Editor's Note: In this segment of One-on-One, Medscape Editor-in-Chief Eric J. Topol, MD, speaks with Donald M. Berwick, MD, MPP, former Administrator of the Centers for Medicare & Medicaid Services (CMS). Dr. Berwick discusses his decades-long career with the Institute for Healthcare Improvement, his tenure at CMS, and why he is running for governor of Massachusetts.
Early Life: An Introduction to Medicine
Dr. Topol: Hello. I'm Eric Topol, Editor-in-Chief of Medscape, and joining me for a Medscape One-on-One interview is Donald Berwick.
It's a thrill to have you here, Don, and you are coming at a remarkable time because you're running for governor of the state of Massachusetts, and obviously that's really interesting to the Medscape community. But before we get into that, let's talk about your origins. You're a New Englander, right? You grew up in Connecticut?
Dr. Berwick: That's right. I grew up in a small town in Connecticut called Moodus. My father was a GP in the town. He made house calls, delivered babies -- did everything. He did fluoroscopy in his office. He rounded out every day of my young life at the hospital 17 miles away -- a real old-style GP.
Dr. Topol: And then you went off to Harvard for college and medical school. And you also have a master's degree in public policy from the Kennedy School, and you trained in pediatrics at Boston Children's Hospital. Is that right?
Dr. Berwick: Yes. I actually did a year of internal medicine first, at Massachusetts General Hospital as a medical intern. I loved that, but I always had a special place for kids in my heart and decided to switch to pediatrics, and so I completed my training at Boston Children's Hospital.
Dr. Topol: Along the way, you started the Institute for Healthcare Improvement. Tell me about that.
Dr. Berwick: My academic career has been in health services research. I've written several books on evaluating healthcare technologies, and I was recruited to the first HMO at Harvard Community Health Plan to run their quality systems and quality of care, and to oversee quality of care and research.
I became very intrigued by the quality world. We had an unlimited budget to measure anything we wanted that related to care. It was something the board really cared about. So we were watching waiting times and complication rates, and patient satisfaction and infant mortality, and I kept noticing that everything stayed the same. We were okay. It was a very good organization, but there wasn't improvement.
Thanks to the vision of the then-CEO, who had come from outside healthcare -- he said, "Look, why don't you take 6 months to travel and find out how other industries deal with improvement." And I did that. From 1982 to 1984, I spent a lot of time with NASA, AT&T, Bell Laboratories, manufacturing companies, and hotel chains. I was interested in how these industries made things better, because I wanted to see how that might also help healthcare be better.