Dr. Don Berwick, Supporter of Lean Healthcare, to be New Obama Appointee


Dr. Donald Berwick (bio), founder of the Institute for Healthcare Improvement, has reportedly named by President Obama to head Centers for Medicare & Medicaid Services (CMS), the organization that administers programs including Medicare and Medicaid (“Berwick to be US healthcare nominee“).

I don't know what Berwick's politics are, having only met him briefly one time  — but I do think it's a great move to have someone in that role who is not just an MD, but someone who also recognizes the role of process in healthcare quality. Dr. Berwick has been a proponent of Lean in healthcare for many years, as a piece of the healthcare quality improvement and cost reduction puzzle. Here is an article from BusinessWeek, with a video, with Dr. Berwick (something I shared on my blog previously). You can also click the “Berwick” link at the bottom of the post for more.

You can also read about Dr. Berwick and his advocacy for Lean and improvement methods from other industries in the book The Best Practice: How the New Quality Movement is Transforming Medicine. Dr. Berwick mentioned Lean many times in his keynote at the IHI national Forum back in December.

I think it's a very positive sign for the future of U.S. healthcare to have someone in such a powerful position who understands process improvement and Lean — not just for the sake of the “lean healthcare” world — but for all of us as patients and family members. Lean is such a powerful method for reducing costs the right way — through quality improvement. I have more hope that the future of U.S. healthcare cost control will be a better path than what would be cooked up by those who confuse price controls with real cost reduction.

So back to the politics of the nomination — I've always thought of IHI being pretty apolitical — focusing on improving healthcare quality is a pretty non-partisan issue and I don't recall IHI ever having a political agenda. The Wikipedia page about Berwick calls IHI a “liberal not-for-profit organization helping to lead the improvement of health care throughout the world.” Liberal? An assumption because of an east coast background and time studying at Harvard?

This blog post (“Report: Donald Berwick tapped for top post at CMS“)  has some highlights about his policy ideas and areas of focus. More patient involvement, better quality, fewer preventable errors, better information systems = liberal?

Here is a good HealthAffairs Blog post that summarizes some of his ideas on quality and patient-centered care (“CMS Nominee Berwick On Empowering Patients And Improving Quality“). The Disease Management Care blog has a political analysis that says the Obama Administration may be hoping for a fight with Republicans over Dr. Berwick's nomination (“A Raw Political Analysis of the Nomination of Donald Berwick to Lead CMS”). Here is an interview with Dr. Berwick from last November.

Back to the issues of quality improvement, here are a few videos of Dr. Berwick:

1) On patient-centered care and the lack of dignity that can occur in addition to preventable errors:


2) Dr. Berwick on checklists and quality improvement (addressing some students)


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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Here’s the formula: Lean = Change = Progressive = Liberal. Right or wrong, that is how most people explicitly or implicitly interpret Lean. This is something the Lean community has had difficulty understanding over the decades, the perception that Lean = Liberal, and accounts in some measure for why Lean is not far more common in business (executives tend to be conservative). The Scientific Management community ran into the same problem in the 1920s and 1930s, an era that was far more favorable for new progressive management practices than today, where liberalism is less popular among the public at large.

  2. I think this is terrific news! I’ve been hoping someone in Washington would realize how much Lean can help improve health care in the U.S. Berwick’s enthusiasm and expertise make me hopeful that the Lean message may finally start to be heard.

  3. This is GREAT news for those of us in healthcare, as well as those who use our services – in other words, in my opinion, good news for everyone.

  4. Bob – I think you are spot on with your Lean = Change = Progressive = Liberal idea. What tends to draw the conservatives to lean is when they see the potential for the financial rewards. Especially CFOs. Sure would be an interesting study to see which party lean advocates tend to identify with, wouldn’t it?

    I’m unable to see the videos Mark provided on Berwick because of the internal internet restrictions where I work, but in the past I didn’t perceive him to be one who strongly championed lean. I thought he was more generic with his approach, saying that we need to improve quality and delivery but not strongly advocating any particular philosophy. It sure would be a big shot in the arm for the lean movement, and healthcare in general if he would come right out and say that lean is the method he most prefers.

  5. Thanks Mark… Yes, it would be interesting to see to see which party Lean advocates identify with, but we are probably better off not knowing. We need to be careful because it will lead to labeling and categorizing people that will surely undercut teamwork and “Respect for People.”

    I think co-existence, mutual respect, and co-prosperity is the way to go. What I have found is that most people don’t explicitly realize that Lean, understood and practiced correctly, is a unique combination of liberal and conservative social, political, and economic beliefs, which I characterized as “conserberal” in Volume Three of my REAL LEAN book series (Chapter 5, “Sharing is Fundamental”), published in 2008. The “conserberal” representation should be more appealing to executives, but it will still be very tough to shake off the longstanding general perception that Lean = Liberal.

  6. This is huge! I was at an IHI Impact meeting some years ago. Tom Nolan was presenting a paper on his transformation model (will – skill – ideas). One of the topics of the paper – waste in healthcare & how to identify and remove muda (that was the term that Nolan used). I’m standing next to Dr. Berwick in the back of the room (it was the afternoon, long day) and he turned to me and said, “I think we need an organized ‘identify and remove the muda effort'”. I know he is interested in and supports the effort to introduce lean thinking in healthcare.
    .-= Mike Stoecklein ´s last blog ..More Thoughts on Innovation =-.

  7. I find a wide range of political persuasions among lean professionals. Here in very-blue Seattle I’ve found quiet conservatives and unabashed liberals adapt and advocate lean practices and strategies with enthusiasm.

    I am glad to see the spread of political stripes in the lean movement. What I am bothered about, though, is a general absence of non-white participation in lean, and I’m wondering how that could change. Lean still suffers from a misunderstood notion that it will eliminate jobs more than waste, and I think this contributes to a resistance to learning more about lean.
    .-= Tom Robinson ´s last blog ..5 Necessary Actions for Organizational Change =-.

  8. I think it is liberal with a lower case “l” IHI would be liberal not because of any political persuasion but because they believe change is better than the contrary.
    Back when I was working with people like Don we discovered some research on risk taking that caused us to conclude that only a minor percentage of people really believe in change as preferable to the alternative. I think those are the people who should be thought of as liberal, regardless of how they vote each November. In any case Don is one of these, as am I, and both of us are proud of it.


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