From the IHI to CMS
Dr. Topol: Did you become CEO with a lot of trepidation, because that was not a conventional route for an academician?
Dr. Berwick: I was very excited by what we were uncovering. I remember that the turning point for me was when I was with NASA. It was before the space shuttle Challenger accident, and I was dealing with the highest level of people working in quality at NASA. I suddenly saw what was possible. These people were able to bring levels of reliability, focus, caring, pride, and joy in their work that we didn't have in healthcare. I was totally excited.
It felt a little risky, and I never left the university; for my entire career, I've been at the School of Public Health at Harvard Medical School. The job at IHI was going out on a limb, but with friends, and it was glorious. We were all so excited, and the response from healthcare was really affirming. There were skeptics, but when we started IHI, we began holding national meetings. We grew rapidly. We taught courses. People were lined up. We had a 2-year waiting list for courses.
Dr. Topol: Did you ever think taking leadership at the IHI would then lead you to become the CMS director?
Dr. Berwick: No, not at all.
Dr. Topol: What was it like to hear that President Obama wants you in that position? You've got this ridiculous kind of congressional landscape, and then under a recess appointment, you're made the CMS director. What were your thoughts about that?
Dr. Berwick: I'd been running IHI for 22 years, and we worked in 50 countries; I was totally happy with my work, but a call did come. It came from Senator Tom Daschle, who was scouting out administration people, and he said, "The President would like you to take over CMS." At that point we didn't have the Affordable Care Act (ACA), but we knew legislation was coming.
I had weighed in a little bit [on the potential for healthcare legislation]. I had sent memoranda and thoughts to the campaign about what I thought should happen. That probably is what triggered my appointment. I remember that Senator Daschle said, "The President would like you to be the administrator of CMS," and I said, "Senator Daschle, I work on improvement of healthcare. You don't want me to run CMS." He said, "Right, we don't want you to run CMS, Don. We want you to change CMS." And with that, he had me at "hello."
I went down and interviewed. I was very excited by the possibility of this kind of tectonic change and improvement in US healthcare. It would let me take what I understood about improvement in hospitals to a very large scale, for 100 million Americans.