Dr. Don Berwick says patient centered health care saves lives, dollars
Photo by Nelson Sigelman
The Schwartz Center for Compassionate Healthcare, a nonprofit organization founded on the premise that even the most advanced medical technologies and treatments will falter if they are not delivered with compassion for patients, held a reception Sunday evening in Chilmark to introduce its mission and seek support from an invited group of seasonal and year-round Islanders.
The centerpiece of the informal gathering at a private home on a hill overlooking Quitsa and Menemsha ponds was guest speaker Dr. Donald Berwick, co-founder of the Institute for Healthcare Improvement, an advocate for patient-centered health care, seasonal Chilmark resident, and most recently, candidate for governor of Massachusetts.
Schwartz Center organizers were quick to point out that the invitation to Dr. Berwick preceded his decision to join the Democratic nomination fray. In his comments, made to about 60 people standing on a patio and a pair of tweeting ospreys in the bleachers, Dr. Berwick, a Harvard-trained pediatrician, laid out a vision for significant changes in the nation's health care delivery system that he said would ultimately benefit patients and reduce costs.
The only political references came at the end of his talk and were connected to Dr. Berwick's brief stint overseeing Medicare and Medicaid despite Republican opposition.
President Obama appointed Mr. Berwick as administrator with a recess appointment in July 2010, allowing him to serve for over a year in the position before he resigned in December 2011 with his chances for permanent confirmation in doubt.
Dr. Berwick said one issue became a political third rail and that was the discussion over end-of-life issues, that gave rise to criticism of the so-called "death panels," or independent payment advisory board, later eliminated from the Obama health care plan.
"We know what people want in the late stages of illness," Dr. Berwick said. "We have the data on how the healthcare system performs in the late stages of illness and it does not perform well. People have procedures that they don't want and can't help them and in fact that the staff doesn't want to give them. Costs soar and people die in hospital beds that want to be at home. We understand what world class hospice care looks like and it exists in communities around this nation and we need to go there as a national policy towards proper, dignified, embracing patient-centered care in approaching the end of life."
Washington politicians avoided any discussion of end of life issues like the plague. "I was under instructions not to discuss it," Dr. Berwick said. "Why? Because somebody thought up the term death panels — which is absolute hogwash, there is no such thing. It was invented out of pure whole cloth and our political leaders reacted to that shallow, rhetorical battle by retreating, by backing down."
Dr. Berwick urged all present to become involved and push back in order to bring the issue to the forefront of the political discussion. "We are all patients," he said.
Path out of the mess
In his opening remarks, Dr. Berwick emphasized the importance of the Schwartz Center's mission and why it was important to support it. "Patient-centered care, putting the patient at the center, and orienting every single activity around the patient, and indeed controlled by patients and families, is the way out of the health care mess," he said.
Dr. Berwick spoke about what that care means in terms of outcomes and cost. But he did not paint an easy picture. "It is going to be not just disruptive but possibly revolutionary in health care but everyone will be better off," he said.
As he did throughout his remarks, Dr. Berwick used an anecdote from his life to illustrate how he arrived at the notion of patient-centered care. A pediatrician, he described an encounter with Kevin, a 15-year-old patient who he pressed to tell him how he could improve his care.
Kevin wrote three suggestions on a piece of paper that Dr. Berwick said he kept for many years. Number one was, it would be better if the various clinicians who came in and out of his room talked to each other; number two was, "before you do something to me tell me you're going to do it;" and the third suggestion was to ask the patient about his or her insights into their illness.
Dr. Berwick said the patient-centered dimension is the keystone. And he described a hospital in England that was the focus of a study he recently completed that described the catastrophic results when that is not the case.
"I have for years been waging battle against visiting hours," Dr. Berwick said. "I don't think it makes sense that a husband and wife of 30 years, who have lived together, worked together, raised kids together, worshipped together, when they come into a hospital suddenly lose the right to be together."
Dr. Berwick highlighted the Medical College of Georgia where visiting hours was eliminated years ago. "Add it works fine, the families become part of the medical care team," he said.
Another example of restructuring around the patient that produced better outcomes was at Virginia Mason Hospital in Seattle, Washington. By eliminating the administrative duties of its nurses, the amount of a nurse's time devoted to patient care lept from 30 percent to 90 percent in two years, he said. By taking all of the waste out of the system the costs go down and care gets better, he said.
"Not only is the patient better off, not only is the work more satisfying, not only do the outcomes improve, costs fall," Dr. Berwick said. "This country, every country is looking for solutions to this dreadful health care problem. The answer lies in what the Schwartz center does. Patient-centered care is less expensive care, not more expensive care."
Making the unbearable, bearable
The Schwartz Center is named for Kenneth Schwartz, a Boston health care attorney, diagnosed with advanced lung cancer in November 1994. In a story for The Boston Globe Magazine published on July 16, 1995, "A Patient's Story," Mr. Schwartz, a patient at Mass general Hospital, described his ordeal as cancer destroyed his body and robbed him of his life and the dream of watching his two-year-old son Ben grow up.
"It has been a harrowing experience for me and for my family," he wrote. "And yet, the ordeal has been punctuated by moments of exquisite compassion. I have been the recipient of an extraordinary array of human and humane responses to my plight. These acts of kindness — the simple human touch from my caregivers — have made the unbearable bearable."
In his professional life, Mr. Schwartz had watched as managed care and an emphasis on cost-consciousness and business began to take precedence. Concerned that the type of compassionate care he had received would disappear, just days before his death in September 1995, he founded the center that bears his name.
Although the Schwartz Center is headquartered in Mass General Hospital, one of its signature programs, Schwartz Center Rounds, can be found in more than 350 hospitals in 39 states, including Martha's Vineyard Hospital. The program brings together caregivers from multiple disciplines once a month to discuss the most challenging social and emotional issues they face in caring for a patient, according to a program description.
Sunday's guests included Terre Young, executive director of Hospice of Martha's Vineyard. "Compassionate care is absolutely one of our core values," Ms. Young said of Hospice.
Ms. Young, a nurse, said Hospice participates, along with other clinicians and staff members, in the Schwartz Rounds that Martha's Vineyard Hospital holds quarterly. One of the goals is to support each other as caregivers. "It's a wonderful opportunity to understand ourselves and each other and we wouldn't be able to do it without the Schwartz Center," she said.
The Sunday night event at the home of Schwartz Center supporters Audrey and Michael Straight was the organization's first on the Island. Executive director Julie A. Rosen described it as a "cultivation event," an opportunity to meet people in a position to help the organization reach its goal of raising $5 million so it can dramatically grow its existing programs.
"We have a very bold vision to create a more compassionate health care system," Ms. Rosen told The Times. The center does that through publications, conference, and educational programs. It operates on a budget of approximately $4 million.
"We are very well-known in the Boston area," Ms. Rosen said. "We are a little less well-known outside, so this is about talking about our vision and asking people to support our vision."
Asked how that vision dovetails with the emphasis on reducing costs, Ms. Rosen said research has shown that increased patient satisfaction produces better outcomes, fewer hospital readmissions, and, not least, fewer lawsuits. The organization educates, supports, and trains clinicians to produce those results.
"We are a very small but mighty organization," Ms. Rosen told those present in her opening remarks.