Switch - Chip Heath [8]
Berwick’s insight was that hospitals could benefit from the same kinds of rigorous process improvements that had worked in other industries. Couldn’t a transplant operation be “produced” as consistently and flawlessly as a Toyota Camry?
Berwick’s ideas were so well supported by research that they were essentially indisputable, yet little was happening. He certainly had no ability to force any changes on the industry. IHI had only seventy-five employees. But Berwick wasn’t deterred.
On December 14, 2004, he gave a speech to a room full of hospital administrators at a large industry convention. He said, “Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, 2006—18 months from today. Some is not a number; soon is not a time. Here’s the number: 100,000. Here’s the time: June 14, 2006—9 a.m.”
The crowd was astonished. The goal was daunting. But Berwick was quite serious about his intentions. He and his tiny team set out to do the impossible.
IHI proposed six very specific interventions to save lives. For instance, one asked hospitals to adopt a set of proven procedures for managing patients on ventilators, to prevent them from getting pneumonia, a common cause of unnecessary death. (One of the procedures called for a patient’s head to be elevated between 30 and 45 degrees, so that oral secretions couldn’t get into the windpipe.)
Of course, all hospital administrators agreed with the goal to save lives, but the road to that goal was filled with obstacles. For one thing, for a hospital to reduce its “defect rate,” it had to acknowledge having a defect rate. In other words, it had to admit that some patients were dying needless deaths. Hospital lawyers were not keen to put this admission on record.
Berwick knew he had to address the hospitals’ squeamishness about admitting error. At his December 14 speech, he was joined by the mother of a girl who’d been killed by a medical error. She said, “I’m a little speechless, and I’m a little sad, because I know that if this campaign had been in place four or five years ago, that Josie would be fine…. But, I’m happy, I’m thrilled to be part of this, because I know you can do it, because you have to do it.”
Another guest on stage, the chair of the North Carolina State Hospital Association, said: “An awful lot of people for a long time have had their heads in the sand on this issue, and it’s time to do the right thing. It’s as simple as that.”
IHI made joining the campaign easy: It required only a one-page form signed by a hospital CEO. By two months after Berwick’s speech, over a thousand hospitals had enrolled. Once a hospital enrolled, the IHI team helped the hospital embrace the new interventions. Team members provided research, step-by-step instruction guides, and training. They arranged conference calls for hospital leaders to share their victories and struggles with one another. They encouraged hospitals with early successes to become “mentors” to hospitals just joining the campaign.
The friction in the system was substantial. Adopting the IHI interventions required hospitals to overcome decades’ worth of habits and routines. Many doctors were irritated by the new procedures, which they perceived as constricting. But the adopting hospitals were seeing dramatic results, and their visible successes attracted more hospitals to join the campaign.
Eighteen months later, at the exact moment he’d promised to return—June 14, 2006, at 9 a.m.—Berwick took the stage again to announce the results: “Hospitals enrolled in the 100,000 Lives Campaign have collectively prevented an estimated 122,300 avoidable deaths and, as importantly, have begun to institutionalize new standards of care that will continue to save lives and improve health outcomes into the future.”
The crowd was euphoric. Don Berwick, with his 75-person team at IHI, had convinced thousands of hospitals to change their behavior, and collectively, they