Profiles in Improvement: Leonard L. Berry, PhD, MBA, IHI Senior Fellow

Publication Date: December 15, 2014


Leonard (Len) L. Berry, PhD, MBA
IHI Senior Fellow
University Distinguished Professor of Marketing, Regents Professor, and M.B. Zale Chair in Retailing and Marketing Leadership
Mays Business School at Texas A&M University


Q:  What has been your career path leading up to IHI?

I’m a marketing professor at Texas A&M in College Station, Texas, a city where I have strong roots — my wife is the mayor. My career-long research specialty has been the marketing of services. To really do justice to this topic I have to focus on quality, because you can’t market a poor-quality service. You can’t price it, you can’t advertise it; who wants to buy a poor-quality service? This perspective, many years ago, led me into the study of service quality.

I have had really good collaborators in my research at Texas A&M, several colleagues I’ve worked closely with on multiple studies over the years, looking at service quality in a variety of industries — retail, hospitality, financial services, insurance, and others.

Then 14 years ago I had a sabbatical and wanted to do something really different. So I went to Mayo Clinic, and at Mayo I got hooked on health care. I was fascinated by the complexity of it and the opportunity for service improvement in health care. I loved being at Mayo Clinic, learned a great deal, and made friends I’m still close to. My time at Mayo also resulted in my co-authored book, Management Lessons from Mayo Clinic, which has been translated into numerous languages.

The sabbatical did exactly what a sabbatical is supposed to do: inspire you, help you find a new mountain to climb. I was inspired at Mayo by the importance of the topic, the service-related issues I found. I realized this is my area, my background; I have ideas about how to address these issues and maybe I can help in some way. So I returned to Texas A&M, determined to devote the rest of my career to the study of health care services. And I’ve been true to that.

Mayo was my starting point but I broadened my perspective early on, began visiting a lot of other health systems, because I knew that Mayo Clinic-style health care is unique. Had I stopped at Mayo, I would have had unrealistic perceptions.

That’s what I’ve been doing for 14 years: health care-related research and writing; publishing my studies on various aspects of health care service. I did a large field study in 2011 where I went to Wisconsin and spent a month each at Bellin Health Care Systems [Green Bay], Gundersen Health System [La Crosse], and ThedaCare Community Health System [Appleton]. And that was a direct result of talking to Maureen [Bisognano, IHI President Emerita and Senior Fellow]; I told her my goals for the research and she said, “Len, you should go to Wisconsin.” And that’s what I did.

I’ve known IHI since the beginning of my health care journey. When I was at Mayo Clinic I kept hearing the name Don Berwick [IHI President Emeritus and Senior Fellow], so I decided I had to meet him. While at Texas A&M, I came to IHI for a day and met Don. He was very gracious, spent a couple of hours with me, and introduced me to Maureen [Bisognano] and others.

The next year when school was out in May I came back to IHI for a week to learn more and get an overview of the organization. On the last day, Maureen asked me at a senior management meeting to give my impressions, which I did. And I’ve stayed close to IHI since then. I go to IHI's National Forum every year and I’m a presenter most years. I’ve also joined other IHI programs.

So I have a long history with IHI. Last year I was ready to go into the field again. I had been to Mayo and the Wisconsin centers, and I was ready for the next big thing, so I called Maureen for her advice. She mentioned the IHI Senior Fellows and explained the role, the opportunity, and said I should apply. So I did. I owe so much to Maureen and Don. They have had a big influence on my career.

Q: What are you focusing on in your work as an IHI Senior Fellow?

I had several research projects in mind for my fellowship year — all really interesting to me. But I picked one that felt right; I sensed it was most important. The topic is: How can we improve the service experience of cancer patients and their families?

Cancer touches all of us, families and households, one way or another, directly or indirectly. You can’t find anybody who doesn’t know somebody they really care about who has cancer or has died of cancer.

We’ve made a lot of progress with the clinical side of cancer care; not so much with the service part. I felt I could bring some fresh eyes to an old problem, and hopefully bring some new ideas that could help a lot of people.

I’m focusing on adults across the whole experience of cancer — from diagnosis through treatment, survivorship, and end-of-life care. So it’s a large and complex study.

It’s going well so far. I’ve interviewed many clinicians, patients, family members, and administrators, and am now completing a series of site visits to cancer centers across the United States. This summer when I’m back in Texas, with my interviews done and my data gathered, I’ll be ready to start writing for publication and presenting my findings and conclusions.

Q: What are some of the challenges you see ahead, in health care and for IHI?

I think the biggest challenge for IHI is that it has such a big heart. What I mean by that is, it’s an extremely generous, caring organization, with a prestigious reputation, working in health care and health — a field in which the stakes are very high for all the people involved. That combination of a generous culture with a reputation for excellence, and an industry under stress, brings many people to the door asking for help. And no matter how focused and strategic the organization is, it winds up inevitably getting overloaded and doing too much.

So I see IHI’s biggest challenge as staying focused on its core mission so it continues to do excellent work, even with so many hands outstretched asking for help. Maureen and Derek [Feeley, IHI Executive Vice President] are excellent leaders and they certainly understand this. But it’s just so hard because people coming to IHI are asking for help with something that’s very, very important to them, maybe even vital to their livelihood, their survival as an organization, as a health system, a community. How do you turn them away?

I applaud the generous, caring nature of the IHI culture — I wouldn’t be here if I didn’t align with it and feel the same way. There’s a tension; you want to give, to help as much as you can, but you’re running an organization so you’ve got staff, overhead, expenses… you have to keep the organization sustainable.

I think IHI’s moving in the right direction with the Leadership Alliance and the Guiding Coalition. And I think IHI is approaching the Guiding Coalition the right way: as the convener, not the sole sponsor. You’ve brought this group together and helped launch the 100 Million Healthier Lives initiative. And IHI will continue to be involved, coordinating progress, hosting meetings, keeping lines of communication open among the partners.

IHI has had an unbelievable impact in its history for how small it is. But I think there’s growing recognition that the path ahead, the broad mission to create health, is a coalition-type of challenge. It can’t be an IHI-only campaign. This isn’t something new for IHI ​— I think back on the stage full of health care leaders that IHI convened when it announced the 100,000 Lives Campaign [during an IHI National Forum keynote presentation].

There’s an increasing appreciation that the way to go is through partnerships. I think building partnerships is the key for IHI’s future. It has been in the past, and it’ll be even more so in the future. These problems are worldwide, they’re very complex, and they’re hard to solve. You need smart people in the room together representing different organizations, different interests, who are all pulling the wagon. It can’t be just IHI.

Q: What are you most excited about?

I’m excited about the study I’m doing, and it’s something I know I could not have done back at Texas A&M, for a couple of reasons. One big reason is IHI: being affiliated with IHI opens doors that I would not have been able to open had I tried from the Business School at Texas A&M. I’m a little odd anyway, studying the service of cancer care as a marketing professor. But by making the contacts and requests from my IHI email address, with my IHI Senior Fellow title, I’ve had many more Yes’s than No’s. If I had approached the people and the organizations I want to talk to and visit from my role at Texas A&M, I think I would have had many more No’s than Yes’s. It’s also my relationships with IHI management and staff who have advised me on my study and who’ve put me in touch with valuable contacts.

The cancer topic is too sensitive — an "eggshell" topic. And the doctors I’m seeking out, prominent oncologists around the country, are so incredibly busy. But they’ve been willing to give me a half-hour interview — half an hour most of them don’t have.  

Overall, I see signs of growing interest in health care improvement; progress in public awareness, in recognition by the medical community that improvement work is important. There’s growing literature on health quality service topics, papers being published, and people reading these papers. There’s a whole industry of consulting companies helping hospitals improve their service quality. And, of course, payment systems are changing, including the shift to making service quality and cost part of the formula for reimbursement. So, all of that is positive.

I’m hopeful about the work in health care quality improvement. It’s a journey without a finish line; I think we all recognize that. We’ll never say, “We’re done, we’ve accomplished it, we’ve succeeded.” But we simply have to go forward every day, make progress every day. We can’t solve all these problems, but we can make progress. If I didn’t think so I wouldn’t be here.

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