Don Berwick on leadership, greed + a promising youth movement
The Father of Disruptive Innovation
I first met Don Berwick, M.D. in 2005 as I was planning one of the first Regional Health Information Organizations, now known as Health Information Exchanges. I asked if I could come to D.C. to assist him. His response was NO, stay where you are and organize your own Health Information Exchange. I did so, along with a group of other foolhardy souls, with some success. It grew into the Southern California HIE. and MedEx, the largest HIE in California with 1800 members. I left MedEx in 2011 but the HIE is still going strong and continues to provide services to all of Southern California. Don Berwick's vision of patient-centered care has been my guide for the past 15 years and I am proud to say that it has served me well. Thank you, Don!
Don was selected to be the first leader of the Office of the National Health Information Technology, by then-President George W. Bush. At that time Bush had a committee studying how much information (data) would be needed for the next twenty or more years. It was a lofty goal.
Don’s group was charged with creating the policies and protocols that would standardize how healthcare information was collected and exchanged. He worked with a wide range of stakeholders including state governments, healthcare providers, technology vendors, patient advocates, insurers, and employers.
He understood that to make the exchange of information more efficient it was important to understand the needs of all parties. He was also mindful that each stakeholder had a different level of technical knowledge and addressed it in his approach.
He crafted solutions to ensure that the information exchanged would be secure, private, and protected. Don’s team created data standards based on industry best practices. This helped create a common language between healthcare providers, insurers, and other stakeholders.
Don saw that technology was the key to transforming healthcare data exchange and ultimately improving patient care. He developed solutions that allowed data to be quickly and securely transferred between systems ensuring the accuracy of data, reducing costs, and saving time for everyone involved.
His work had a profound impact on the industry and set an example for others to follow.
Berwick served his term well, and transferred his leadership abilities to the private sector. In 2019, he established Don Berwick & Associates: a consulting firm that specializes in healthcare data and analytics.
Since then, Don has been advising clients on how to maximize the value of their data assets. He’s helped them develop strategies for securely exchanging information between systems and establishing data-driven processes to improve patient care. In 2021, he released a book titled “Data-Driven Healthcare: Driving Transformation with Data Science, AI, and Analytics” which provides a comprehensive guide to using data in the healthcare industry.
Berwick’s commitment to patient care has inspired others across the globe to use data as a tool to improve their practices. He continues to work on innovative solutions for securely exchanging critical healthcare information, and his team is exploring new ways to utilize artificial intelligence (AI) and predictive analytics to better serve patients. Don also stays active in the healthcare data community by speaking at conferences and sharing insights with industry experts.
He has made it his mission to help bridge the gap between data science and healthcare, ultimately creating an environment where clinicians and researchers can collaborate.
Don Berwick is on to other missions now. He has become a leader in the push for healthcare reform, working to create systems that are more cost-effective and accessible. His global initiatives have impacted thousands of lives, inspiring leaders across the world to use data-driven insights to address health disparities and improve care delivery.
Don continues to serve as a passionate advocate for quality patient care through his ongoing work with the Institute for Healthcare Improvement. His advocacy continues to raise awareness of how data and technology can revolutionize healthcare delivery and improve patient outcomes.
He is a true leader, leveraging his knowledge and influence to champion improvements in healthcare access and quality. He has demonstrated that with dedication, commitment, and hard work, we can create a more equitable system of care for everyone.
Don Berwick on leadership, greed + a promising youth movement (podcast with Robert Pearl MD, former head of Kaiser Permanente) Berwick is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign. He’s the former administrator of the Centers for Medicare & Medicaid Services (CMS).
In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask Don to discuss what is holding back healthcare leadership from instituting meaningful change and from kicking off what Don describes as a necessary “revolution.”
The discussion leads to the incumbents of healthcare—pharma, health insurance, hospital system execs, etc.—and why they do well when healthcare fails to improve. Don opines on private vs. public care, a global movement toward integrated care systems, and the ways ChatGPT can support the “frail memory” of individual physicians.
Robert Pearl, M.D. compares health leaders to 5 Fatal Flaws Of Healthcare Leaders: Inspired By HBO’s ‘Succession’
As with Waystar Royko, the institutions of medicine (hospitals, medical groups, insurers, pharma, and med-tech companies) need excellent leadership just to survive. With millions of dollars and hundreds or thousands of jobs resting on the decisions of top administrators, any major flaw can prove fatal—erasing decades of organizational success.
For the past few years, I have studied healthcare leaders who fail—whether they be CEOs of major hospital systems, heads of medical groups, insurance execs or top pharma and med-tech system executives. A common thread among all these flawed characters is a set of five fatal flaws that can quickly derail any healthcare leader’s best efforts to improve patient care.
The five fatal flaws of healthcare leadership are lack of vision, weak communication skills, poor decision-making, a lack of empathy, and an unwillingness to take risks.
These flaws can quickly lead to mistrust between staff and administrators, muddled goals, and stalled progress in patient care initiatives. Healthcare organizations are highly complex entities with many moving parts.
Healthcare’s delusional leaders overestimate their abilities. Their ideas are unrealistic and their vision for the future: is pure fiction. But no matter how outlandish their outlook, delusional leaders will always find apostles among the disenfranchised who, themselves, feel undervalued and overlooked. When confronted with the harshness of reality, deluded leaders and their followers double down, insisting that everyone else is myopic. “Just follow and you’ll see,” they demand. Unless senior executives or board members step in to relieve this leader of power, the organization will be as doomed.
Healthcare’s narcissistic leaders bask in praise and blind loyalty. They reject and punish those who provide honest feedback and fair criticism. Their obsession with status and self-importance blinds them to long-term threats and opportunities, alike.
Unlike delusional leaders, who fail because their vision cuts against the grain of reality, the narcissistic leader’s passion for winning may advance an organization—in the short run. Long-term, however, their flaws will be exposed and weaknesses manipulated by seasoned competitors.
The Political Leader
Political leaders are better at advancing within an organization than advancing the organization itself. Like chameleons, these leaders change with the scenery, shifting alliances and values as organizational power waxes and wanes. While they’re busy focusing on rumors and relationships, they fail to muster real-life business acumen and experience.
The Three Attributes Of Excellent Healthcare Leaders
1. A Clear Mission And Purpose
Leaders have three jobs. They must create a vision, align people around it and motivate them to succeed. To accomplish these tasks, executives may use carrots and sticks, incentives and disincentives, or positive and negative reinforcement. But these tactics will fail unless they reflect a clear mission and purpose.
Years ago, former Centers for Medicare & Medicaid Services administrator Don Berwick started a program with an audacious goal of maximizing patient safety and preventing unnecessary deaths. He called it the 100,000 Lives Campaign. And when he spoke of the program, he leaned hard on its righteous mission. Instead of presenting metrics and statistics, he talked about the weddings and graduation ceremonies that parents and grandparents would attend, thanks to the program and the people behind it. Even hard-weathered clinicians in the audience had tears in their eyes.
Financial incentives drive change in healthcare, but rarely achieve the outcomes intended. Everyone engaged in the 100,000 Lives Campaign knew exactly what they needed to accomplish and were motivated to do so.
2. Experience And Expertise
Bold ideas and glittering promises always capture attention. Words are powerful and relationships can take aspiring leaders far. But when it comes time to turn big plans into action, there is no substitute for a leader who has been there and done it well.
Exceptional performance, not promises, separate great leaders from the rest—and success from failure. In every industry, past performance is the best predictor of future success. Of course, poor leaders can get lucky and even great ones in bad circumstances may fail. But the odds always favor those who have achieved recurring success throughout their careers.
3. Personal Integrity
Emerging leaders can work on their weaknesses. Coaching, training, and even therapy can help them quell maladaptive behaviors.
Fixing Healthcare flashback with Don Berwick
When asked by Dr. Robert Pearl what his revolutionary revision of our health system would be. He answered with usual humility, Don Berwick bridles at the position of ‘Czar for Healthcare. The first part of the plan that you're asking for is that although you're appointing me czar of fixing healthcare, I decline. Berwick has no fast quick fixes for an existing system that is broken.
Berwick posits that we the senior leaders should look to the next generation of students, residents, and young physicians, along with fresh young graduates in health administration. Their task will be as great as physicians in overcoming the inertia of the current hospital administration.
Because the majority of health institutions are for-profit, boards of directors will need to guide their stockholders in medical ethics. Often time boards of directors are chosen from local business CEOs who may have little to no experience in medical or clinical matters.
Sometimes leadership must come from the bottom up.
Reagnomics theory of trickle-down economics will not work in health carfe
How do you improve healthcare by more centralization of a individualistic entity, health? Every patient is different with unique needs. Let the individual control the funds, they will seek value and quality as in all other purchases. Patients would re-establish a more fruitful patient-physician relationship.