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Escape Fire: Lessons for the Future of Health Care

As a professor of health care policy, pediatrician, and cofounder of the Institute for Healthcare Improvement, Don Berwick, M.D., was one of the first voices to call for quality improvement in the health care system. A few years ago, after his wife fell ill with a serious disease, his work gained a new sense of urgency. Berwick describes what he calls "the enormous, costly, and painful gaps between what we got in our days of need, and what we needed" in a remarkable essay, Escape Fire. In this monograph, Dr. Berwick outlines the problems with the health care system—medical errors, confusing and inconsistent information, and a lack of personal attention and continuity in care—and then sketches an ambitious program for reform.

He calls this program an "escape fire," the term firefighters use for a deliberately burnt patch of land that, in an emergency, can provide refuge from an oncoming blaze.

Inspired by this firefighting technique, invented in 1949 by a smokejumper facing a quickly moving grassfire, Berwick argues that the health care system can avoid crisis only through a similarly inspired leap of faith. Berwick's "escape fire" for health care reform consists of unencumbered access to care, reliance on the best available science, and a focus on healing relationships. In this new system, Berwick concludes, "the possibility of invention and the opportunity to make sense will open not just routes of escape, but vistas of achievement, that the old order could never have imagined."

Publication Details



Escape Fire: Lessons for the Future of Health Care, Donald M. Berwick, M.D., The Commonwealth Fund, November 2002