election cycles—the show has explored countless ideas for ... The post FHC #151: Six years later, Don Berwick's vision for healthcare remains unfulfilled appeared first on Fixing Healthcare.

Dr. Don Berwick brings decades of healthcare leadership to a conversation with Matt and Wendy about the effect of social, moral, and structural determinants of health on the physician experience. He offers a welcome reminder of the essential good at the heart of our profession and implores us to work together for the change we wish to see.

Today we're looking back to one of our favorite conversations from season 1 with Dr. Don Berwick, President Emeritus and Senior Fellow of the Institute for Healthcare Improvement. Dr. Berwick is a long-time advocate for improving healthcare for both patients and providers. During this conversation, we talk about the moral imperative of change in healthcare; how we can approach the challenges more effectively; and why working together will be critical. We want to hear from you. Send a voice memo or note to podcast@moralinjury.healthcare. CME: https://earnc.me/0aUaBU Support the podcast: https://www.fixmoralinjury.org/get-started Twitter - @fixmoralinjury Instagram - @moralinjury Facebook - @MoralInjuryofHC LinkedIn - Moral Injury of Healthcare

On May 22, the MaineHealth ACO will host the Working Together to Advance Value-Based Care symposium in Freeport, with health policy superstar Dr. Don Berwick headlining as keynote speaker. In this BACON episode, we take a deep dive into one of the symposium's afternoon workshops. Focused on payment bundles for specialty care, the workshop will be led by our two podcast guests, Dr. James Powers and Sue Seekins.

For a full transcript of this episode, click here. This conversation I am having with Dan Mendelson, my guest today, all started with a post that he had written on LinkedIn considering how pharmacy benefits can or should be optimized within the broader context of value-based care. Total cost of care, value-based medical care, and pharmacy benefits—these worlds have to collide. There is just so much intertwined into all of this, which is why I pretty much immediately invited him to come back on the pod to discuss in greater detail. A few years ago, I heard a doctor say that practicing medicine without considering pharmacy is like getting to the 90 yard line, putting down the ball, and walking off the field. And, yeah … when a patient gets to a certain point in a whole lot of disease progressions, optimal medical therapy includes pharmacy. It's a thing. Adherence is a thing. In fact, I saw a stat the other day that patients not taking their meds costs an estimated $3874 PEPY (per employee per year). Also, half of all hospital admits are caused by nonadherence. Those two stats, by the way, are from a post on LinkedIn by Brian Bellware, who was recapping a video from Eric Bricker, MD. But also, as Barbara Wachsman (EP430) said on the show, half, I think she said, of all ER visits are due to patients not taking their meds right. Olivia Webb (EP337) was on the pod, if you want to go back and listen to that one, talking about how she spends hours every month trying to figure out how to navigate access issues to manage to get her Crohn's disease drug. So, yeah … one underlying reason why a lot of this stuff happens is that pharmacy benefits are purchased and siloed a lot of times. In fact, I have yet to see, really, any mainstream contract wherein a PBM (pharmacy benefit manager) is held accountable in any way for downstream medical costs, which may be incurred because of suboptimal pharmacy benefit design, right? And there are so many examples of bad downstream medical impacts. I really like how Mark Fendrick, MD, put it in episode 308. He said benefits, including pharmacy benefits, are like peanut butter and jelly relative to enabling high-quality care. You gotta have both working in concert, like CMS or a plan sponsor just paid a ton of money to get a patient an organ transplant, and then the patient can't afford their transplant meds, which aren't on formulary and are really expensive, and therefore there's organ rejection. This happens. Or a patient with uncontrolled diabetes with a huge co-pay for insulin. Doctor says, “Hey, you gotta take your insulin.” Patient says, “Can't afford it.” Right? This makes no sense, and it's shockingly common. I'm thinking right now of that young man who died in the Midwest because he could not get his asthma inhaler. It wasn't on formulary. So, here's the game plan. I talk with Dan about the five kind of vital considerations he had brought up in that aforementioned LinkedIn post when considering how pharmacy benefits can or should be optimized within the broader context of value-based care. Dan's advice for the pharma industry is woven in here as much as his advice for EBCs (employee benefit consultants) and employers. I am sure that most of our listeners are going to be very familiar with Dan Mendelson, my guest today, and his work; but the quick background here is that he runs Morgan Health. The mission over there at Morgan Health is to drive innovation in employer-sponsored healthcare, and they do that by investing and working with their portfolio companies in the context of the 300,000 or so employees over at JPMorgan Chase. At the same time, Morgan Health also engages in policy discussions because, as Dan says, no one employer is going to control public policy. As a footnote here, I just will say that I actively seek out opportunities to listen to Dan Mendelson's thoughts. He has spoken a lot and really eloquently and with great insight about setting up the economic models for healthcare, not sick care. Recently, actually, he was on a panel at the Milken conference along with Natalie Davis; Yele Aluko, MD, MBA; and Henry Ting, MD. There are definitely insights to be gleaned. Also mentioned in this episode are Brian Bellware, CIC, CHVP; Eric Bricker, MD; Barbara Wachsman; Olivia Webb; Mark Fendrick, MD; Natalie Davis; Yele Aluko, MD, MBA, FACC, FSCAI; Henry Ting, MD; Ashok Subramanian; Rik Renard; Nina Lathia, RPh, MSc, PhD; Don Berwick, MD; Kenny Cole, MD; Steve Pearson, MD, MSc; Sarah Emond; Alex Sommers, MD, ABEM, DipABLM; and Jodilyn Owen. You can learn more at the Morgan Health Web site and follow Dan on LinkedIn.   Dan Mendelson is the chief executive officer of Morgan Health at JPMorgan Chase & Co. He oversees a business unit at JPMorgan Chase focused on accelerating the delivery of new care models that improve the quality, equity, and affordability of employer-sponsored healthcare. Mendelson was previously founder and CEO of Avalere Health, a healthcare advisory company based in Washington, DC. He also served as operating partner at Welsh Carson, a private equity firm. Before founding Avalere, Mendelson served as associate director for health at the Office of Management and Budget in the Clinton White House. Mendelson currently serves on the boards of Vera Whole Health and Champions Oncology (CSBR). He is also an adjunct professor at the Georgetown University McDonough School of Business. He previously served on the boards of Coventry Healthcare, HMS Holdings, Pharmerica, Partners in Primary Care, Centrexion, and Audacious Inquiry. Mendelson holds a Bachelor of Arts degree from Oberlin College and a Master of Public Policy (MPP) from the Kennedy School of Government at Harvard University.   04:50 How do we connect the dots between value-based care and pharmacy benefits? 07:43 Where do things need to go for employers in terms of drug spend integration? 08:42 How do we think about having a value-based component in the decision-making process? 09:44 How do we enable the necessary information to make proper decisions? 10:56 EP206 with Ashok Subramanian. 11:21 “Many payviders just haven't gotten to pharmacy yet; they need to.” 14:14 Why do pharmaceutical companies need to be prepared to contract on the basis of value? 16:46 EP426 with Nina Lathia, RPh, MSc, PhD. 17:36 EP431 with Kenny Cole, MD. 18:07 Why is it important to “let the market work”? 21:04 Why do we have cost sharing, and when does it not make sense to have that as a co-pay? 23:59 Why are evidence requirements good for everyone? 28:45 Why is pooling of risk important? 29:49 How do you pool risk without going to an insurance company? 32:03 What is Dan's advice to hospitals? 33:30 “In a value-based world, buy and bill does not make sense.” 33:36 What is Dan's advice to primary care doctors? 33:54 What is Dan's advice to entrepreneurs and innovators?   You can learn more at the Morgan Health Web site and follow Dan on LinkedIn.   @dnmendelson discusses #pharmacybenefits on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard

Neste último episódio, o Dr. Lucas Zambon, Diretor Científico do IBSP faz uma restrospectiva da temporada, analisando os principais pontos de uma entrevista publicada pelo New England Journal of Medicine/NEJM Catalyst 2023, na qual algumas das maiores lideranças em Segurança do Paciente do mundo expuseram as suas opiniões sobre os dados atuais da Segurança do Paciente.Esta edição trouxe também o importante ponto de vista de Don Berwick, Presidente Emérito do IHI, quem refletiu sobre o tema em seu artigo "Constansy of Purpose for Improve Patient Safety - Missing in Action", publicado em janeiro de 2023 na New England Journal of Medicine.#IBSP #SegurançaDoPaciente #PodCast #IBSPPodcast #NovoEpisódio #NEJM #Qualidade #Dados #patientsafety

“In the United States we don't ration medicine, we ration people.”We are honored this week to welcome an esteemed author, pediatrician, educator and co-founder of the Institute for Healthcare Improvement, Dr. Don Berwick.Dr. Berwick has dedicated his career to reigniting our healthcare system, to ensure it can meet the needs of disadvantaged people, and limit the excess profits being hoarded as wealth by the powers that be.Formerly serving as the former Administrator of the Centers for Medicare and Medicaid Services under Barack Obama, he knows the details of our system inside out - challenging misinformation and calling out partisan refusals to collaborate for the good of everyone, not just the stakeholders.In our discussion, he shares his story, his experiences in government, common misconceptions about his philosophies, his worry at the corporatization of our system, and some seeds of hope amidst a climate of greed.“Anybody that says we can't meet the needs of the American public isn't reading the information. What they mean is, we can't meet the needs of the American public and satisfy all the greed that we've unleashed in the current system.”Follow me on Instagram and Facebook @ericfethkemd and checkout my website at www.EricFethkeMD.com. My brand new book, The Privilege of Caring, is out now on Amazon! https://www.amazon.com/dp/B0CP6H6QN4

I don't know about you but I'm FASCINATED with Medicare Advantage (MA). Massive growth, fueled by its shrewd marketing of added benefits beyond traditional Medicare. But also chaotic, messy, a program in need of reining in.   It's a bit of the wild west.  I like some things about MA, including its emphasis on preventative care and aligning patients outcomes with rewards. But I'm also routinely disappointed by its excesses and denial of medically necessary care.   Some days MA seems poised to overtake and end traditional Medicare. But every time I think that, another shoe drops. Intensive audits from the OIG, and sharp criticism from the likes of former CMS administrator Don Berwick. Two weeks ago we saw the nation's largest ACO get hit with a whistleblower lawsuit for alleged upcoding abuses.  To get a big picture overview and figure out where we are with the program I invited 4Sight Health's David Burda to join me on the podcast. David is 4SightHealth's news editor and columnist and hosts a podcast, the 4sighthealth roundup, covering MA and other adjacent topics.  Listen in as we discuss:  David's journalism background and eventual path into covering healthcare  MAs rapid adoption: Will it continue until Medicare is phased out—or is a reckoning coming?   The problems with MA: Gaming of risk adjustment/upcoding to make patients appear sicker, denial of medically necessary care, prior authorization nightmares, and sky-high insurer profits  What MA is doing well, should be preserved, and what needs reform  Is healthcare compatible with a free-market economy and shareholder ROI?   How David stays on top of the torrent of healthcare news, and his cool addition to the #OTR Spotify playlist     Additional reading from 4sighthealth:   What Will Happen to Traditional Medicare? https://www.4sighthealth.com/ken-terry-what-will-happen-to-traditional-medicare/   Spy vs. Spy? More Like Medicare vs. Medicare Advantage https://www.4sighthealth.com/spy-vs-spy-more-like-medicare-vs-medicare-advantage/   

MedPod Today: the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. This week, MedPage Today reporters discuss leaked emails from the AAMCthat reveal concern about an exodus from the standard residency application pathway, the APA's thoughts on the rise of ketamine clinics, and a conversation about Medicare Advantage she had with Don Berwick, MD

This episode features regular guest Jakob Emerson, Associate News Director at Becker's Healthcare. Here, he discusses the current trend of health systems planning to sell their insurance subsidiaries, and shares some insights from a conversation he had with former CMS Administrator, Dr. Don Berwick.

Join Dr. Don Berwick, former CMS Administrator and esteemed health policy lecturer at Harvard Medical School, as he engages in a dynamic conversation with moderator Jakob Emerson of Becker's Healthcare. Together, they delve into the intricacies of Medicare Advantage in 2024, exploring the ongoing challenges within the industry. Gain valuable insights and expert analysis from this insightful discussion on the current state and future trajectory of Medicare Advantage plans, offering a comprehensive understanding of its implications for patients and providers alike. Tune in to this enlightening podcast for a nuanced perspective on vital healthcare policy issues.

Join Dr. Don Berwick, former CMS Administrator and esteemed health policy lecturer at Harvard Medical School, as he engages in a dynamic conversation with moderator Jakob Emerson of Becker's Healthcare. Together, they delve into the intricacies of Medicare Advantage in 2024, exploring the ongoing challenges within the industry. Gain valuable insights and expert analysis from this insightful discussion on the current state and future trajectory of Medicare Advantage plans, offering a comprehensive understanding of its implications for patients and providers alike. Tune in to this enlightening podcast for a nuanced perspective on vital healthcare policy issues.

Today we wrap up our conversation with Dr Ehab Sharawy and Dr David Cook of OneHealth by discussing the differences of the “big v” and the “little v” in value-based care and the positive impact of direct collaboration between the individual, the primary care provider and the specialist. Well good afternoon gentlemen and welcome to the Move to Value podcast. we're back for episode #3 this afternoon, it's good to have you. Well listen we've really not talked that much about value-based care in our time together, so I'd like to start this session off with a question framed around some of the things I've heard you all say over the last year or so and oftentimes when we talk about value and value based care I've heard you say there's value with the big V and value with a little V and doctor Sharawy you want to take that and tell us what you mean by that?Dr. Sharawy: Sure, so I'm going to leave the big V little V to the expert over there across from me, Dr Cook. Nobody articulates it better than he does, but I'll just start I think with some kind of real life analogies, because the word value means something different to everybody and within healthcare I think it means something different. When you talk about value if you talk about from a health system lens it's something different than it is from a payer lens than it is from a physician provider lens from a consumer lens, you know those are the kind of things. So just think of an analogy of you know folks that are lucky enough to be able to afford going to let's say a with two star Michelin restaurant, you know where you're going to go in and know it's going to be costly. OK let's just say it's $300 a head to go there. But when you get in there and let's just say that's the best food I've ever eaten you know in my whole life I've never tasted something that and somebody said was that good value for you if you're going to say yeah it was fantastic great value because you were so happy with the quality and all that and the cost was not the factors mitigated by not mitigated but overcome by the fantastic experience that you had. Then if you flip it to the other side and you say listen you know I got a family of four and I'm on a fixed budget and you know I want to go out and have a nice meal so I'm going to go to a restaurant where the cost is very reasonable I can afford it and by the way the food was good you know it didn't knock my socks off but it was good and we enjoyed ourselves have a good time. That would be defined as value and those are two different experiences but both of them have satisfaction. What I always think in Healthcare is for so many people that situation is just upside down and really when we talk about value in healthcare we got to figure out how to make it right for everybody so everybody gets value in that regard. I want to let David expound on that.Dr. Cook: yeah completely agree with Dr. Sharawy I mean that what a great anecdotal or model to look at because it's very hard to understand value in healthcare. Except I would say this I heard Don Berwick say this one time a long time ago and I'll start my conversation with big V and the little V with this is that there really is no value in healthcare delivery. There's only value in health. OK you're not thinking about hey I love taking my car to the shop and getting it worked all the time. No what you like is your car running really well for a long time right and so when we talk about the big V, Dr. Sharawy and I have always said this is what really matters. it's health it's longevity I'm going to say this again longevity it's the human experience, it's quality of life, enjoyment of life doing things you like to do, feeling safe in your healthcare journey. It's really experiencing something that's unique in your healthcare journey. The third piece is reduce suffering and I'm going to use this term reduce suffering, both mentally and emotionally, physically and financially, OK That's...

Returning to the Fixing Healthcare podcast for a third time is Dr. Don Berwick, here to talk about the dire need for leadership to address our nation's many healthcare crises. ... The post FHC #98: Don Berwick on leadership, greed + a promising youth movement appeared first on Fixing Healthcare.

We need to change the calculus of self-interest in health care. If the trend of unfettered greed in fee-for-service medicine continues, we will have a bleak future ahead of us. Our industry is on a ventilator, demanding another cigarette. Yet despite its moribund appearance, a few critical vital signs do offer hope. There is an opportunity to find optimism with unifying language and shared virtues to guide health care transformation. By developing a shared vernacular for value-based care, we will be able to have the meaningful conversations to reimagine care delivery. And this new language will be shaped by the evidence from leading exemplars in the value movement.  Amidst the vast wilderness of the healthcare landscape, we can find hope in these green shoots, sprouting with resilience and the promise of a brighter future. This post-pandemic era is a tremendous opportunity for value creation. Now is the time to have the conversation and be the change we want to be. The elevation of social consciousness related to health equity, transparency, and financial accountability—coupled with industry challenges related to escalating inflationary pressures, workforce shortages, lack of patient access, supply chain disruption, and weaknesses in our public health infrastructure—will provide the catalyst for a new modus operandi in American healthcare. Joining Eric Weaver on the Race to Value this week are Craig Solid and Andrew Kopolow. Together they recently co-wrote an article published by the American Journal of Medical Quality entitled, “Changing the Calculus of Self-Interest in Health Care.”  In this podcast discussion, they discuss their views about greed in healthcare and what it will take to transform our industry to a more sustainable, value-based model. “Greed has poisoned men's souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost…”  -- The Final Speech from “The Great Dictator” (Charlie Chaplin) Episode Bookmarks: 01:30 Referencing the recently published article, “Changing the Calculus of Self-Interest in Health Care” written by Eric, Craig, and Andrew. 01:45 Eric reads an excerpt from The Final Speech from “The Great Dictator” by Charlie Chaplin. 02:45 How is the greed of fee-for-service healthcare holding us back from our human potential? 03:00 Introduction to Craig Solid, PhD and Andrew Kopolow, MPA MSW CPHQ PMP CLSSMBB FNAHQ. 05:30 Don Berwick's JAMA article entitled, “Salve Lucrum: The Existential Threat of Greed in US Health Care” which called out our industry for the glorification of profit (Salve Lucrum) 07:30 The difficulty in addressing profit motive through value transformation when “none of us speak the same language” through a shared vernacular in healthcare. 08:30 The emotionality of Dr. Berwick's article as a recognition of the existential threat of greed in healthcare. 09:15 Hospital closures across the healthcare landscape are seen as just the normal course of business. 09:45 How can we even talk about the quality of care when people can't even access the care they need? 10:00 The oversimplification of “quality” and “value” is holding us back. 10:45 What is the solution to price gouging of prescription drugs, exploitive market consolidation, upcoding, overpaid executives, lack of transparency, and patient medical bankruptcies? 11:30 The need to align incentives in healthcare so that it does not personify greed as a primary virtue. 12:00 Optimism for socially-conscious healthcare based on Bright Spots and Green Shoots! 12:45 The exemplars of value-based health care (i.e.

We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America's Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program's overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality.

Welcome to Turn on the Lights! Kedar Mate and Don Berwick introduce the Turn on the Lights podcast, where they help anyone understand the thorniest problems and discuss the most innovative solutions in healthcare. Tune in to this new podcast that puts a spotlight on ways to improve the US healthcare system! Learn more about the Institute of Healthcare Improvement on its website. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this teaser episode, hosts Don Berwick and Kedar Mate introduce themselves and their roles within the Institute for Healthcare Improvement (IHI). They explain how Turn on the Lights is a thought-provoking podcast that will explore how the US healthcare system is working and not working. The podcast will feature candid conversations with healthcare workers, patients, innovators, activists, and researchers who share practical solutions and personal stories to improve healthcare delivery, equity, and quality. Topics discussed in the podcast will include improving health and healthcare delivery, health equity and quality, and social justice. The hosts encourage listeners to join the conversation and become part of the movement to improve health care worldwide. Learn more about your ad choices. Visit megaphone.fm/adchoices

Are you ready to climb the mountain and reach new heights for a transformative future? In the “race to value”, the mountain climber must not be intimidated by the steep terrain of a broken healthcare system. Instead we must look within ourselves, while also finding inspiration from others, to keep climbing! The ultimate summit of value transformation is what drives us, but the climb itself is what matters.  If you are looking for inspiration in your value journey, look no further than our guest this week, Debbie Welle-Powell. Debbie is a healthcare thought leader, educator, national speaker, and content expert in delivery systems, clinical models of care, population health, and digital care. She is also an avid mountain climber, having attempted three of the Seven Summits while also reaching the summit of all 58 of Colorado's 14,000 peaks. She has also climbed Mt. Rainer in in Washington and Grand Teton in Wyoming and, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska.  In this podcast, you will learn how taking the path least travelled is when you learn the most about yourself and why value transformation is a most noble journey to undertake in healthcare. As the former Chief Population Health Officer at Essentia Health – an integrated delivery system with 14 hospitals, and 1,500 provider health system spanning the states of Minnesota, North Dakota, and Wisconsin – Debbie Welle-Powell designed, built, and operationalized Essentia's $2.5 billion dollar transition from a primarily fee-for-service model of care to one that focused on value.  She oversaw risk-based contracting with payers and care delivery transformation, resulting in forty-five percent of the system's fee-for-service revenue tied to financial and clinical performance which produced record earnings on shared savings. Debbie's exceptional experience and background in multi-state, large integrated delivery systems, coupled with industry involvement and insights into emerging opportunities, trends, and challenges, have been valuable to health systems and purchasers seeking to grow, diversity, and promote expertise in the development and implementation of data-driven strategies and solutions in population health and value-based care. Episode Bookmarks: 01:30 Introduction to Debbie Welle-Powell, a nationally-recognized leader in value-based care transformation. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 The grim statistics of American healthcare and the moral and economic imperative to reform it! 05:00 Recent article from Don Berwick about the excess profiteering and greed in healthcare: “Salve Lucrum: The Existential Threat of Greed in US Health Care” 06:30 Debbie discusses the current state of the healthcare industry and how she spent her career moving healthcare delivery to full-risk and globally capitated payments. 07:30 A leadership commitment to test models of care that address the moral imperative for improved outcomes. 08:30 Reflections on Dr. Berwick's article and the need to expand the conversation by focusing on solutions. 11:00 The Innovation Center Strategy Refresh is a stake in the ground for 100% of Medicare beneficiaries to be in an accountable care relationship. 12:00 The need for innovation in specialty care and new risk models that improve health equity. 13:00 “Medicare is a laboratory for change.” (e.g. alignment of quality measures, multi-payer approaches to improvement, expansion of access in rural areas) 13:45 Two-thirds of those in Medicare Shared Savings contracts are now taking risk. 14:00 Balancing the need to move fast while not being too aggressive (“people are exhausted!”) 15:00 In the last year, hospitals have seen their operating costs increase upwards of 10%, and their bottom lines are now hemorrhaging to the tune of billions of dollars.

You would think that hospitals with the most money would offer the most charity care—trickle down and all of that. If my health system is big and I have lots of money and profitable commercial patients, I can stuff more dollar bills into the charitable donation balance sheet bucket, right? Except, in general, it's a fairly solid no on that. Let's talk about some of my takeaways from the conversation that I had with Vikas Saini, MD, and Judith Garber from the Lown Institute. During the conversation, there's also mention of a powerhouse of a New York Times article. So, let's circle up on but a few of the more interesting (according to me) reasons why some rich hospitals fail to offer the level of charity care that you might think they could or should: #1: Chasing commercial contracts because they are very profitable means building in areas where there are frankly not a whole lot of poor people. You see hospital chains doing this all of the time and saying at the 2023 JPM (J.P. Morgan) conference that they intend to do more of it, opening up in a fancy suburb with no affordable housing. When this happens, there is just less opportunity to offer charity care. The need for financial aid in that ZIP code is just less. #2: The Ambulatory Surgical Center (ASC) movement, which is weird to say because, in other respects, I'm a big fan. There are a lot of services and surgeries moving out of the hospital into ambulatory surgical centers or just the outpatient setting, and this is going on for a bunch of reasons, including Medicare and employers being very on board with this to save facility fees. But here's a consequence: Surgeons and other docs are now not in the hospital. So, indigent patient shows up in the emergency room and needs an emergency surgery or some intervention. But wait … those physicians and their teams are no longer in the hospital. And now the hospital doesn't have the “capability or the capacity” to serve that patient. I heard from a surgeon the other day, and when he's on call at his hospital, he's getting patients shipped to him on the regular from hospitals in other states. Now, about this “oh, so sorry … we can't possibly help you so we're gonna stick you in an ambulance and take you to another state” plan of action. I called up emergency room expert Al Lewis. He told me that if this “ship 'em out” is being done routinely as a pattern by hospitals who have an ER, you could call it evidence of an EMTALA (Emergency Medical Treatment and Labor Act) violation on several levels. You can't have an emergency room and then routinely not be able to handle emergencies, especially when the emergencies you can't handle always seem to be of a certain kind and for a certain kind of patient. Speaking of violations, one more that reduces the need and level of charity care is canoodling with ambulance companies to take the poor people to some other hospital and the rich people to your hospital, which was allegedly transpiring in New Jersey, based on a recent lawsuit. #3: [play some foreboding music here] This last one is the big kahuna underlying reason why some very rich hospitals may not offer the level of charity care which you'd think they would. This was superbly summed up by Tricia Schildhouse on LinkedIn the other day. She knew a physician leader who would go around saying, “Non-profit and for-profit is a tax position, not a philosophy.” Bottom line, this whole thing boils down to what has been normalized as OK behavior at some of these rich hospitals. You have people in decision-making roles taking full advantage of their so-called tax position to jack up their revenues—revenues which they have no interest in frittering away on charitable causes. Why would they do that when they can use the money to, I don't know, stand up a venture fund or make Wall Street investments? Don Berwick's latest article in JAMA is entitled “The Existential Threat of Greed in US Health Care.” And, yeah … exactly. Back to that New York Times article that we talk about in this healthcare podcast, here's what it says about a hospital in Washington State. It says: “The executives, led by [the hospital's CFO] at the time, devised … a program called Rev-Up. “Rev-Up provided [the hospital's] employees with a detailed playbook for wringing money out of patients—even those who were supposed to receive free care because of their low incomes.” All of this being said, there are hospitals out there who are, in fact, living up to their social contract and serving their communities well with very constrained resources. You also have hospitals just in general working within some really whack payment models that we have in this country, which easily could be a root cause precipitating this suboptimal-ness. Dr. Saini and Judith Garber mention three direct solves for hospital charity shortfalls and also the larger context of the issue. So, there's, of course, better reporting and better auditing, which is pretty nonexistent in any kind of standardized way right now. I also really liked one of the solutions that Dr. Saini mentions on the show: Maybe instead of all the hospitals doing their own charity care thing, they all should pool their money regionally and then put a community board in charge of distributing it. That way, if there is a hospital in an area where the charity care is really needed, even if the rich hospital nearby doesn't have a facility there, they can help fund this care that their larger community really needs—including, by the way, public health needs, which is currently a big underfunded problem. As mentioned earlier, I am speaking with Vikas Saini, MD, and Judith Garber. Dr. Saini is president of the Lown Institute. Judith Garber is a senior policy analyst there. They've studied hospitals from a number of dimensions, not just charity care.   You can learn more at lowninstitute.org and lownhospitalsindex.org.    Vikas Saini, MD, is president of the Lown Institute. He is a clinical cardiologist trained by Dr. Bernard Lown at Harvard, where he has taught and done research. Dr. Saini leads the Institute's signature project, the Lown Institute Hospitals Index, the first ranking to measure hospital social responsibility. The Index, first launched in July 2020, evaluates hospitals on equity, value, and outcomes and includes never-before-used metrics such as avoiding overuse, pay equity, and racial inclusivity. In his role at the Lown Institute since 2012, Dr. Saini led the development of the Right Care series of papers published by The Lancet in 2017, convened six national conferences featuring world-renowned leaders in healthcare, and guided other Lown Institute projects such as the “Shkreli Awards.” Dr. Saini also serves as co-chair of the Right Care Alliance, a grassroots network of clinicians, patient activists, and community leaders organizing to put patients, not profits, at the heart of healthcare. Prior to the Lown Institute, Dr. Saini was in private practice in cardiology for over 15 years on Cape Cod, where he also founded a primary care physician network participating in global payment contracts. He also co-founded Aspect Medical Systems, the pioneer in noninvasive consciousness monitoring in the operating room with the BIS device. Dr. Saini is an expert on the optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation, and health equity. He has spoken and presented research at professional meetings around the world and has been quoted in numerous print media, on radio, and on television.  Judith Garber is a senior policy analyst at the Lown Institute. She joined the Lown team in 2016, after receiving her Master of Public Policy degree from the Heller School of Social Policy. Her research interests include hospital community benefit policy, overuse and value-based care, and racial health disparities. She has authored several white papers, journal articles, op-eds, and other publications on these topics. Judith previously worked at the Aspen Institute Financial Security Program, the Midas Collaborative, and Pearson Education. She has a bachelor's degree in American studies and political science from Rutgers University.   06:50 Why does America need socially responsible hospitals? 08:23 What standards are hospitals beholden to with their charitable spending? 08:47 “It's the honor system, essentially.”—Dr. Saini 11:38 What is fair share spending? 13:43 Which hospitals are paying their fair share? 15:05 Why do hospitals that are financially more strapped tend to give back to their communities more? 17:25 Why is it hard for hospitals with the most privately insured patients to do the most for their community? 18:56 “These outcomes … are the outcomes of the [current system].”—Dr. Saini 21:23 “A key problem here is [that] systems have gotten so big.”—Dr. Saini 22:30 What's the solution to fixing the problem with hospital charity care? 23:52 EP374 with Dave Chase. 29:21 What would be the level of acceptance with changing the system as it stands with hospitals?   You can learn more at lowninstitute.org and lownhospitalsindex.org.   @DrVikasSaini and @JudiTheGarber of @lowninstitute discuss #hospitalcharitycare on our #healthcarepodcast. #healthcare #podcast #hospitals Recent past interviews: Click a guest's name for their latest RHV episode! David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari  

Episode page with video and more What do you do when you are chosen as Jim Murray's US Micro Whiskey of the Year? You pop in to join Mark and Jamie on Lean Whiskey to talk about it. At least that's what our friend David Meier of Glenns Creek Distilling did in Episode 38. While we were able to drink, and celebrate, the success of OCD #5, we also explored David's continued learning, problem solving, and improvement of whiskey production. We also learned that he was featured on an episode of Moonshiners: American Spirit, more of a documentary exploring the production of American spirits than the original show.  After David departs, Mark and Jamie discuss a recent report featured on NBC outlining that 1 in 4 hospital visits result in adverse events. This comes from a recent study on patient safety published in the New England Journal of Medicine. We break down the statistics, explore the real meaning behind those numbers, and discuss the causes and contributing factors. Throughout the dialogue we cover process improvement, problem solving, near misses, organizational learning, and psychological safety. We also spend time looking at Dr. Don Berwick's editorial about the study, and at least try to summarize his contributions to patient safety.  Mark and Jamie wrap up the first episode of 2023 talking about books. We hope everyone has a wonderful 2023. Happy New Year, and Cheers!  Glenns Creek Distilling's OCD #5 selected US Micro Whiskey of the Year Jim Murray's Whisky Bible website Moonshiners: American Spirit Glenn's Creek Distilling  NBC's reporting that 1 in 4 patients experience adverse effects, and the New England Journal of Medicine published study behind the statistic Patient safety advocate Don Berwick's Commentary in the New England Journal of Medicine Upcoming webinar hosted by Mark on the proposed National Patient Safety Board The Economist's reporting on today's healthcare system challenges around the world Jamie's book recommendation Ikigai Mark's future read: If I Betray These Words: Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First  Podcast feed at LeanWhiskey.com or leanblog.org/leanwhiskey or jflinch.com/leanwhiskey  Please review us and follow!   

This week, Fixing Healthcare hosts Jeremy Corr and Dr. Robert Pearl conclude their holiday tribute to episodes past with this 2018 interview of Dr. Don Berwick. Don is the former ... The post FHC #77: Fixing Healthcare flashback with Don Berwick appeared first on Fixing Healthcare.

On this episode of On the Evidence, Don Berwick of the National Academy of Medicine's Climate Collaborative, Tom DiLiberto of the National Oceanic and Atmospheric Administration, and Aparna Keshaviah of Mathematica explore the risks that climate change and extreme heat pose to human health and how data can help inform solutions. Learn more about ClimaWATCH, an interactive online tool that can support communities seeking to understand and adapt to the local effects of heat waves on their residents' health: https://mathematica.org/publications/climawatch-tool Learn more about Mathematica's interdisciplinary climate change practice: https://mathematica.org/sp/climate-change/climate-action Learn more about the National Oceanic and Atmospheric Administration's work over the past five years with more than 65 communities to map urban heat islands and use data-driven insights to mitigate the harmful and inequitable effects of extreme heat: https://www.noaa.gov/news-release/noaa-and-communities-to-map-heat-inequities-in-14-us-cities-and-counties Learn more about the National Academy of Medicine's Action Collaborative on Decarbonizing the U.S. Health Sector: https://nam.edu/programs/climate-change-and-human-health/action-collaborative-on-decarbonizing-the-u-s-health-sector/

We conclude this series of podcasts linked to the publication How To Be Wrong with Don Berwick, renowned health policy maker and scientist. Don's short paper Era 3 for Medicine and Health Care was the catalyst for the network that produced the How To Be Wrong paper. In this podcast, Don reflects on the paper, its reception and the prospects for new ways of thinking about learning.

Returning to the podcast this week is a household name in medicine, Dr. Don Berwick, who made his first appearance on the show in season one. Back then, Don said ... The post FHC #60: Don Berwick on ‘breaking the rules for better patient care' appeared first on Fixing Healthcare.

At the beginning of the pandemic when nursing homes were a hotbed for COVID-19 infections and many untimely deaths, the Institute for Healthcare Improvement (IHI) began hosting daily phone calls where hundreds of facilities joined to quickly get and share information that would improve their response. It led to a larger project over the next year that included every nursing home in the country sharing knowledge and information, and is an excellent example of how IHI achieves its mission of helping to improve quality and outcomes by learning and teaching best practices.IHI was founded more than 30 years ago to improve the safety and quality of healthcare by studying how leading companies in other industries systematize processes to apply learnings across the healthcare ecosystem. Don Berwick, IHI's founder, and Maureen Bisognano, president emerita, talked about the genesis of the organization as guests on the Healthcare is Hard podcast in February 2019. Since July 2020, the organization has been led by our guest for this episode: IHI's current president and CEO, Dr. Kedar Mate.In this episode, Dr. Mate talked to Keith Figlioli about his background as an Indian-American and how time spent in his youth traveling between both countries helped drive him towards a career dedicated to addressing health related injustice and inequities. They discuss many facets of the work he's doing at IHI including:Questioning IHI's relevance. After three decades of measurable success working towards its mission, one of Dr. Mate's first decisions as IHI's new CEO was to audit the organization and its relevance in a rapidly-evolving healthcare landscape. He describes three core value propositions – the organization's methods, ability to inspire, and quest for driving results at scale – and how they apply today.Teaching – and learning – globally. With so many challenges around quality, outcomes and costs to overcome in the U.S. healthcare system alone, Dr. Mate talks about why IHI has chosen a broader, global focus. Much like the organization's mission of bringing knowledge from other industries into healthcare, its involvement in healthcare delivery around the world enables it to identify and share strategies that are working across healthcare economies. Measuring outcomes vs. process. Dr. Mate shares his belief about the current flaws in measuring care quality. He talks about how outcome-based measurement is underrepresented in favor of process-based measurement, and how the industry has a tendency to continue creating new measures without sunsetting old ones. He also shares the important reminder that measurement itself is not the objective, and that we must not lose sight of giving organizations tools and methods so they can actually change their measures and create better results.Quality and new care delivery. With new sites of care and options for virtual care continuing to grow, Dr. Mate and Keith talk about the role quality measurements will plan in the future of healthcare. They discuss the imperative for setting standards and measurements for virtual care and technology-enabled services, and how quality can become the major differentiator when there are no limitations on geographic boundaries.To hear Dr. Mate and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

This week, we're replaying a classic episode where your hosts Steve Lowry and Yvonne Godfrey interview Laura Shamp of Shamp Silk, LLC (https://www.shampsilk.com/).   Remember to rate and review GTP in iTunes: Click Here To Rate and Review   Episode Details: Laura Shamp obtained a verdict of $11 million dollars for an ex-smoker in a case against Philip Morris USA Inc. The jury awarded $3.2 million in punitive damages after finding that the tobacco company had committed fraud and intentionally misrepresented the dangers of smoking to consumers. (Jordan v. Philip Morris Tobacco Co.) The verdict was affirmed on appeal. Click Here to Read/Download Trial Documents   Guest Bio: Laura M. Shamp From her career as a college athlete playing in the Final Four to graduating with honors from Harvard Law School, Laura Shamp has always been a fierce competitor and has always played to win. Over the past 20 years, she has handled all types of major litigation and is known as one of the few trial lawyers able to get multi-million dollar verdicts in some of the toughest jurisdictions and has an $11 million dollar jury verdict against Philip Morris to prove it. So, it is not surprising that she is consistently listed as one of Georgia's “Super Lawyers.” Laura's success as a trial lawyer is only matched by her success as an appellate advocate. Her reported cases have helped shaped the law in Georgia regarding medical malpractice and the use of expert witness testimony in professional negligence cases and include: Hankla v. Postell, 293 Ga. 692, Georgia Supreme Court 2013; EHCA Cartersville v. Turner, 280 Ga. 333, Georgia Supreme Court 2006; Lee v. Phoebe Putney Memorial Hospital, 297 Ga. App. 692, Georgia Court of Appeals (2009); Houston v. Phoebe Putney Memorial Hospital, 295 Ga. App. 674, Georgia Court of Appeals 2009. Laura also chairs the Georgia Trial Lawyers Amicus Committee, which submits “friend of the court” briefs to the Georgia Supreme Court and Georgia Court of Appeals on issues affecting the civil justice system. Laura graduated in 1988 from Harvard Law School with honors. After graduating, she served as a federal law clerk to United States District Court Judge Robert H. Hall. In 2004, she returned to Harvard to study patient safety and medical errors under Don Berwick and Lucian Leape, leaders in the field of patient safety, and in 2005 obtained a Masters Degree in Public Health from the Harvard School of Public Health. Laura is dedicated to working to try and improve the quality of medical care in Georgia and serves on several committees that review legislation to try and address issues of medical error and patient safety. Before founding Shamp Silk, Laura had a successful solo practice for over 15 years. Before that she was at Doffermyre, Shields, Canfield, Knowles & Devine, where she practiced for four years doing plaintiffs and general civil litigation work. She began her career at Sutherland Asbill & Brennan as a general civil litigator. Laura is admitted to practice before the United States Supreme Court and the Supreme Court of the State of Georgia, as well as all other trial and appellate courts in the State of Georgia. Read Full Bio   Show Sponsors: Legal Technology Services - LegalTechService.com Digital Law Marketing - DigitalLawMarketing.com Harris Lowry Manton LLP - hlmlawfirm.com   Free Resources: Stages Of A Jury Trial - Part 1 Stages Of A Jury Trial - Part 2

ChenMed is a family-owned, physician-run organization that was created to better serve low-moderate income elderly patients. Starting in 1985, Dr. James Chen created ChenMed as a one-stop shop where physicians are held accountable for their patients, and now ChenMed operates over 100 senior health centers across the US. The full-risk, capitation model of ChenMed aligns economic incentives where preventative value based care is the foundational framework.  However, what really allows ChenMed to transform care delivery in the U.S. is how they honor the sacred nature of the physician-patient relationship. The ChenMed model for primary care exemplifies the power of the provider-patient relationship and realigns physicians with their altruistic calling.  In doing so, clinicians are able to address the moral determinants of health that lead to improved health equity and social justice in our society. Joining us this week is Dr. Faisel Syed, the National Director of Primary Care at ChenMed. Dr. Syed believes a physician-led culture can improve primary care influence and lead to a new era of transformation in the United States.  He is on a mission to restore the intimate and sacred nature of the doctor-patient relationship and, in doing so, create care models that can replicate at scale.  In this episode, Dr. Syed discusses how ChenMed honors seniors with affordable, VIP care that delivers better health. He shares how this moral consensus has an enormous impact on patients and the health of communities.  A physician-led culture in primary care, coupled with trusting relationships, can truly change the world! Episode Bookmarks: 01:30 Background on Faisel Syed, M.D. and the full-risk capitation model of ChenMed 03:30 The ChenMed model as “old-fashioned medicine with technology that treats patients like family” 04:30 How family influence and emerging technologies created a calling to practice medicine 07:15 “We should restore the intimate and sacred nature of the doctor-patient relationship.” 09:20 Don Berwick's article on “The Moral Determinants of Health” 10:20 “ChenMed starts with the mission to honor seniors with affordable, VIP care that delivers better health. That is our moral consensus.” 11:00 Healthcare as a right – everyone deserves access to primary care, especially those in underserved communities 12:45 Referencing Michael Marmot's book, “The Health Gap: The Challenge of an Unequal World” and the impact of income inequality on health 14:30 “Understanding pathophysiology alone is not enough to improve health. We must address social determinants of health.” 15:30 Faisel provides an excellent overview of SDOH and how ChenMed's relationship-based care model improves population health outcomes 18:30 1 out of 5 Americans (over 51 million) are living with a behavioral health condition and 20 million individuals have a substance use disorder 19:30 How a holistic (non-transactional) approach to primary care with aligned financial incentives impacts behavioral health outcomes 22:00 The sacred nature of healing relationships that goes back to the roots of shamanism (and how transactional economics limits healthcare effectiveness) 24:00 Reflections on how the ChenMed model supports healing through trusting relationships 25:00 How openness and trust between a doctor and a patient prevents avoidable ER visits 28:30 How a famous clip from “I Love Lucy” sums up physician burnout that results from the culture of a fee-for-service system 29:30 How ChenMed allows physicians to truly fulfill their purpose in practicing medicine (and how that prevents the burnout all too common in FFS) 32:30 Referencing the article “Primary Care, Specialty Care, and Life Chances” and how PCPs in a given geography correlate with lower mortality and improved societal health 34:00 Primary care doctors need “influence and leadership” to catalyze a national transformation of healthcare in our country

More Health Policy this week! Today, we discuss “SNPs” but this is not a podcast about haircuts during the pandemic. We take a deeper dive into the world of Medicare Advantage and what it means for vulnerable patients facing serious illness and those at the end of life.  We are joined by UCSF geriatrics fellow Alex Kazberouk to talk to Dr. Claire Ankuda (Assistant Professor at Icahn School of Medicine at Mount Sinai and Palliative Care Physician) and Dr. Cheryl Phillips (President and CEO of the Special Needs Plan Alliance and past president of the American Geriatrics Society).  We discuss:  Special Needs Plans (SNPs) for older adults – what they are and what they mean for our patients What happens when a Medicare Advantage patient enrolls in hospice and how that may change with the new “Hospice Carve-In” This is part two of a two part series on Medicare Advantage and healthcare financing. On our prior episode, we heard Dr. Don Berwick's and Dr. Rick Gilfillan's critique of Medicare Advantage plans. This week, we bring up a rebuttal to their critique and also talk about quality data and reporting for Medicare Advantage patients.  Alex plays The Purchaser's Option by Rihannon Giddens (she has so many terrific songs!). Astute online viewers will also spot an appearance of the Team Canada Tokyo 2021 Olympic Jacket and Cheryl's dog. 

Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit?  On today's podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick (founder of the Institute for Healthcare Improvement, former administrator of Center for Medicare and Medicaid Services) and Dr. Richard Gilfillan (former CEO of Geisinger Health Plan and Director of the Center for Medicare and Medicaid Innovation). Their recent two part post on the Health Affairs Blog about the Medicare “Money Machine” has stirred up a debate about challenges and misaligned incentives within Medicare Advantage. We talk about: What Medicare Advantage is all about - its history, operations, potential benefits, and what it means for us and our patients Rick and Don's Health Affairs post on the downsides of MA plans and the Medicare “Money Machine” Policy solutions to improve the system without throwing the baby out with the bathwater We also touch upon prior podcast topics such as the area deprivation index and population health. As a special, Alex plays a superb rendition of this song which is definitely not a Rickroll. This is part one of a two part series on Medicare Advantage and healthcare financing. We have a follow-up with Claire Ankuda and Cheryl Philips on Special Needs Plans and the Medicare Advantage Hospice Carve-In coming soon.

If you want to go deep on Big Picture Learning, check out this longitudinal study of big picture students and alumni that Eva coauthored!Episode Notes If you want to learn more about Don Berwick, listen to Stacey Caillier's interviews with him: "Improvement as Learning" and "Building Courageous Networks" A short biography of W. Edwards Deming A short biography of Anthony (Tony) Bryk A short biography of Peter Senge

Our guest this week is Dr. Jim Walton, President and CEO of Genesis Physicians Group. Dr. Walton was drawn into medicine at an early age – he followed his dad making house calls, going to nursing homes, and forging deep ties in the community. His clinical work throughout his medical career was focused in poor communities, coordinating care for complex patients from diverse backgrounds. As an experienced and innovative physician leader, Dr. Walton provides executive leadership to more than 1,700 physician and allied health members in a North Texas independent practice association. He also established and leads the group's ACO which is focused on creating physician-led risk-based solutions. Dr. Walton's passion is engaging physicians to stay independent by providing them with a population health infrastructure for succeeding in risk. Add that to his passion for treating the underserved and caring for those living on the extreme fringe of vulnerability, it's easy to see why he is an ideal leader in the race to value. Episode Bookmarks: 05:05 Dr. Walton shares his prior experiences in treating marginalized populations 06:30 A personal patient story that had a profound impact on Dr. Walton's career in service to the underserved 08:20 Establishing rural clinics to care for the uninsured and AIDS patients in the early nineties 10:00 Developing community medicine strategies to mitigate racial disparities in care 11:40 “The role of the profession of medicine is to design solutions to improve community health.” 14:00 Starting a value journey with a legacy model, fee-for-service physician IPA 15:40 Succeeding in a Medicare ACO provided confidence to take risk with Medicaid 18:20 The importance of solving community-based social issues and lessons learned fromMedical Home Network 19:30 Integrating both clinical and social determinants of health data to develop an AI-based predictive analysis 20:00 Building an infrastructure for social interventions to better care for Medicaid patients 22:00 Value-based care as an enabler of physician independence 23:00 Physician leadership involvement in the structure of financial rewards to incentivize practice transformation 25:00 Dr. Walton discusses how his physician-led risk-bearing entity is competing with PE-backed firms and hospital systems 25:30 “The joy of practicing medicine can be found in a team-based, physician-led model that promotes independent practices.” 27:30 Dr. Walton on how managed care contributes to physician burnout and why value-based care is different when built by physicians 30:30 Tapping in to both the intrinsic and extrinsic motivations of physicians to improve patient care 33:30 How diminishing fee-for-service rates creates a deleterious treadmill effect with doctors (unless they adopt value-based care) 36:00 Developing a compelling value proposition for payers 39:30 COVID-19 as the ultimate crucible for testing the resiliency of physicians 41:00 The siphoning of patients by urgent care facilities and retail primary care models 42:00 Primary care redesign of patient panels leading to specialization in chronic disease 43:00 Responding to emergent physician needs during the pandemic 43:45 “Prospective payment is the destination” 45:00 Dr. Walton discusses how the ACO Provider Relations team engages physicians 47:00 Tapping into the clinical intuition when stratifying risk in a patient population 48:30 Dr. Walton speaks about how younger physicians will find purpose in their practice of medicine 53:20 Parting thoughts about the inspiration of Dr. Don Berwick and the Triple Aim 55:00 “Value-based care allows us to reimagine our professional duty to improve quality, reduce unnecessary suffering, and eliminate health disparities.”

Episode Notes Learn more about Don Berwick and the Institute for Healthcare Improvement at http://www.ihi.org/

One in five Americans now has medical debt in collections and rising health care costs today threaten every small business in America. Dr. Makary, one of the nation's leading health care experts, travels across America and details why health care has become a bubble. Drawing from on-the-ground stories, his research, and his own experience, The Price We Pay paints a vivid picture of price-gouging, middlemen, and a series of elusive money games in need of a serious shake-up. Dr. Makary shows how so much of health care spending goes to things that have nothing to do with health and what you can do about it. Dr. Makary challenges the medical establishment to remember medicine's noble heritage of caring for people when they are vulnerable. The Price We Pay offers a roadmap for everyday Americans and business leaders to get a better deal on their health care, and profiles the disruptors who are innovating medical care. The movement to restore medicine to its mission, Makary argues, is alive and well--a mission that can rebuild the public trust and save our country from the crushing cost of health care. Dr. Marty Makary is a New York Times bestselling author and leading voice for transparency in health care. He is the recipient of the 2020 Business Book of the Year Award for The Price We Pay. A professor at the Johns Hopkins Bloomberg School of Public Health, he has published over 250 scientific articles on the re-design of health care, medical innovation, and vulnerable populations. Dr. Makary has been elected to the National Academy of Medicine and is Editor-in-Chief of Medpage Today. He has written for The Wall Street Journal, The New York Times, and USA Today and is a frequent medical commentator. ​ Clinically, Dr. Makary practices pancreas surgery and has pioneered novel operations at Johns Hopkins.  He is the recipient of the Nobility in Science Award from the National Pancreas Foundation and has been a visiting professor at over 20 medical schools.​ Dr. Makary was the lead author of the original publications on the surgery checklist and later served in leadership roles at the World Health Organization. Dr. Makary is the chairman of the African Mission Healthcare medical advisory board and leads several health care collaboratives. His current research focuses on the underlying causes of disease and relationship-based medicine. His book Unaccountable turned into the T.V. series “The Resident” and his newest bestselling book of The Price We Pay was has been described by Don Berwick as “a deep dive into the real issues driving up the price of health care” and by Steve Forbes as “A must-read for every American”.  He speaks nationally and internationally on the appropriateness of care, lifestyle choices that influence health outcomes, employee health benefits design, and health care costs.

Dr. Sachin Jain says he got a silent education about healthcare and medicine around the dinner table from his father, an anesthesiologist and pioneer in pain management. But he still wasn’t sold on a career in healthcare until the end of his junior year at Harvard when he took a course on the quality of healthcare in the U.S. taught by Dr. Howard Hiatt and (one of this podcast’s first guest) Dr. Don Berwick.That decision kicked-off a career where Sachin has packed experience from nearly every angle of the healthcare industry into the last 20 years. Immediately following his junior year at Harvard, Don Berwick offered him a summer internship with the Institute for Healthcare Improvement (IHI) working on its Pursuing Perfection Initiative. This provided an opportunity to visit and study the nation’s best health systems at Don’s side and opened the door to a tremendous network of national healthcare leaders.A few year later, Sachin landed in Washington, DC as Special Assistant to the National Coordinator for Health IT during the Obama Administration and then Senior Advisor to the CMS Administrator (his mentor, Don Berwick). He then jumped back to the provider side as a resident at Brigham and Women’s Hospital in Boston for four years, before seeing healthcare through the pharmaceutical lens as Chief Medical Information and Innovation Officer at Merck. In 2014, he was recruited to the west coast by Anthem Blue Cross Blue Shield, where he was CEO of its subsidiary, CareMore Health, a care delivery system for Medicare and Medicaid patients, and CEO of Aspire, a large palliative care provider that was acquired by Anthem in 2018.In July 2020, Sachin became CEO at SCAN Health Plan, a non-profit founded as the Senior Care Action Network in the late 70s that’s now a Medicare Advantage HMO with 220,000 members and revenues over $3.5 billion.At SCAN, Sachin has continued his commitment to disrupting the status quo in healthcare. On this episode of Healthcare Is Hard, he discussed many of his ideas with Keith Figlioli, including:Making hospitals less necessary. A few years back, Sachin was in the running to lead a nationally-known integrated health system and laughs at himself when he thinks of his final pitch to the board. He argued for revenues to go down, fewer beds and facilities, less fee for service revenue, and more risk-based revenue. While he fully understands how this goes against everything driving health systems for the past two decades, it aligns with his fundamental belief that healthcare needs to focus more intensely on outpatient management of people with chronic diseases to keep them out of hospitals as much as possible.Medicare advantage as a blueprint of Medicare for all. Sachin says he doesn’t think Americans trust the public sector to fund and provide healthcare, but he believes people could get behind healthcare that is government funded and privately delivered. With elements like a coordinated network, transparency around quality, incentives for consumer experience, and rewards for higher participation, he believes MA could be a solution to full coverage.Islands of innovation. While Sachin sees lots of creativity and reinvention around individual verticals and addressing single diseases, he’s frustrated with the lack of connective tissue between them and thinks this will get worse before it gets better. He says the next phase will have to be focused on connecting all these pieces to treat the full patient and that it will be incumbent on private markets to think creatively about deal structure to incentivize it.To hear Sachin and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Episode Notes Learn more about Don Berwick and the Institute for Healthcare Improvement at http://www.ihi.org/ The book Don recommended is The Improvement Guide Learn more about the Center for Research on Equity and Innovation here A full transcript is available on the Unboxed Website

An industry inflection point is coming in the transition to value: federal and state governments are feeling an insurmountable level of pressure as public debt and spending increase, large employers are reeling from high healthcare costs, and provider organizations are being crushed by the current environment as they realize that FFS is perilous in the middle of a pandemic. Health system executives not leading with a strategy in health value are increasingly facing significant financial uncertainty. The coming industry shift to value is all but inevitable, however, pivoting successfully will require long-term strategic planning and investment in cultural alignment, technology and infrastructure, and partnerships. When Travis Turner heard Dr. Don Berwick speak about the transformation to population health and value-based payments, he listened. Berwick had said the worst position to be in when transitioning from fee-for-service is static, stuck with a foot in each canoe – the change must be fast to achieve critical mass that enables modifying provider behavior. This became a priority for Travis, something that has been aggressively pursued and which has driven to his organization's success. This week, we speak with Travis Turner, SVP Chief Population Health Officer and COO of Mary Washington Medicare Advantage at Mary Washington Healthcare. Mary Washington Health Alliance is a physician-led, physician governed CIN – founded in 2013, the ACO has 437 participants that cover around 60,000 lives. During the 2017 MSSP performance year, the ACO achieved $11.9 million in savings. For the first three years it participated in the CMS Bundled Payment for Care Improvement program, it achieved $12.6 million in savings. The ACO now participates in the Next Generation ACO model and is active in the BPCI Track 2 for all 48 episodes of care. Episode Bookmarks: 3:30 The inflection point in value-based care for employers, providers, and government 4:40 The value-based care journey of Mary Washington Health Alliance (MWHA) over the last 7 years 6:15 Transitioning from the upside-only MSSP to taking institutional risk in the NextGen ACO and BPCI programs 7:25 Entering downside risk by applying lessons learned from other value-based contracts 7:40 Reaching a critical mass in value to change the behavior of providers 8:00 Don Berwick's influence on MWHA's fast transition to value 10:00 “There has to be a bottom-up, top-down acceptance at every level for population health to succeed in a value-driven organization.” 10:30 Travis reflects on the slow uptake of value-based care in the national landscape and how learning environments will catalyze adoption 11:10 VBC is key to partnering with independent physicians 11:30 “Reaching critical mass in value is all about achieving the Triple Aim. That will overcome any perceived risks of demand destruction.” 12:15 The challenges of adapting to CMS changes to payment models 13:30 NEJM on care patterns in Medicare and the challenges of fragmented, uncoordinated care 14:30 “A true, clinically integrated network will be able to drive enterprise-level change with data.” 15:30 The challenges in siloed initiatives like Oncology Care Model and ESRD Treatment Choices Model in driving system change 16:00 Democratization of data with FHIR-based technologies and how that will improve population health analytics 16:45 Success in clinical integration means treating all patients the same (even those that are not attributed to value-based contracts) 19:15 Taking advantage of clinical integration by entering into single-signature commercial agreements 19:45 Stark and Anti-Kickback concerns associated with clinically integrated networks 20:15 The win-win-win advantages of employer and health system partnerships 20:45 Single negotiated rate advantages with clinical integration 22:25 How FFS can co-exist with VBC in reaching critical mass in value

The National Academy of Medicine's 2000 report "To Err Is Human" launched the health care quality movement in the US. Victor Dzau, MD, president of the National Academy of Medicine, and Don Berwick, MD, MPP, from the Institute for Healthcare Improvement, discuss progress to date in advancing quality and prospects for improving outcomes and reducing harms, errors, and cost in the next 20 years. Recorded December 22, 2020. Related Article(s): Two Decades Since To Err Is Human

Legendary healthcare expert Don Berwick, MD, Founder & CEO of the Institute for Healthcare Improvement, and former Administrator of CMS, talks with APG CEO Don Crane about his assessment of where we are today with progress in the value-based care movement a decade after passage of the Affordable Care Act. “It’s a mixed bag…I wish we were seeing more progress than we are.” Dr. Berwick elaborates on the four things that he believes will move us toward a better healthcare system: universal healthcare, addressing social determinants of health, improving quality of care, and reducing costs.

In this episode of Moral Matters, Dr. Wendy Dean interviews Dr. Don Berwick, President Emeritus and Senior Fellow of the Institute for Healthcare Improvement. Dr. Berwick is a long-time advocate for improving healthcare for both patients and providers. During this conversation, we talk about the moral imperative of change in healthcare; how we can approach the challenges more effectively; and why working together will be critical.We want to hear from you. Send a voice memo or note to info@moralinjury.healthcare.

Don Berwick, President Emeritus & Senior Fellow of the Institute for Healthcare Improvement in Boston, talks about the forthcoming International Forum on Quality and Safety in Healthcare, which will take place online on 2nd-6th Nov 2020. https://internationalforum.bmj.com/copenhagen/

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I'm delighted to welcome back to this podcast Dr. Don Berwick – one of the leading authorities on healthcare quality ...

In this virtual panel discussion, Dr. Ernest Grant (President of the American Nurses Association), Dr. Jan Jones-Schenk (Senior Vice President – College of Health Professions, WGU), and Jason Thompson (Vice President - Diversity, Equity and Inclusion, WGU) will discuss how we must eliminate barriers to equity in access and learning in order to reduce racial disparities in care. Progress in advancing diversity in the US health care workforce has been slow. This is evidenced by the low numbers of people from historically underrepresented populations joining the health professions workforce, ongoing reports of bias and discrimination in health professions learning environments, and a continuing dearth of proven and replicable best practices to advance diversity. Many of our health professions schools and clinical practice sites are taking some action on diversity and the more contemporary concepts of equity and inclusion, but without making the necessary commitment to comprehensive, system-wide approaches that create meaningful culture change. As a result, addressing harmful bias and eliminating discrimination remain critical challenges to achieving excellence in health care and health professions education. Within the registered nurse (RN) workforce, according to the National Council of State Boards of Nursing (NCSBN), 81% are White/Caucasian (vs 60% of the US population), while 19% of nurses are from underrepresented racial/ethnic populations. The Accountable Care Learning Collaborative believes that nursing programs must address bias and reduce discrimination in health professions learning environments because, in not doing so, racial disparities in care will persist. In our Accountable Care Atlas, we identified a specific competency to “understand the unique cultural characteristics of the population served to implement changes in the organization to provide high-value care”. This cultural competency failure is reinforced by research that shows that care. If you would like to watch a video recording of this webinar, you can do so here. Bookmarks: 1:40 ACLC Leadership takes a stance on institutional racism and how BLM movement is a public health issue 4:00 Introduction to panelists: Dr. Ernest Grant, Dr. Jan Jones-Schenk, and Jason Thompson 4:50 Reference to population health research that shows us that the American health care system is not immune to institutional racial discrimination 8:05 Jason Thompson on how we can engage in a societal conversation to foster a better understanding about the presence of racism 8:26 “I can't make you racist in 45-minutes…and I can't undo it in 45-minutes.  It takes multiple conversations and constant engagement.” 9:51 “There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.” 10:19  “Advancing health equity will require a justice-oriented framework that identifies structural racism's manifestation in medical care.” 10:50 Reference to Don Berwick's recent article, “The Moral Determinants of Health“ 12:05 Dr. Ernest Grant on how our country can reorient value-based care and public health policies around racial and health justice 13:30 Dr. Ernest Grant on how the nursing profession can mobilize around the issue of institutional racism and health inequity 13:50 Dr. Ernest Grant references his testimony to the House Ways and Means Committee on the disparate impact of COVID-19 in the African American community 14:37 “As nurses we have the responsibility to use our voice to call for change.  Our code of ethics obligates us as nurses to be allies and to speak up against racism, discrimination, and injustice.” 16:00 Dr. Jones-Schenk speaks to how we need to “go upstream to the source” to address seek solutions in reforming society 17:05 “As a profession, we make a promise to society that we will address the health needs of society.

Welcome to Episode #104 (Season 4) of Creating a New Healthcare. I’m delighted to welcome back to this podcast Dr. Don Berwick - one of the leading authorities on healthcare quality & improvement over the past few decades.  Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI), an organization that he co-founded and led as President and CEO for 18 years. In July 2010, President Obama appointed Dr. Berwick to the position of Administrator of the Centers for Medicare and Medicaid Services (CMS), which he held until December 2011. An elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the IOM’s governing Council, and was a member of the IOM’s Global Health Board. He served on President Clinton's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. His body of work & contributions to the field of healthcare quality & safety are unparalleled, including two classics: the 1999 IOM report, ‘To Err is Human’ and the 2001 IOM report, ‘Crossing the Quality Chasm’. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II, the highest honor awarded by the UK to non-British individuals, in recognition of his work with the British National Health Service. To say that Dr. Berwick brings a seasoned perspective on the current state of our healthcare system and the challenges we face as a nation is, to put it mildly, an understatement. What distinguishes Dr. Berwick even more than his record of accomplishment or his brilliant mind is his tireless reminders of the ethical responsibility we have to attend to the health of the American public - especially for those of us who are providers, administrators, policy makers, health insurance companies, as well as pharmaceutical and device manufacturers. A relevant quote from one of Dr. Berwick’s recent articles underscores this responsibility;  “Fate will not create the new normal; choices will.”  In this episode, we’ll cover a range of topics, including the following:Dr. Berwick’s recent article, Choices for the “New Normal” - which is a call-to-action and a leadership roadmap outlining crucial choices in six critical domains that will play a significant role in determining the future of healthcare delivery.Inequality and Inequity -  the relative lack of social support services provided in the US as compared to other developed nations; which Dr. Berwick describes as “the most notable wake-up call”.An ethical reframing of the social determinants of health, described in his recent article, The Moral Determinants of Health; along with some shocking statistics on inequities related to poverty, hunger, homelessness, social isolation, and the uninsured.The tragic and insidious institutional racism that is embedded in our healthcare delivery system, as well as in other institutions such as our criminal justice system.A critical reframing of healthcare that Dr Berwick refers to as “What Matters to You Medicine”; which he suggests should disrupt and replace the legacy “What’s the Matter With You” paradigm.Dr. Berwick is one of the greatest healthcare humanitarians and transformational leaders of our era. He is the quintessential example of empathic ethical leadership. We need more leaders like this in and around healthcare. Dr. Berwick’s recent publications are seminal. In these articles, he courageously cuts to the stark realities of our healthcare system. He not only lays bare the truth for all to see but also outlines the crucial leadership choices of our time. And even beyond that, he lays out a pathway for positive action. Dr. Berwick writes, speaks & acts with intellectual integrity, academic rigor, and with a disarmingly insightful and honest authenticity - as well as with a powerful voice based in morals and compassion. At times, it’s unsettling, uncomfortable and inconvenient. Make no mistake about it, Dr. Berwick’s message is not an academic treatise. It is a call for ethical action.Until next time, Be safe and be well.Zeev E. Neuwirth, MD

"This is altruism in the political space it's saying we're going to take our political energies and move our government agenda toward justice, that would be to me that would be healing to me-- that would be healing and we're supposed to be healers." Dr Don Berwick is one of America's most well-known physicians, having served as former Administrator of the Centers for Medicare and Medicaid Services (CMS). Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement a not-for-profit organization. Join for this engaging conversation as Dr Ashley McClure interviews Dr Berwick about his personal reasons for engaging in climate solutions advocacy as a grandfather, citizen and physician leader. Dr Berwick shares about the healing power of solidarity, and how the responsibility of physicians has 'gotten bigger' since many went to medical school, but how our values as a profession compel engaging in advocating for social and climate justice because the policies determined by politics affect our patients' health more powerfully than our direct medical care. You can read his article: The Moral Determinants of Health here: https://jamanetwork.com/journals/jama/fullarticle/2767353?resultClick=1 If you live in California, please join us by visiting: www.climatehealthnow.org and introduce yourself and become a member by emailing: caclimatehealthnow@gmail.com If you don't live in California, find your state clinicians for climate action group here: https://medsocietiesforclimatehealth.org/about/affiliates/

Get an insight and understanding into the way the health care system works so you can receive safe and appropriate medical treatment.Gain health care literacy to navigate in today's society and ultimately as a consumer or patient, promote medicine's noble heritage of caring for people when they are vulnerable.Dr. Marty Makary, one of the nation's leading health care experts, shows how much of health care spending goes to things that have nothing to do with health and what you can do about it.Drawing from on-the-ground stories, his research, and his own experience, we explore price-gouging, middlemen, and a series of elusive money games in need of a serious shake-up.Dr. Makary's work, including his book The Price We Pay, offers a roadmap for everyday civilians and business leader to get a better deal on their health care, and profiles the disruptors who are innovating medical care.The movement to restore medicine to its mission is alive and well - a mission that can rebuild the public trust and save countries from the crushing cost of health care.ABOUT DR. MARTY MAKARYDr. Makary is a New York Times bestselling author, Johns Hopkins surgeon and Professor of Health Policy.His book The Price We Pay takes on the high cost of health care and reveals how individuals and businesses can get a better deal on their health care.Described by Steve Forbes as “a must-read for every American” and a “deep dive into the real issues driving up the cost of health care” by Dr. Don Berwick, The Price We Pay is the “The Big Short” of American Medicine.Makary is a frequent medical guest on NBC and FOX News and a leading voice for physicians, writing for the Wall Street Journal and USA today.Dr. Makary is a gastrointestinal surgeon and serves jointly as on the faculty of the Johns Hopkins School of Public Health.He is an advocate for the re-design of medical care and studies innovations that improve health, reduce waste, and address the root causes of illness.He currently serves as executive director of Improving Wisely, a national physician collaboration to reduce unnecessary medical care and is the founder of Restoring Medicine, an advocacy effort to help people who can't afford their medical bills.Dr. Makary has been elected to the National Academy of Medicine and named one of America's 20 most influential people in health care by Health Leaders magazine.IN THIS EPISODE WE DISCUSS:The increase in medical complexities and sophistication and the increase of hyper-specialisations and sub-specialisations.The Crisis of Medical AppropriatenessWe have the most medicalised generation in human history. At the same time we have the most sickRevolutionising Medicine through the medical education system.Medical error, if it were a disease, would rank as the third leading cause of disease in the United States.Anti-microbial resistance is a public health crisis.The medical system taking advantage of the elderly.Healthy Skepticism & Trust.The true heritage and purpose of hospitals and doctors.Price Gouging Medicinal ServicesHospitals Suing PatientsDoctors Nudging PatientsAsk your doctor about their individual C-Section RatesThe importance of vaginal deliveryIt is not doctors who are responsible for this.+ MoreHELP SUPPORT THIS SHOW!Starting and growing a podcast requires a lot of time, enerSupport the show (https://www.paypal.com/donate/?token=y_kaqK9wLLV2hJsCYl7mFwBcEPNGyuzRIZuHMW5dxoRj2vyQJPvcov1xOO9ZUsn_lG-6Km&country.x=AU&locale.x=AU)

WBUR's Morning Edition spoke to Don Berwick, a senior fellow at the Institute for Health Care Improvement in Boston, who is also a commission member.

Don Berwick, MD, MPP, of the Institute for Healthcare Improvement, discusses choices societies and the medical profession can make to improve health care and reduce inequities as we move out of the acute phase of the coronavirus pandemic.

Don Berwick, MD, MPP, of the Institute for Healthcare Improvement, discusses choices societies and the medical profession can make to improve health care and reduce inequities as we move out of the acute phase of the coronavirus pandemic.

Don Berwick has a global perspective on healthcare, yet he still retains a focus on the individual patient, firmly believing that the future of healthcare relies on improving the quality of healthcare. In this episode we discuss the gaps in global healthcare, why current healthcare quality is frustrating, quality in healthcare needing to be a local issue, technologies and approaches that can improve future healthcare, and whether the healthcare of employees an employer’s responsibility.

RCGP Vice Chair for Membership, Professor Mike Holmes talks to RCGP Clinical Support Fellow for Collaborative General Practice, Dr Alka Patel about motivations in general practice, Don Berwick’s Triple Aim (https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.3.759) , which includes, improving the experience of care for patients, improve healthcare outcomes and reducing costs. They also support the need for a fourth aim, the Quadruple Aim, which focuses on improving the experience of delivery of care.

This is an exciting interview with Dr. Marty Makary, a New York Times bestselling author and Johns Hopkins surgeon, who talks about what he calls the "hybrid specialist" and the importance of non-traditional careers in medicine. Get a free audiobook along with a free 30-day Audible trial membership at www.audibletrial.com/TUMS Dr. Marty Makary Dr. Makary is a New York Times bestselling author and Johns Hopkins general surgeon and Professor of Health Policy. His book The Price We Pay (book trailer below) takes on surprise medical bills and reveals how individuals and businesses can lower their health care costs. Described as “a must-read for every American” by Steve Forbes and a “deep dive into the real issues driving up the cost of health care” by Dr. Don Berwick, The Price We Pay is the “The Big Short” of American Medicine. Makary is a frequent medical guest on NBC and FOX News and a leading voice for physicians, writing for the Wall Street Journal and USA Today. Dr. Makary serves as executive director of Improving Wisely, a national physician collaboration to reduce unnecessary medical care and lower health care costs.  He is also the founder of Restoring Medicine, an advocacy effort to help people who can’t afford their medical bills. His current research focuses on the appropriateness of medical care, administrative waste, price and quality transparency, and the impact of health care costs on low-income populations. Dr. Makary was the lead author of the original articles on the Surgical Checklist and later served in leadership with Atul Gawande on the World Health Organization Surgery Checklist project. Makary has published more than 250 scientific articles, including articles on payment reform, vulnerable populations, and opioid prescribing guidelines. He is also an advocate for treating medical conditions when possible with healthy foods and lifestyle medicine.  Dr. Makary has been elected to the National Academy of Medicine and named one of America’s 20 most influential people in health care by Health Leaders magazine. Lastly, his book Unaccountable was adapted for television into the hit medical series The Resident. His newest book, The Price We Pay, now available for order online and in stores on September 10, 2019, tells the stories of health care’s disruptive innovators and the new movement to restore medicine to its mission.

This week, your hosts Steve Lowry and Yvonne Godfrey interview Laura Shamp of Shamp, Jordan, and Woodward Trial Attorneys (https://www.sjwtriallaw.com).     Remember to rate and review GTP in iTunes: Click Here To Rate and Review     Case Details:   Laura Shamp obtained a verdict of $11 million dollars for an ex-smoker in a case against Philip Morris USA Inc. The jury awarded $3.2 million in punitive damages after finding that the tobacco company had committed fraud and intentionally misrepresented the dangers of smoking to consumers. (Jordan v. Philip Morris Tobacco Co.) The verdict was affirmed on appeal.   Click Here to Read/Download the Complete Trial Documents     Guest Bio:     Laura is a plaintiff's trial lawyer practicing principally in the areas of medical negligence, product liability and catastrophic injury in both state and federal court.     Laura graduated with honors from the Harvard Law School and thereafter clerked for the Honorable Robert H. Hall at the United States District Court for the Northern District of Georgia. In 1996 Laura formed her own firm where she focused on complex commercial litigation, medical negligence, and product liability, almost exclusively on behalf of plaintiffs. In 2004, she returned to Harvard to study patient safety and medical errors under Don Berwick and Lucian Leape, leaders in the field of patient safety, and in 2005 obtained a Masters Degree in Public Health from the Harvard School of Public Health. Laura is dedicated to working to try and improve the quality of medical care in Georgia and serves on committees that review legislation to try and address issues of medical error and patient safety.     Read Full Bio     Show Sponsors     Legal Technology Services - LTSatlanta.com     Forge Consulting - ForgeConsulting.com     Harris, Lowry, and Manton - hlmlawfirm.com     Free Resources:   Stages Of A Jury Trial - Part 1 Stages Of A Jury Trial - Part 2  

Don Berwick and Maureen Bisognano lived and breathed different sides of the healthcare industry before starting the Institute for Healthcare Improvement (IHI) – a $60 million not-for-profit organization with 150 employees across more than 70 countries that drives results in health and healthcare improvement worldwide.What most people don’t know is that Don and Maureen hatched the idea for IHI while working together – Don as a research and quality guide physician and pediatrician, and Maureen as a nurse and hospital CEO. They would discuss each other’s work problems in-depth from very different perspectives, but in a way that helped facilitate actionable improvements.In the mid-1980s, Don, Maureen, and a larger group started meeting people from outside healthcare who understood how to improve things systematically, without having to rely on incentives. They began teaching people around them what they were learning from different industries, and quickly understood that it’s unfair to send a “changed” person back to an unchanged organization. It became quickly apparent to them that it would take a new breed of leaders, as well as people on the front lines, to create long-term change in healthcare.IHI was born with an aggressive goal, literally written on the back of an envelope. Don and Maureen set out to solve six problems in US healthcare, and engaged 2,000 hospitals and saved 100,000 lives[to date?]. With the guidance of their children who fortunately had political campaign experience, they started their own campaign to change healthcare. Originally supported by the John. A. Hartford Foundation, the IHI became a reality in 1991 – and the rest is history.In this episode of Healthcare is Hard: A Podcast for Insiders, Don and Maureen draw upon their extensive industry experience to cover a number of pressing topics with host Keith Figlioli, including: Achieving the “Triple Aim” in Healthcare – the Triple Aim is the trifecta of achieving better care for individuals, better health outcomes, and lower per capita costs. Don and Maureen saw this happening in other industries and in healthcare markets across the world. They talk about how they took this aim and created a leadership alliance within IHI where 40 organizations came together with a common goal of achieving the Triple Aim. Healthcare’s Defects in Areas that Other Industries Don’t Tolerate – among these areas are safety issues, effectiveness, reliability, patient focus, coordination, waste and delay, and most importantly, equity. Don and Maureen discuss how they understood that people were aware of this in the mid-1980s, but no one had a way to deal with it directly at the time. The Will for Change in Healthcare – who needs this inspiration and how can the will for change be built? As Maureen explains, painting the story of a patient can help build such inspiration, especially for senior-level executives who may be a little further removed. It doesn’t matter whether it’s a good or bad story; it’s about providing a background for these ideas to grow.The Next Big Things in Healthcare – telemedicine, telehealth, global budgeting, and healthcare for millennials are just some of the innovations Don and Maureen are excited about. To hear Don Berwick and Maureen Bisognano talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Our our next guest, is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign, a nationwide initiative to reduce mortality in America. The post Episode 5: Dr. Don Berwick brings a global perspective to fixing American healthcare appeared first on Fixing Healthcare Podcast.

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Don Berwick, President Emeritus of the Institute for Healthcare Improvement and former CMS Administrator who oversaw the launch of the Affordable Care Act. He talks about inherent political challenges in American health care, the need for providers to get active politically, and the promise of real innovations in the health system coming from outside the industry. The post The Political Challenges in American Health Reform: Former CMS Administrator Don Berwick on the Need for Clinician Activism appeared first on Healthy Communities Online.

As the NHS turns 70, what state is it in? What will it look like in another 70 years? Helen McKenna talks about how the NHS is changing with Don Berwick, International Visiting Fellow at The King's Fund, Ceinwen Giles, Founding Director at Shine Cancer Support and Siva Anandaciva, Chief Analyst at The King's Fund. Related reading: The NHS at 70 The public and the NHS: what's the deal? How can the NHS work effectively with patients and the public?

Don Berwick, president emeritus of the Institute of Healthcare Improvement, and former Administrator of the Centers for Medicare and Medicaid Services. In this conversation he discusses how he went from being a paediatrician to running Medicare for Obama, how we can create headroom in stressed systems, and breaking the rules to make things better for patients and staff. Quality improvement series:

In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Don Berwick – widely recognized as one of the most influential & impactful healthcare leaders of our time. ...

In this episode of Creating a New Healthcare, Dr. Zeev Neuwirth interviews Don Berwick - widely recognized as one of the most influential & impactful healthcare leaders of our time. His foundational contributions to the quality, safety & reliability movement in healthcare - beginning in the late 1980’s - have led to profound reductions in medical errors in the United States and abroad.  Among his numerous contributions, Don co-founded and led the Institute for Healthcare Improvement for 18 years - an organization that has shifted the landscape of healthcare delivery; catalyzed the healthcare quality movement; and whose overall positive impact on domestic & global healthcare is almost immeasurable.  He has served numerous key leadership roles such as in the Institute of Medicine (IOM) & the Center for Medicare & Medicaid Services; and has authored and co-authored numerous landmark publications such as the IOM's 'To Err is Human' and ‘Crossing the Quality Chasm’.  In this interview, Dr. Berwick provides us with detailed principles for the creation of a “third era of medicine” - an era in which we can more fully realize the goals of the triple aim - better medical care for patients, better health & health outcomes, and lower costs of care; and in which we can support our physicians & other providers of care in performing clinical work that is meaningful and sustainable.  Dr. Berwick is an unparalleled physician-scientist-scholar, and a humanitarian leader whose integrity, vision & insights hold practical wisdom and guidance for any leader contemplating the future of healthcare delivery; and whose compelling stories provide us with directed purpose, inspiration & hope. 

In our October 2017 podcast, his first session with Tripp, Joshua Macht, Executive Vice President, Product Innovation, and Group Publisher of the Harvard Business Review (HBR) Group, shares his goal of how to recast management ideas to those new to management, with a focus on innovation, strategy, and core principles of leadership.    Long before he traveled to Gothenberg, Sweden in 2016 to attend an international healthcare conference, Josh was aware of Dr. Deming as an "old friend" of management, much the same as he assessed Peter Drucker.   Yet, upon witnessing Dr. Don Berwick conduct the classic "red bead experiment," he quickly joined the ranks of those deeply struck by the revelation that the performance of willing workers in any organization is largely governed by the system itself, far more than the performance of the workers taken separately.   So began his desire to review a series of videos and books about Dr. Deming, leading to his HBR article in 2016, a 6-page tribute to Dr. Deming, "The management thinker we should never have forgotten." In parallel, he also wrote about Dr. Deming in a 2016 article for the Boston Globe. Interview highlights include:  What's happening at the HBR – expansion, podcasts, innovation, new and expanded audience Thinking systemically Needs of young professionals New HBR product launched in India, ASCEND Lasting impressions of the red bead experiment, including whimsical measures of quality Now, more than ever, the need for a refresher on Dr. Deming Layoffs and the erosion of trust How good people fall prey to a bad system Dr. Deming's world of human nature Efforts that obliterate trust Barriers to success How workers treat each other in ways that are counter-productive Taylorism vs. Deming management HBR and the Watertown (Massachusetts) Arsenal, an early site of Taylorism Organizational undercurrents of “Us” vs “Them” Passion for innovation and a role as a digital renegade The need to be useful and feel valued The joy of learning

Date: January 26, 2017 Featuring: Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, IHI What are your plans to improve patient safety in 2017? Are they hospital-specific or do they extend across the continuum of care? Are they proactive or reactive? Is the work part of an overall system of safety, knitted together by an engaged staff, a thriving safety culture, and continuous learning? However you answer these questions, IHI is heading into the new year more determined than ever to help hospitals and health systems make greater gains in reducing harm to patients, anchored by a renewed focus and new framing.  ​ Who better to explain all this than IHI President and CEO, Derek Feeley, and IHI President Emeritus, Don Berwick. Derek was eager to talk about six principles that organizations can use to guide their safety work going forward. Among them: Shifting from a mindset of preventing things from going wrong to making as many things as possible go right; and inviting patients and families into the process of co-producing safety as opposed to keeping their input at arm’s length.   What are some ways to translate this deepening perspective into action? How do you stay focused on patient safety when so many other performance expectations in health care demand your attention?  ​

Date: June 3, 2010 Featuring: Carol Beasley, Director, Institute for Healthcare Improvement Tom Nolan, PhD, Statistician and Co-Founder, Associates in Process Improvement; Senior Fellow, IHI Laura K. Landy, President and CEO, Fannie E. Rippel Foundation   What happens when health care leaders from different regions in the country get in the same room and talk about their efforts to redesign patient care? Among other things, there’s often a sense of relief that, across state lines and political affiliations, there’s a shared concern for improving people’s health, improving their health care experiences, and lowering the costs of care. Washington may be able to bring about broad reforms for health care, but communities of all shapes and sizes are increasingly being looked to for the day-to-day solutions and innovations that will “bend the cost curve” and offer new, humane models for the future.   Fresh off a meeting in the Washington, DC, focused on building low-cost, high-quality health care regions in America, WIHI hosts a timely discussion about what 14 “Hospital Referral Regions” are starting to figure out about their quality data, their cost data, and the way forward. John Hogan is at the nexus of important changes taking place in Tallahassee, Florida; Tom Nolan, Carol Beasley, and Laura Landy are part of a group of national leaders (others include Don Berwick, Elliott Fisher, Atul Gawande, and Mark McClellan) who’ve been digging for the data and the ingenuity across the country that can be harnessed, shared, and turned into blueprints for change the nation so badly needs.   Grab your competitor from across town, or find a collaborator, or notify anyone you think is a stakeholder in your community looking for fresh thinking about costs, quality, and the health of the population. You’re sure to walk away with some new ideas from this WIHI.

Date: February 18, 2016 Featuring:  Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement Jessica Berwick, MD, MPH, Internist, Beth Israel Deaconess Medical  Center (Boston) What is the “true north” for the health care quality improvement movement? What are the questions leaders and champions of quality and safety initiatives must periodically ask themselves as a natural part of the process of seeking dramatic change? If you’re IHI’s founder and President Emeritus and Senior Fellow, Don Berwick, the questions, and the answers, are often moral ones. Don is known for reminding improvers at critical moments that whatever they’re working hard on must, finally, come back to the patients themselves and principles of service and healing relationships. When the vision starts to go blurry in a miasma of metrics and measures and monitoring, Don argues, we lose our way. In December, Don took to the podium at IHI’s National Forum in Orlando and delivered a keynote calling for what he labeled a “moral era” for the health care quality improvement movement — Era Three. In the keynote, Don outlined five developments from earlier eras that he believes have started to obscure the improvement movement’s sense of purpose: excessive measurement; complex (pay for performance) incentives; preoccupation with money; and professional prerogative. Increasing attention to five activities in Era Three, broadly defined, can help: improvement science; transparency; civility; listening (to patients, family members, and staff); and rejecting greed. During this WIHI, Don was joined by his daughter, Dr. Jessica Berwick, an internist at Beth Israel Deaconess Medical Center in Boston, who shared the perspective of a relatively new physician navigating many of the competing forces Don describes in his speech.

Date: October 12, 2012 Featuring: Donald M. Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare & Medicaid Services Chris Jennings, President, Jennings Policy Strategies (Washington, DC); Former Senior Health Care Advisor (Domestic Policy & National Economic Councils) to President Bill Clinton We’re just weeks out from the November elections in the US and, depending on the outcome, health care reforms championed by the Obama administration will either continue unabated or possibly face some serious challenges — from a new President or a differently configured Congress. In the midst of this uncertainty, numerous individuals are keeping a close eye on the national policies and initiatives that have done the most of late to accelerate new payment schemes and the redesign of health care delivery, as well as expand insurance coverage.IHI has two programs this fall to help you navigate this election cycle with a clarity of purpose that health care improvement requires more than ever in these tumultuous times: a WIHI with Dr. Don Berwick and Chris Jennings on October 12 and, on November 8, Out of the Blocks, an in-person, one-day conference in Washington, DC, featuring post-election analysis from Sen. Tom Daschle and Sen. Bill Frist, IHI President and CEO Maureen Bisognano, Virginia Mason CEO Gary Kaplan, and moderated by Don Berwick and NBC’s Nancy Snyderman, MD.Because health care reform has become such a political flash point, it’s sometimes hard to find the “through line” for the improvement community in particular and the country as a whole. But Don Berwick says this is precisely what needs to happen. In this WIHI, he explains what “continuity of purpose” might entail in order to stay focused on a robust agenda that includes much greater attention to improving care across the continuum, reducing costs, and helping people and communities lead healthier lives. You can also count on Chris Jennings to summon his 25 years of experience as a health policy strategist to provide the freshest and most sanguine ways to think about reinventing health care in the US, even when political winds can, and often do, change directions.Madge Kaplan hosts this special pre-election WIHI... Whether you’re steeped in forming an accountable care organization or patient-centered medical home, innovating to improve the patient experience, hard at work on reducing avoidable readmissions, or engaged in any combination of these efforts and more.

Date: January 12, 2017   Featuring: Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement Elizabeth A. McGlynn, PhD, Vice President, Kaiser Permanente Research A little over 13 years ago, a team of researchers reported in the New England Journal of Medicine that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. The study, by then RAND Corporation health care analyst and lead author Beth McGlynn, acted as a call to action, challenging providers to do much, much better at incorporating evidence-based practices.   Has the situation improved? Not nearly enough, according to a study first published online in 2016 in the Journal of the American Medical Association’s JAMA Internal Medicine. Why that's the case is the focus of the January 12 WIHI: Improving the Rate of Recommended Care. In the spirit of January, we looked back and looked ahead with Beth McGlynn and Don Berwick, two health care luminaries who have devoted their careers to the uptick of evidence-based care and improving quality in health care. 

Date: February 9, 2012 Featuring: Donald Berwick, MD, MPP, Former Administrator, Centers for Medicare & Medicaid Services; Former President and CEO, Institute for Healthcare Improvement (IHI) Gerard M. Shea, Assistant to the President for External Affairs, American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) Imagine this. You’re driving or walking or maybe even bicycling by your local hospital and you notice a big sign over the entrance that you’ve never seen before. Here’s what it says: “This hospital saved 5 Million Dollars in 2011 by improving patient care and reducing unnecessary procedures. We have returned the money to local employers, local unions, and the state.” Sound preposterous? Hopefully not, because this is the kind of bold commitment and public declaration that Don Berwick and Gerry Shea would like everyone in health care to start thinking about, seriously. It’s just that urgent, they say, and they’ll explain why.WIHI host Madge Kaplan welcomes Berwick and Shea to the program, fresh off Dr. Berwick’s 18 months implementing change at the Centers for Medicare & Medicaid Services (CMS), and building on Gerry Shea’s extensive knowledge of quality improvement and the promise of better care and lower health care costs for working Americans. The problem is, we’re nowhere near there yet, especially where costs are concerned, and both Berwick and Shea believe one of the reasons is that there’s still too much of a disconnect between what better use of health care services and improvement initiatives can achieve, and what health care payers (Medicare and Medicaid, employers, individuals, etc.) are able to reap in return. As Berwick puts it, “Payers aren’t seeing it yet,” and this means that anyone footing the bill, and that’s pretty much all of us, continues to be squeezed in ways that society can’t afford.So, what can dedicated legions of health professionals, already deeply immersed in improvement work, do differently or better? Berwick started to lay this out on December 7, 2011, at IHI’s National Forum. Berwick and Shea both say that one area ripe for review is the conceptual and often actual way in which health care organizations separate their quality and “lean” strategies, when these should be one and the same. Implementing greater efficiencies has everything to do with safety and better care, the two say. Getting this right would speed things up and generate greater savings. The question then becomes, where should the money go?

In this episode of Yoga | Birth | Babies, I speak OB/GYN, Dr. Neel Shah.  Dr Shah has been recognized for his work to help reduced unnecessary caesarean births in our country.  In this podcast, we explore why in the past 40 years, cesareans have increased 500% without seeing better results for moms and babies!  He also explains where you give birth can be one of the biggest factors in the risk of having a cesarean birth.  This episode is so important for any women who may become pregnant, expectant mothers and partners.  Please enjoy! In this episode: How Dr Shah got started on this path to exploring the caesarean rate in our country. The increased cesarean rate in the US since the 1970’s and what accounts for this. Are we seeing better results for mothers and babies with this massive increase in c-sections? Recognizing there is a place of caesarean births what is the sweet spot for best outcomes with cesarean births? World Heatlh Organization (WHO) recommends caesarean rates should be between 10-15%. Risks of a cesarean surgery for both mother and baby, both short and long term. Are the risks of a c-section well explained to mother ahead of timed? Minimizing the possibility of an unnecessary c-section The role of the care provider in the likelihood of a mother having a caesarean. What role does the hospital play in the likelihood of a mother having a caesarean ? The correlation between the hospital and the c section rate. Exploring an article authored by Dr Shah-  “In the United States it appears that about half the cesareans we do may be avoidable in hindsight. Getting to perfect may be hard but there is tremendous room for improvement.”  What might be some of the red flags that you see in hindsight that may have been avoidable? Are hospitals are always the safest place to give birth? What we can learn from other countries who have created a supportive system to offer home birth. The role of midwives in US birth. About Dr Shah: Dr. Neel Shah, MD, MPP is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, and Director of the Delivery Decisions Initiative at Harvard’s Ariadne Labs. As an obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston, Dr. Shah cares for patients during critical life moments that range from surgery to primary care to childbirth. As a scientist and social entrepreneur, he is a globally recognized expert in designing, testing, and spreading solutions that improve healthcare. Dr. Shah is listed among the “40 smartest people in health care” by the Becker’s Hospital Review, and has been profiled by the New York Times, CNN, and other outlets. He is senior author of the book Understanding Value-Based Healthcare (McGraw-Hill), which Don Berwick has called “an instant classic” and Atul Gawande called “a masterful primer for all clinicians.” Prior to joining the Harvard faculty, Dr. Shah founded Costs of Care, a global NGO that curates insights from clinicians to help delivery systems provide better care. In 2017, Dr. Shah co-founded the March for Moms Association, a coalition of 20 leading organizations, to increase public and private investment in the wellbeing of mothers. Follow Dr. Shah on Twitter: @Neel_Shah on in Learn more about your ad choices. Visit megaphone.fm/adchoices

State Sen. Harriette Chandler of Worcester and state Rep. William “Smitty” Pignatelli of Lenox have introduced bills in the Legislature to create a new practitioner called “dental therapists,” a highly trained dental hygienist who can perform basic procedures such as fillings, simple extractions of non-impacted teeth, and x-ray readings. Dr. Ray Martin, president of the dental society and a dentist with a private practice in Mansfield, joined The Codcast to talk about the measure along with One-time gubernatorial candidate Dr. Don Berwick, a pediatrician who was administrator for the Centers for Medicare and Medicaid Services in the Obama administration.

"Those who do not study the past are doomed to repeat it." At the International Forum on Quality and Safety in Healthcare, in Gothenburg in April, Don Berwick spoke on the scientific foundations of improvement. This is the full audio of his talk. Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. On twitter, he's @donberwick.

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is. Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Watch out for the extended versions of these recordings, up next Friday.

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is. Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Watch out for the extended versions of these recordings, up next Friday.

Martha Coakley's Scott Brown apology tour continues--and while Coakley and her rivals Steve Grossman and Don Berwick all identify with the term "progressive," its meaning is nebulous at best.

Interview with Don Berwick, MD, author of A New Frontier in Patient Safety

This is a rebroadcast of the context piece offered to the press prior to the release of the proposed rule on Accountable Care Organizations, published in the Federal Register, Thursday, March 31st, 2011. The call begins with Secretary Kathleen Sebelius, followed by Dr. Don Berwick, Administrator, of CMS, with participation from FTC, DOY, and Treasury. A very informative overview of what's inside the regs!

Death and taxes in 2010; more on new diagnostic tests for tuberculosis; comments about health care reform in 2009 by Michael Porter, MBA, PhD, and Don Berwick, MD, MPP from a recent Brookings Institution forum; plus a summary of all the article in this week's issue.

Guest: Donald Berwick, MD, MPP Host: Bill Rutenberg, MD What are the best ways to bring safety to the hospital setting? What type of support systems are available to doctors when errors occur? Dr. Don Berwick, President and CEO of the Institute for Healthcare Improvement shares thoughts on these topics and more in an interesting interview with host Dr. Bill Rutenberg.

Guest: Donald Berwick, MD, MPP Host: Bill Rutenberg, MD How has our healthcare system gotten to its current fragmented state? Where are the opportunities to make the greatest impacts to improve the healthcare system? Join host, Dr. Bill Rutenberg in talking with healthcare expert Dr. Don Berwick, who is President and CEO of the Institute for Healthcare Improvement.