It’s our job to redesign healthcare, contain costs

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 4 May 2010




(2010), "It’s our job to redesign healthcare, contain costs", Leadership in Health Services, Vol. 23 No. 2.



Emerald Group Publishing Limited

Copyright © 2010, Emerald Group Publishing Limited

It’s our job to redesign healthcare, contain costs

Article Type: News and views From: Leadership in Health Services, Volume 23, Issue 2

Keywords: Healthcare improvement, Healthcare reform, Quality improvement

Donald M. Berwick, MD, president and CEO, Institute for Healthcare Improvement (IHI), gave a nod of approval to healthcare reform legislation being negotiated in Congress. “We ought to pass that law”, he said during his keynote address at the twenty-first annual IHI Forum in Orlando, FL, USA which drew more than 6,500 attendees in person and via satellite.

Yet Berwick acknowledged: “Congress won’t lead us to better health care”, referring to the draft legislation’s focus on expanding insurance coverage rather than healthcare reform. The job of containing costs and improving quality resides with hospitals, physicians, and other healthcare stakeholders, he said. “Healthcare redesign is not Washington’s job”, he said. “It’s our job. It won’t come from what they do, but what we do”.

He celebrated the progress that has already been made, highlighting significant improvements by a dozen or so providers. For instance, Palmetto Hospital has cut mortality rates in half, and Denver Health has saved more than $30 million in three years using Lean production principles.

However, to ensure a viable healthcare system for future generations, stakeholders need to “think out of the building” and work across the continuum to contain overall healthcare costs in their communities – without harming quality.

As an example, Berwick pointed to Cedar Rapids, Iowa, where Medicare costs are 27 percent lower than the US average and quality measures are comparable to other high-performing areas. Despite having two competing hospitals – Mercy Medical Center and St Luke’s Hospital – and a freestanding physician base, Cedar Rapids has developed a cooperative approach to clinical program development. There is only one cardiac surgery program in town, and the two hospitals are close to agreeing to only one cancer center.

Referencing research by Nobel prize-winning economist Elinor Ostrom, Berwick outlined a seven-step process for containing healthcare costs across communities, or what he referred to as “commons”:

  1. 1.

    define your healthcare commons;

  2. 2.

    set aims: reduce total resource consumption by 10 percent over three years;

  3. 3.

    develop your institutional structures for local rule-making;

  4. 4.

    develop monitors of use for the commons;

  5. 5.

    create consequences for rule-breaking;

  6. 6.

    identify and address conflicts early; and

  7. 7.

    offer and expect civility.

Challenging IHI attendees to action, Berwick predicted “that real reform will remain zero unless action is taken close to home”.

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