By John Reichard, CQ HealthBeat Editor
February 7, 2011 -- To those accustomed to hearing Centers for Medicare and Medicaid Services administrators rattle off the dry details of policy initiatives when they deliver speeches, Donald M. Berwick's remarks may have seemed startling.
Berwick did talk policy, announcing that his agency will soon unveil "the largest national effort on patient safety that we've ever seen." He wasn't prepared to discuss the details; in fact, he used the issue as just one example of his efforts to create a culture at CMS that is committed to more than just processing claims and pushing paper.
To a large extent, Berwick focused on what he's doing to motivate the 4,500-person CMS workforce. He named as a key goal achieving "unprecedented pride and joy in work in the entire CMS workforce, and a reputation in government and the private sector for speed, responsiveness, reliability, and cooperation."
Berwick said CMS has recently been developing a strategy for the coming months. He summarized the fruits of that effort as follows: building operational excellence; improving care for individuals; integrating care for populations, and improving the health of populations and communities.
But "strategy doesn't matter until you've touched values," he said. When employees' values are strong, rules aren't needed to drive behavior, he said. And when values are weak, rules aren't sufficient.
It isn't the first time Berwick has talked at length in public about matters of the heart rather than the head. Previously, he described the example his father set as a small-town physician in Connecticut of the kind of medicine he wanted to practice.
Motivational efforts and inspirational talk may seem more the bailiwick of Super Bowl coaches than government bureaucrats. But when one considers that Berwick's successful career as a national leader in health care quality improvement boiled down to fostering an internal drive on the part of individuals and organizations to do better work, the efforts perhaps are no surprise at all.
On patient safety, Berwick said he's meeting regularly with Carolyn Clancy, administrator of the Agency for Healthcare Research and Quality, on the coming campaign. He said the pair are "talking hard" about how to build momentum behind the project of the kind that motivated the nation to land a man on the moon.
"We do have tremendous knowledge about how to make care safe," he said. Some organizations have tremendous records in patient safety, but there are only "pockets of excellence." Berwick says he wants to "bring excellence to scale" and says CMS is up to the job.
And that's where motivation comes in.
Berwick said the self-image and vision he wants to foster at CMS is that "we are here to make health and health care better for people." He said his job is to connect each of the 4,500 workers at CMS to this self image. "It all comes down to pride and joy in work," he quoted quality guru W. Edwards Deming as saying.
"We can do well with a joyous work force, we can't without it," he said. And, Berwick said, "I myself will be teaching the first four 90-minute classes on improving the work."
