New CMS chief targets infections
"I have climbed Mount Rainier five times. Each time I made that tough trek, my risk of dying was about 100 times smaller than the risk I will face on the operating table." Don Berwick, director of the Centers for Medicare and Medicaid Services (CMS)
This analogy is a bit of a stretch, but Don Berwick, MD, taking the helm at CMS is a little like renowned needle safety advocate Janine Jagger, PhD, becoming the head of the Occupational Safety and Health Administration (OSHA). One doesn't expect bureaucratic business as usual when a life-long crusader rises to political power.
Named the head of the CMS on July 12th of this year, Berwick is one of the principals behind the landmark To Err is Human report that essentially began the modern patient safety movement.1 There may be a good reason it wasn't subtitled "To forgive is divine."
It is not wild speculation to surmise that Berwick is going to have little patience for any suggestion that health care associated infections (HAIs) are an inevitable consequence of patient care. A Berwick-led CMS is going to be demanding HAI prevention. Period. It was no coincidence that President Obama decided to head off the critics and appoint Berwick during a Congressional recess. He doesn't seem to be particularly interested in compromises, political or otherwise.
"Those who wish only to preserve the status quo are not going to be constructive contributors to our nation's future," he said Sept. 14th in his first official speech as CMS director. "They cannot be effective partners, and we simply do not have time to pretend that they are. We just do not have time for games anymore."
Berwick comes to CMS from the Institute for Healthcare Improvement, which has featured several initiatives on heath care associated infections such as methicillin-resistant Staphylococcus aureus and Clostridium difficile.
"He is very familiar with [HAIs] and I would think he would carry on that expertise with CMS," says Russell Olmsted, MPH, CIC, president-elect of the Association for Professionals in Infection Control and Epidemiology. "I think he is going to continue to drive this agenda."
In his recent speech, Berwick drew on some personal anecdotes, imagining that his late physician father who made house calls and delivered babies would be somewhat shocked at the state of health care today.
"He would have laughed if anyone had called his practice 'a medical home' or said he practiced 'patient-centered care,'" Berwick said. "I suspect he would have asked, 'What other care is there?' It was just his work to him, embedded in his community. But that's what it was that's what he was home base for the people who needed him. And that is the image etched in my mind permanently as what health care is. 'Patient-centered care' is my father's car starting in the middle of the night. . . . The world of commitment and caring that my father represents to me is not gone. It is far too important to lose. And I took this job to do whatever I can to make sure that it thrives."
The Affordable Care Act is a watershed moment, a turning point in access, coverage, quality, and cost of health care, he said.
"We cannot with our current system of care give Americans the care they want, need, and deserve," he said. "The problems do not lie in any failure of good will, benign intentions, or skills of our doctors, nurses, health care managers, or staffs. With rare exceptions, they are doing their best. The problems lie in the design of the care systems in which they work, systems never built for the levels of reliability, safety, patient-centeredness, efficiency, or equity that we owe to ourselves and our neighbors. . . . To Err Is Human is over ten years old now, and we still lack the firm national commitment to make the safest care the standard of care everywhere no matter where an American patient goes. . . . As the commercial says, 'You can pay me now, or you can pay me later.' And prevention, if we get serious about it, is a big, big bargain."
Reference
- Institute of Medicine Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
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