Dr. Topol: Were you concerned that your appointment wasn't going through the normal channels, and how that would be a different kind of road for you?
Dr. Berwick: I left the politics to the politicians. I knew the President wanted me. They were trying everything they could. We had lost Senator Kennedy's seat [to the Republicans], so the Democrats no longer had a filibuster-proof majority. The Republicans were quite up in arms about what would become Obamacare at that time, and so the President decided to use recess appointment authority, which means he didn't need confirmation for the appointment. It does limit the time of the appointment, but it was the President's call and it was fine with me. I got to serve him for 17 months, and it was unbelievable. It's just an amazing time and place; I enjoyed it immensely.
Dr. Topol: What was it that you liked so much?
Dr. Berwick: Being able to help at a scale that I never had dreamed of. One by one, the issues would come to me. Issues about how to protect elders in nursing homes from oversedation, issues about how to make sure elders could get access to medications, how to protect kids accessing Medicaid, and working on patient safety, which is the thing I care most about.
I got to launch the largest patient safety initiative in human history: the Partnership for Patients program. I was able to take what I knew about making healthcare better and, to some extent, making the health of communities better, and bring it to a scale I couldn't have imagined.
Dr. Topol: You really were able to fulfill [Daschle's vision] and changed CMS.
Dr. Berwick: Absolutely. What I did at CMS was what I spent 30 years studying and learning: leadership for improvement. I went to the agency, with 5500 employees who had not had an administrator for 6 years. They were hungry for leadership, and I got the chance.
I had the triple aim, doing what we had developed at IHI -- better care, better health, and lower costs for 100 million people. I said, "I don't think we should be past that. I think we should be active leaders of change, leaders of improvement." I ran training programs for all 5500 people, giving four 90-minute lectures. I was bringing improvement into the agency, and the response was wonderful.