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Obama adviser to make ‘zero harm in the NHS a reality’, pledges PM

Don Berwick, the man who advised President Barack Obama on his health reforms, has been appointed to spearhead a “zero harm” agenda in the NHS, David Cameron has revealed.

President Obama

President Obama

The eye-catching appointment is potentially a substantial coup for the prime minister, who announced the move to the House of Commons this afternoon.

Mr Berwick previously advised Bill Clinton and is regarded as one of the world’s leading health advisers.

Mr Cameron told Parliament harm inflicted by hospitals on patients, such as hospital infections or bed sores, was unacceptable.

He said: “Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards and a little bit of these things is somehow OK. It is not OK. They are unacceptable.

“That’s what zero harm means. So I have asked Don Berwick – who has advised President Obama on this issue – to make zero harm a reality in our NHS.”

The Department of Health told HSJ Mr Berwick would publish his findings in July but that further details on his brief were not yet available.

Mr Berwick was nominated by President Obama to take charge of Medicare and Medicaid in 2010 but stood down after substantial Republican opposition to his appointment. It is widely thought that he had become a symbol of everything Republicans disliked about President Obama’s healthcare policies. One of his greatest perceived sins was speaking highly of the NHS.

Don Berwick: adviser to the presidents and Harvard alumni

Don Berwick was appointed by President Obama to run the Centers for Medicare and Medicaid Services − the US agency which run various health insurance programmes − as a recess appointment in 2010.

He left in December 2011 after the Republicans signaled they would block his confirmation.

His praise for the NHS was seen as one of the reasons he had become a “become a symbol of all that Republicans disliked about Obama’s healthcare policies”.

Before advising Obama, he was president and chief executive officer of the well-regarded Institute for Healthcare Improvement where he spent nearly 20 years. He developed online courses for healthcare professionals for reducing C. difficile infections as one of many projects at the institute.

Other posts he has held include:

  • Clinical professor of peadiatrics and healthcare policy at Harvard Medical School, and professor in the department of health policy and management at the Harvard School of Public Health.
  • Vice chair of the US preventive services task force.
  • The first “independent member” of the American Hospital Association board of trustees, and chair of the national advisory council of the Agency for Healthcare Research and Quality.
  • A member of President Clinton’s advisory commission on consumer protection and quality in the healthcare industry.

Readers' comments (12)

  • This is possibly the best appointment Mr Cameron has ever made. Mr Berwick has an incredible track record and a consistently patient centred approach.
    He has been talking about patient safety and prevention of healthcare acquired morbidity for a very long time. We stand to learn a lot.

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  • Fantastic! Another US import, following in the footsteps of United, kaiser et al.

    great emphasis on hospitals today... fair enough, Mid Staffs is a hospital. But let's not forget about all of the community services, residential and nursing homes where people come to harm, or where harm starts.

    I hope he is the panacea Dave thinks

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  • How can anyone from the USA when they have a service which treats only a proportion of the population advise the UK. It might be zero harm, but they wouldn't harm anyone not treated? My relatives know many occasions where with a cancer diagnosis and no Medicare you are just sent home to die. Zero harm and zero treatment.

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  • Pity there is not a vacancy for the CE of the NHSCB!

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  • Interesting appointment, someone who has praised the NHS and annoyed republican conservatives! Says a lot about this country that there was no one suitable for such an job. I wonder when he was approached...

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  • Couldn't agree more about challenging the unacceptable. This story shows that it is never just about hospitals. Don Berwick is certainly a very positive appointment but unless I am mistaken he is also thinking of running for Governor. Ultimately this is about the NHS taking more responsibility for its own beliefs and actions. We can't rely on the centre to do it for us - mainly because they will make a mess of it.

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  • Don Berwick's work at the Institute of Healthcare Improvement has resulted in massive improvements in Patient Safety in the USA.

    The NHS has brought about significant improvements in Patient Safety in the UK over the last few years but there is still a lot we can learn from him.

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  • Need to define ;zero harm' here. The dementia patient who falls over on their way to the toilet ?

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  • Yes Don is considering running as Governor of Mass

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  • Don Berwick delivered a wonderful lecture to the Royal College of Physicians on 17th April 2013.

    It was called "Can Healthcare Change?" and was on the Science and Nature of Patient Safety.

    It covered areas which all doctors and managers need to know like:

    - Why mistakes happen

    - The Science of Safety

    - Human factors in Safety

    - The extent of medical injuries

    - Types of errors

    - Learning from other high risk industries

    - High Reliability organisations.

    Don Berwick has led work by the Institute of Healthcare Improvement in the USA which has already saved over 100,000 lives.

    The lecture is at

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  • I love Berwick, nice chap with a good heart, who's done some great stuff. But on this occasion he's out of his depth - his favourite Deming-only approach to process engineering ain't going to cut the mustard.

    "Zero Harm" means intolerance: it means blaming not learning; it means compliance to orthodoxy not professional judgement; it means historical evidence not cutting edge practice; and it means killing the sort of innovation and development that has made the NHS world leading. The old fail-safe industrial theories are mostly irrelevant, read some Weick, Reason, or Vincent. Modern complex human system must be, safe to fail, assuming the presence of and necessity to recognise, prevent and (when it inevitably occurs) recover from, failure.

    What Berwick really mean is Less Avoidable Harm, but for that, you need a professional debate that the politicians couldn't possibly engage in!

    Less (failure created by standardised processes that were not applicable in the situation and for the person who ended up getting hurt by staff that are made to comply with doctrine, rather than practice the situational awareness and adaptability that command and control organisations will beat out of them) Harm. People know what harm means, but it has been academically redefined for convenience, and the ZERO is a harmful message.

    Healthcare is bloody dangerous and most people should be doing their utmost never to be anywhere near it. We put people in harms way deliberately, with their consent, and for their own greater good. Surgery is dangerous, it takes effort to recover from knocking you out and cutting you open, let alone the problem it's aimed to overcome. Chemotherapy deliberately poisons people to try and save their life and it is bloody crippling! Zero harm means zero science, no risk taking, no experimentation and no building the new science that makes the old assumptions of evidence, irrelevant.

    Zero Tolerance doesn't work, because in the real world it means that diversity is unacceptable. It is based on old fashioned monotheistic dogma that people must comply to an ideology, no matter what the situation. It means the kind of secretive, hidden, protectionist fog of a culture that creates Mid Staffs. Zero is a fascist ideology, or perhaps from my favourite philosophers, "only a sith deals in absolutes"!

    In the real clinical world some people fight every step of the way, with anything and everything they can get their hands on, all the way down to the day that they die ... so that you won't have to.

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  • SUNIL GUPTA, I agree with you, he knows his stuff and is a fabulous ambassador for Healthcare management(albeit that the clinicians saved the 100,000 lives not the IHI campaigners).

    Why is someone I admire greatly, now advocating this absolute cobblers of ideological intolerance. He knows better!

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