Eleven worthy aims for clinical leadership of health system reform
D. M. Berwick
Institute for Healthcare Improvement, Boston, MA 02116.
Clinicians ought to be playing a central role in making the changes in the
health care system that will allow the system to offer better outcomes,
greater ease of use, lower cost, and more social justice in health status.
Instead, most of the proposed changes that are today called "health care
reform" are actually changes in the surroundings of care rather than
changes in the care itself. Clinicians have an opportunity to exercise
leadership for the improvement of care, but they must first agree to
address the aims of reform and to adopt an agenda of specific changes in
their own work that are likely to meet the social needs driving the reform
movement. Health services research offers a sound scientific basis for
identifying promising improvement aims for clinician-led reform. Eleven
plausible aims are these: (1) reducing inappropriate surgery, hospital
admissions, and diagnostic tests; (2) reducing key underlying root causes
of illness (especially smoking, handgun violence, preventable childhood
injuries, and alcohol and cocaine abuse); (3) reducing cesarean section
rates to pre-1980 levels; (4) reducing the use of unwanted medical
procedures at the end of life; (5) simplifying pharmaceutical use,
especially for antibiotics and medication of the elderly; (6) increasing
active patient participation in therapeutic decision making; (7) decreasing
waiting times in health care settings; (8) reducing inventory levels in
health care organizations; (9) recording only useful information only once;
(10) consolidating and reducing the total supply of high-technology medical
and surgical care; and (11) reducing the racial gap in infant mortality and
low birth weight. Health care professions and their professional
organizations in concert should embrace these 11 aims, establish
measurements of progress toward them, and commit to continuous and
fundamental changes in their pursuit.
Barriers and Strategies to Influencing Physician Behavior
Bain
American Journal of Medical Quality 2007;22:5-7.
Physician Leadership Styles and Effectiveness: An Empirical Study
Xirasagar et al.
Med Care Res Rev 2005;62:720-740.
ABSTRACT
Organizational Characteristics and Preventive Service Delivery in Private Practices: A Peek Inside the "Black Box" of Private Practices Caring for Children
Randolph et al.
Pediatrics 2005;115:1704-1711.
ABSTRACT
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A Three-Part Intervention To Change the Use of Hormone Replacement Therapy in Response to New Evidence
Roumie et al.
ANN INTERN MED 2004;141:118-125.
ABSTRACT
| FULL TEXT
The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement
Diabetes Spectr. 2004;17:97-101.
ABSTRACT
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Behind Schedule: Improving Access to Care for Children One Practice at a Time
Randolph et al.
Pediatrics 2004;113:e230-237.
ABSTRACT
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Using Practice Guideline Compendiums To Provide Better Preventive Care
Weingarten
ANN INTERN MED 1999;130:454-458.
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THE COST-EFFECTIVENESS OF ROUTINE TYPE AND SCREEN ADMISSION TESTING FOR EXPECTED VAGINAL DELIVERY
Eisenbrey et al.
Obstet Gynecol 1999;93:321-322.
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Tools to Improve Documentation of Smoking Status: Continuous Quality Improvement and Electronic Medical Records
Spencer et al.
Arch Fam Med 1999;8:18-22.
ABSTRACT
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Payment by Capitation and the Quality of Care- Part Five of Six
Berwick
NEJM 1996;335:1227-1231.
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A primer on leading the improvement of systems
Berwick
BMJ 1996;312:619-622.
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