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Jim Kim Copies Cambridge

Dr. Donald Berwick, the administrator of the federal government’s Centers for Medicare and Medicaid Services, will be leaving his job at the end of the year. The Times reports him as saying that he believes that 20-30% of all medical spending “is ‘waste’ that yields no benefit to patients.”

The Times story also described the process that brought Berwick to his senior position in Washington (Medicare and Medicaid cover one third of Americans):

Dr. Berwick said he had not sought the job. Indeed, he said, “I did not even know if I was fit for it.” He took the post, he said, because he sensed that “tectonic shifts” were occurring in the health care delivery system.

The good doctor’s previous position? He ran the Institute for Healthcare Improvement, an organization that seeks to study and understand the inefficiencies in the delivery of healthcare, develop better methods, and train professionals to better run our healthcare system. Sound familiar?


It should. But unlike Jim Kim’s pet project at Dartmouth, the Center for Health Care Delivery Science, the Institute for Healthcare Improvement is up and running, and it has been doing good work for over twenty years. Look at an excerpt from its statement of purpose:

IHI focuses on motivating and building the will for change; identifying and testing new models of care in partnership with both patients and health care professionals; and ensuring the broadest possible adoption of best practices and effective innovations.

Here’s how Jim Kim pitches his project:

Center for Health Del Sc.png

Dartmouth’s Center for Health Care Delivery Science is hardly a “next step.” IHI’s staff of more than 100 people offers a wide range of research activities, conferences, and training with identical goals for the practice of medicine and for health care professionals. It is already doing all of the things that Kim’s project promises to get to one day.


IHI has been doing this work since the late 1980’s:

In our first decade, IHI focused primarily on the identification and subsequent spread of best practices — mostly through our Breakthrough Series Collaborative model. This work was organized fundamentally around reducing defects and errors in microsystems such as the ED or the ICU.

In our second decade, we established a keener focus on innovation, R&D, and the creation of new solutions to old problems. Through broad-scale Idealized Design projects, we worked to reinvent multidimensional systems of care, such as the Office Practice and the Medication System. In recent years, this work has expanded even further through engagements designed to transform entire systems. The Pursuing Perfection initiative in 2002 gave us the unprecedented opportunity, with support from the Robert Wood Johnson Foundation, to work intensely with the leaders of highly ambitious provider organizations seeking total transformation through redesign all of major care processes.

This work was ultimately manifested in the 100,000 Lives Campaign and 5 Million Lives Campaign, in which IHI spread best practice changes to thousands of hospitals through the United States, and created a national network for improvement focused on reducing needless deaths and preventing harm from care.

The above language is an echo of the things that Jim Kim has been saying for two and half years to the College community, except the folks down in (surprise!) Cambridge have been saying it for a very long time now. And we thought that we were doing something quite original in Hanover, didn’t we? How did we come by that idea?

Note: In last night’s webcast, President Kim cited his goal of implementing one “fundamental innovation” at the College each year. He modestly pointed to the Center for Health Care Delivery Science as his first achievement in this regard, and he observed that six similar centers have now been created at other universities in emulation of Dartmouth.

Note: The activity that President Kim listed as his second “fundamental innovation” is the Learning Collaborative on High-Risk Drinking — Kim’s effort to reduce drinking by students. The “collaborative” methodology that the group is using was also developed in Cambridge by the Institute for Healthcare Improvement.

Addendum: President Kim used the below slide in his webcast this evening.


Addendum: The Times’ Joe Nocera has a full column on Donald Berwick, including the following:

Berwick started out as a pediatrician and health care researcher at the Harvard School of Public Health and eventually became vice president of the Harvard Community Health Plan (now known as Harvard Pilgrim Health Care). There, he became enamored with the ideas being promulgated by management gurus like W. Edwards Deming and companies like Toyota, which believed that companies could create processes — and a mind-set — that would allow for both continuous improvement and continuous cost reduction. Indeed, they believed that the two went hand in hand.

The next time you hear President Kim go on about the need to apply Deming’s principles of quality control and continuous improvement processes (Kaizen in Japanese) to modern medicine, you’ll know from where he borrowed these ideas.


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