Donald Berwick is important to behavioral healthcare

Excerpts from Donald Berwick is important to behavioral healthcare (Click here to go to MIWatch   ( ) for other important news. )

When I told Don Berwick that people with a serious behavioral health problem generally die at least 25 years sooner than the average person, he was shocked and dismayed.  Our conversation occurred at the offices of the Institute for Healthcare Improvement in January of 2007.  Don Berwick, MD who was recently given a recess appointment by President Obama to be the Administrator of the Center for Medicare Medicaid Services, is that rare combination of a systems thinker and a high class, experienced clinician. He understood the statistic on lost years of life as proof of how our systems have failed both people with a serious behavioral health problem and the rest of us who are deprived of their knowledge, contribution and companionship.

Don Berwick comes to this from experience as a clinician, a medical practitioner, as a husband and a father who also receives health care, and as an esteemed teacher.  As such, he called for action from “all health care constituencies–health professionals, federal and state policy makers, public and private purchasers of care, regulators, organization managers and governing boards, and consumers.”

At our organization, IBHI, attention is focused on improving outcomes for people in the behavioral health system.  Three of the principles from Crossing the Quality Chasm are especially important:  

  1. Care is based on continuous healing relationships.
  2. Care is customized according to patient needs and values.
  3. The patient is the source of control.

If only we had such universal measures in behavioral health.  At this time we have no way of knowing which organization or provider has a better success rate than another.  Without these comparisons each provider and organization thinks they are providing the best of all possible care.  General health care now has developed ways to learn how to improve from each other, but you can only do that by word of mouth in behavioral health. It is only reasonable to expect that behavioral health will be asked soon to develop similar capability. CMS seems poised to begin asking primary care providers and others in general healthcare to report relative levels of health and costs per capita.  Behavioral health should not expect to be left out of that request for long.

Importantly, one of Dr. Berwick’s most important tenets is: we aren’t going to do a better job just by trying harder.  To make any real difference, we have to change the system of care.  Our part of the system seems even more dysfunctional than general health care.

If we learn from the quality movement IHI and others have developed in general healthcare, we can begin to achieve the same types of improvement in behavioral health.  I expect CMS to begin demanding these things from all of healthcare. We must use careful measurement and improvement methods to assure our programs curb illness and extend both life and the quality of life.   We owe it to consumers, and to the nation as a whole and we should be embarrassed if we do not deliver.