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National Health Care Leader Speaks with COPH Students

Donald Berwick, M.D., former Administrator of the Centers for Medicare and Medicare Services and president emeritus of the Institute for Healthcare Improvement, met with UAMS students on Oct. 13 following his presentation, “Clinicians as Leaders in Health Care Reform,” held at UAMS. His lecture was part of the 2015 Winthrop Rockefeller Distinguished Lecture series.

Donald Berwick M D and Professors Kevin Ryan and Holly Felix talking after forum discussion

(left to right) Kevin Ryan, Donald Berwick, and Holly Felix

Organized and facilitated by COPH Associate Dean Kevin Ryan, JD, the forum gave students an opportunity to engage directly with Dr. Berwick and ask questions. Students were not shy about asking questions, nor was he shy about asking questions in return.

In response to a query for career advice, Dr. Berwick emphasized importance of other people.

He told students that his personality type had precluded mapping out his life in a straight line and that looking back, “chance encounters” had played a huge role in setting his life course. One such person was a stranger Berwick as a young man met at a scientific meeting. It was a rainy night, and the man needed a ride back to his hotel. Berwick gave him a lift and their conversation on that short trip changed his life path. The two have remained friends since.

“Be open to chance – it is so much more fun,” he said.

When life or decisions are difficult, Berwick has “gone to the core” of family for support.

“I can’t overstate the importance of family,” he said.

His advice about mentors was simple: Get one, and the earlier the better. The bond he formed as a young man with his mentor, now in his 90s, continues today as a friendship.

“I never made an important decision without him,” Berwick said. “Nothing replaces a mentor.”

Other insights offered by Berwick touched on teamwork, technological innovation, the cost of health care, and the role of public health.

In the workplace, be willing to model behaviors that foster positive change, he advised. For example, regularly ask co-workers, especially those subordinate, “Is there anything I could have done last week to make your work easier?” Then, be open to the answer you get.

“Telemedicine – the more I look at it, it is the frontier,” Dr. Berwick said, also noting how phone apps have been effective helping the poor be healthier. “Opportunities in cellphone-based text coaching innovation is wide-open, but policy has not kept up with it.”

As for the current US economic model for its healthcare system, Dr. Berwick said that he favored a single-payer, federal government system that would eliminate insurance companies as the payers. This would reduce administrative costs, which amount to 15 percent of US health care expenditures.  In comparison, such costs for the single-payer Medicare system amount to 2-3 percent of total expenditures. The difference between the two models is about $3 trillion annually.

As for the role of public health in population health improvement, hospitals are still where the action is, because “hospitals are still where the money is,” Dr. Berwick said. “Public health is still the poor stepchild of this.”

The solution? “Not only do we have to think outside health care, but we need to think outside public health too,” Dr. Berwick said, adding that public health has created self-limiting definitions and siloes. He suggested a shift in thinking about population health that emphasizes community, social justice, and health and wellness for everyone.

“It is the community that is the owner of health,” he said. “How do we get a community to act to improve health?”