Escape Fire

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.

Preface ix

Acknowledgments xv

Introduction xix
Frank Davidoff, MD

1. Kevin Speaks 1

2. Buckling Down to Change 11

3. Quality Comes Home 43

4. Run to Space 61

5. Sauerkraut, Sobriety, and the Spread of Change 93

6. Why the Vasa Sank 127

7. Eagles and Weasels 155

8. Escape Fire 177

9. Dirty Words and Magic Spells 211

10. Every Single One 239

11. Plenty 269

About the Author 297

About the Commentary Authors 299

Index 305

"Why Is Changing Health Care So Hard?"

In this provocative and much-needed book, health care expert Dr. Donald Berwick shares eleven of his most compelling speeches. These unforgettable speeches (which were delivered at the Institute for Healthcare Improvement’s annual National Forum on Quality Improvement in Health Care from 1992 to 2002) dramatically show that we need to create a new system that guarantees that every patient has the benefit of care drawn from the best scientific knowledge available. No mere diatribe, Berwick’s vision for change includes practical suggestions and tools that can truly transform our broken system and puts the patient at the center of the health care system.

"In this vibrant book, Don Berwick speaks about one of the most vexing issues of our time with compelling competence, penetrating clarity, relentless honesty, and heart-warming humor. In an era when so many public voices lack these qualities, Berwick gives us reason to hope that our most difficult social problems have solutions that are within reach. We are the solution, of course–if we are willing to emulate the intellectual and moral courage modeled by leaders like Don Berwick."
–Parker J. Palmer, author, The Courage to Teach and Let Your Life Speak

"[Berwick’s] target is a health care system that has evolved primarily to serve the needs and interests of those who work in the system–doctors, nurses, administrators, payors, insurers–rather than the needs and interests of patients."
–from the Introduction by Frank Davidoff

"In this vibrant book, Don Berwick speaks about one of the most vexing issues of our time with compelling competence, penetrating clarity, relentless honesty, and heart-warming humor. In an era when so many public voices lack these qualities, Berwick gives us reason to hope that our most difficult social problems have solutions that are within reach. We are the solution, of course— if we are willing to emulate the intellectual and moral courage modeled by leaders like Don Berwick."
— Parker J. Palmer, author, The Courage to Teach and Let Your Life Speak

"[Berwick's] target is a health care system that has evolved primarily to serve the needs and interests of those who work in the system— doctors, nurses, administrators, payors, insurers— rather than the needs and interests of patients."
— from the Introduction by Frank Davidoff