Soon, President Obama will nominate Donald Berwick to be administrator for the Centers for Medicare and Medicaid Services. CMS is a vast government bureaucracy that employs 4,400 people and spends $800 billion per year implementing Medicare and Medicaid, government health insurance programs that cover nearly 100 million Americans.
The CMS administrator job has always been exceptionally challenging, but the recently enacted health overhaul will create new ones for whomever eventually fills the post. For starters, the overhaul contemplates expanding Medicaid to cover 16 million more people, and squeezing nearly $500 billion out of Medicare over the next decade.I know Don well, having worked closely with him on several projects from 1987-1995. I helped his team develop and teach “Improving Health Care Quality,” the flagship course for Don’s National Demonstration Project (which later became the Institute for Healthcare Improvement). We even published a paper together back in the day.Don has had a tremendously positive impact on my career. I can say more about that, but what I prefer to do instead is speculate a bit about how Don will approach his new challenge. (For other takes on Don’s nomination, see here, here and here.)Don Will Create a Vision for CMS-He probably has ideas for this already, but Don will consider his ideas to be a starting-point. He will develop them into final form by seeking input from CMS staffers at all levels of the organization. That process will be egalitarian and collaborative. When it is done, nearly all 4,400 people at CMS will have had a chance to give input. As a result, nearly everyone at CMS will own the vision. They will be deeply motivated to make it happen.Ultimately, the Vision Will be Driven by Customer Need-CMS has millions of customers, including beneficiaries, providers and taxpayers. Their needs often conflict. Don will be at ease with this and will work with his teams to sort them out. In the process, he will reinforce and expand the commitment to customer-service for every CMS employee.
Don Will Use Process Performance Metrics to Assess Progress in Meeting Customer Needs-He will work with staff to identify the processes at CMS that have the greatest impact on customer satisfaction. As the Administrator, Don might only see a top-level “Report Card” of these metrics, but he will make sure that successive layers of his organization have identified which of their own processes contribute to the metrics he sees. In this way, Don will assure that everyone at CMS understands how their work contributes to overall performance of the organization, and ultimately to making its customers happy.CMS Employees will Love Working for Don-Don will help them see that when errors do occur, they are almost always caused process design failures and not the people who work in these processes. That insight will encourage people to improve the processes in which they work, a supremely empowering concept that brings out the best in people while accelerating process improvement across CMS.Beyond this, Don will listen to his people and value their input. He knows they are his most valuable asset. He will make his people believe this, too.Don Will Use Benchmarking to Improve CMS Performance-There might be a state agency, or even a city or county agency that has achieved performance breakthroughs in an area relevant to CMS. Don will ask his people to learn from those agencies. His people will understand it’s OK to learn new ways and accept new ideas, including those from agencies that may have nothing to do with health care.Don Will Approach HIT Using these Same Principles-Don knows it is hard to implement EHRs hospitals, which are among the most complex sociotechnical systems in modern society. He knows that process knowledge holds the key to successful EHR implementation in such settings, and that when things go wrong it may or may not be caused by the EHR, or the people that use them. And to be sure, Don will emphasize the EHRs’ role in patient safety. Don will also assure that providers’ concerns about Meaningful Use are aired, understood and acted upon.There’s more, but this is the gist. Don is going to be great. He has been training his whole career for a role like this. Don Berwick to CMS is a brilliant move by President Obama. Good luck, Don!Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs, Practice Fusion
The CMS administrator job has always been exceptionally challenging, but the recently enacted health overhaul will create new ones for whomever eventually fills the post. For starters, the overhaul contemplates expanding Medicaid to cover 16 million more people, and squeezing nearly $500 billion out of Medicare over the next decade.I know Don well, having worked closely with him on several projects from 1987-1995. I helped his team develop and teach “Improving Health Care Quality,” the flagship course for Don’s National Demonstration Project (which later became the Institute for Healthcare Improvement). We even published a paper together back in the day.Don has had a tremendously positive impact on my career. I can say more about that, but what I prefer to do instead is speculate a bit about how Don will approach his new challenge. (For other takes on Don’s nomination, see here, here and here.)Don Will Create a Vision for CMS-He probably has ideas for this already, but Don will consider his ideas to be a starting-point. He will develop them into final form by seeking input from CMS staffers at all levels of the organization. That process will be egalitarian and collaborative. When it is done, nearly all 4,400 people at CMS will have had a chance to give input. As a result, nearly everyone at CMS will own the vision. They will be deeply motivated to make it happen.Ultimately, the Vision Will be Driven by Customer Need-CMS has millions of customers, including beneficiaries, providers and taxpayers. Their needs often conflict. Don will be at ease with this and will work with his teams to sort them out. In the process, he will reinforce and expand the commitment to customer-service for every CMS employee.
Don Will Use Process Performance Metrics to Assess Progress in Meeting Customer Needs-He will work with staff to identify the processes at CMS that have the greatest impact on customer satisfaction. As the Administrator, Don might only see a top-level “Report Card” of these metrics, but he will make sure that successive layers of his organization have identified which of their own processes contribute to the metrics he sees. In this way, Don will assure that everyone at CMS understands how their work contributes to overall performance of the organization, and ultimately to making its customers happy.CMS Employees will Love Working for Don-Don will help them see that when errors do occur, they are almost always caused process design failures and not the people who work in these processes. That insight will encourage people to improve the processes in which they work, a supremely empowering concept that brings out the best in people while accelerating process improvement across CMS.Beyond this, Don will listen to his people and value their input. He knows they are his most valuable asset. He will make his people believe this, too.Don Will Use Benchmarking to Improve CMS Performance-There might be a state agency, or even a city or county agency that has achieved performance breakthroughs in an area relevant to CMS. Don will ask his people to learn from those agencies. His people will understand it’s OK to learn new ways and accept new ideas, including those from agencies that may have nothing to do with health care.Don Will Approach HIT Using these Same Principles-Don knows it is hard to implement EHRs hospitals, which are among the most complex sociotechnical systems in modern society. He knows that process knowledge holds the key to successful EHR implementation in such settings, and that when things go wrong it may or may not be caused by the EHR, or the people that use them. And to be sure, Don will emphasize the EHRs’ role in patient safety. Don will also assure that providers’ concerns about Meaningful Use are aired, understood and acted upon.There’s more, but this is the gist. Don is going to be great. He has been training his whole career for a role like this. Don Berwick to CMS is a brilliant move by President Obama. Good luck, Don!Glenn Laffel, MD, PhDSr. VP Clinical Affairs, Practice Fusion
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