Escape Fire: Designs for the Future of Health Care

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Spanning a decade (1992-2002), these speeches echo the theme that our health care system needs fundamental change and a revolutionary new design. Throughout the book, Berwick identifies innovations and ideas from a number of surprising sources—a girls' soccer team, a sinking ship, and the safety standards at NASA. Escape Fire takes its title from the 1949 Mann Gulch tragedy in which thirteen young firefighters were trapped in a wildfire on a Montana hillside. The firefighter's leader, Wag Dodge, devised a creative solution for avoiding the encroaching fire. He burned a patch of grass and lay down in the middle of the scorched earth. His team refused to join him, and most perished in the fire. Dodge survived. Berwick applies the lessons learned from the catastrophe to our ailing health care system—we must not let ingrained processes obstruct life-saving innovation.

Not content to simply define the problems with our flawed system, Berwick outlines new designs and suggests practical tools for change: name the problem, build on success, take leaps of faith, look outside of the medical field, set aims, understand systems, make action lists, and—the most fundamental of all—never lose sight of the patient as the central figure.

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About the author

Donald M. Berwick, MD, MPP, is president, CEO, and cofounder of the Institute for Healthcare Improvement in Boston, Massachusetts. Dr. Berwick is a clinical professor of pediatrics and health care policy at the Harvard Medical School, and a pediatrician. An associate in pediatrics at Boston’s Children’s Hospital, he is also a consultant in pediatrics at Massachusetts General Hospital. Dr. Berwick is the coauthor of the books, Curing Health Care and New Rules, also available from Jossey-Bass.
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Additional Information

Publisher
John Wiley & Sons
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Published on
Dec 17, 2010
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Pages
352
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ISBN
9781118040881
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Language
English
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Genres
Medical / General
Medical / Public Health
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Content Protection
This content is DRM protected.
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Available on Android devices
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Promising Care: How We Can Rescue Health Care by Improving It collects 16 speeches given over a period of 10 years by Donald M. Berwick, an internationally acclaimed champion of health care improvement throughout the course of his long and storied career as a physician, health care educator and policy expert, leader of the Institute for Healthcare Improvement (IHI), and administrator of the Centers for Medicare & Medicaid Services. These landmark speeches (including all of Berwick’s speeches delivered at IHI’s annual National Forum on Quality Improvement in Health Care from 2003 to 2012) clearly show why our medical systems don’t reliably contribute to our overall health. As a remedy he offers a vision for making our systems better – safer, more effective, more efficient, and more humane.

Each of Berwick’s compelling speeches is preceded by a brief commentary by a prominent figure in health care, policy, or politics who has a unique connection to that particular speech. Contributors include such notables as Tom Daschle, Paul Batalden, and Lord Nigel Crisp. Their commentaries reflect on how it felt to hear the speech in the context in which it was delivered, and assess its relevance in today’s health care environment. The introduction is by Maureen Bisognano, CEO of Institute for Healthcare Improvement, and author of Pursuing the Triple Aim.

Praise for previous books by Don Berwick

Curing Health Care:

"The book is an easy and affirming read for anyone who is familiar with and has used the TQM teachings of Dr. Joseph M. Juran and Dr. W. Edwards Deming and would be a simple and informative introduction to the concepts for anyone who has been hearing about TQM but has no idea what it is all about and wants to know more." 
—Permanent Fixes (blog)

"Donald Berwick is the most clearly heard evangelist of applying industrial methods of continuous quality improvement in health care."
—Annals of Internal Medicine

Escape Fire:

"With an effective blend of common sense, real-life stories, persuasive metaphors, and out-of-the-box thinking, Dr. Berwick’s presentations make for fascinating reading for anyone interested in improving America’s $1.7 trillion health care system."
—Piper Report

"Anyone interested in change in the healthcare system would enjoy this book. In degree programs, the various speeches would be useful for discussion in a health policy readings course."
—The Annals of Pharmacotherapy

Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care. Both disturbing and illuminating, it immerses readers in the lives of four generations of a poor, African-American family beset with the devastating illnesses that are all too common in America's inner-cities.

The story takes place in North Lawndale, a neighborhood that lies in the shadows of Chicago's Loop. Although surrounded by some of the city's finest medical facilities, North Lawndale is one of the sickest, most medically underserved communities in the country. Headed by Jackie Banes, who oversees the care of a diabetic grandmother, a husband on kidney dialysis, an ailing father, and three children, the Banes family contends with countless medical crises. From visits to emergency rooms and dialysis units, to trials with home care, to struggles for Medicaid eligibility, Abraham chronicles their access (or lack of access) to medical care.

Told sympathetically but without sentimentality, their story reveals an inadequate health care system that is further undermined by the direct and indirect effects of poverty. When people are poor, they become sick easily. When people are sick, their families quickly become poorer.

Embedded in the family narrative is a lucid analysis of the gaps, inconsistencies, and inequalities the poor face when they seek health care. This book reveals what health care policies crafted in Washington, D. C. or state capitals look like when they hit the street. It shows how Medicaid and Medicare work and don't work, the Catch-22s of hospital financing in the inner city, the racial politics of organ transplants, the failure of childhood immunization programs, the vexed issues of individual responsibility and institutional paternalism. One observer puts it this way: "Show me the poor woman who finds a way to get everything she's entitled to in the system, and I'll show you a woman who could run General Motors."

Abraham deftly weaves these themes together to make a persuasive case for health care reform while unflinchingly presenting the complexities that will make true reform as difficult as it is necessary. Mama Might Be Better Off Dead is a book with the power to change the way health care is understood in America. For those seeking to learn what our current system of health care promises and what it delivers, it offers a place for the debate to begin.


Promising Care: How We Can Rescue Health Care by Improving It collects 16 speeches given over a period of 10 years by Donald M. Berwick, an internationally acclaimed champion of health care improvement throughout the course of his long and storied career as a physician, health care educator and policy expert, leader of the Institute for Healthcare Improvement (IHI), and administrator of the Centers for Medicare & Medicaid Services. These landmark speeches (including all of Berwick’s speeches delivered at IHI’s annual National Forum on Quality Improvement in Health Care from 2003 to 2012) clearly show why our medical systems don’t reliably contribute to our overall health. As a remedy he offers a vision for making our systems better – safer, more effective, more efficient, and more humane.

Each of Berwick’s compelling speeches is preceded by a brief commentary by a prominent figure in health care, policy, or politics who has a unique connection to that particular speech. Contributors include such notables as Tom Daschle, Paul Batalden, and Lord Nigel Crisp. Their commentaries reflect on how it felt to hear the speech in the context in which it was delivered, and assess its relevance in today’s health care environment. The introduction is by Maureen Bisognano, CEO of Institute for Healthcare Improvement, and author of Pursuing the Triple Aim.

Praise for previous books by Don Berwick

Curing Health Care:

"The book is an easy and affirming read for anyone who is familiar with and has used the TQM teachings of Dr. Joseph M. Juran and Dr. W. Edwards Deming and would be a simple and informative introduction to the concepts for anyone who has been hearing about TQM but has no idea what it is all about and wants to know more." 
—Permanent Fixes (blog)

"Donald Berwick is the most clearly heard evangelist of applying industrial methods of continuous quality improvement in health care."
—Annals of Internal Medicine

Escape Fire:

"With an effective blend of common sense, real-life stories, persuasive metaphors, and out-of-the-box thinking, Dr. Berwick’s presentations make for fascinating reading for anyone interested in improving America’s $1.7 trillion health care system."
—Piper Report

"Anyone interested in change in the healthcare system would enjoy this book. In degree programs, the various speeches would be useful for discussion in a health policy readings course."
—The Annals of Pharmacotherapy

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