WIHI: Morality Matters: How to Reset the Mission of Quality Improvement

Date: February 18, 2016


  •  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.


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