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ESCAPE FIRE Designs for the Future of Health Care by mirit35


									                                                                                                the bookshelf
ESCAPE FIRE: Designs for
the Future of Health Care.
By Donald M. Berwick. Jossey-Bass, 2004.
Book Review by Jennifer Barlow

   Escape Fire is one of those delightful dis-     we want to be, Berwick demands that we do           care from both manufacturing design and
coveries: an important book that’s fun to          something about it. He insists that we have the     coaching girls’ soccer. In “Dirty Words and
read. It’s a collection of 11 keynote addresses    knowledge we need. And he provides motiva-          Magic Spells,” he draws parallels with Harry
by Donald Berwick to the annual National           tion by painting a picture of what health care      Potter’s fight against the unspeakable Volde-
Forum on Quality Improvement in Health             could be, what a difference it would make in        mort. The dirty words represent outmoded
Care. They span the decade 1992-2002, and          people’s lives if we used the patient’s experi-     and ineffective ways of thinking about care
reflect the progress of the quality movement        ence as the only measure of quality.                delivery. (Read this one to see why “dis-
in health care.                                       Berwick has a vision of excellent health care.   charge” is a dirty word.)
   Berwick is a pediatrician, a professor at       The focus of everyone’s work is on relieving           In some of the most moving chapters,
Harvard Medical School, and the president          suffering. We build and use knowledge. We           Berwick shares his own personal experi-
of the Institute for Healthcare Improvement.       cooperate; we truly function as a system.           ences of health care misadventure. “Quality
From reading his speeches to the Forums, it’s      New thinking is needed to get us there — a          Comes Home” relates the story of his father’s
clear he is a riveting speaker with exciting       revolution in health care that, Berwick argues,     inadequate treatment and the everlasting
ideas about transforming health care.              must come from within its ranks.                    harm that was done. The title chapter, “Es-
   Care in our country isn’t as good as it could      There’s been positive change in recent           cape Fire,” tells of Berwick’s wife’s painful
be. Our system’s deficiencies have been well        years. The quality movement has gained              ordeal as she was diagnosed and treated for
documented in the Institute of Medicine’s          momentum and gone global. Yet the scope             a rare disorder.
reports “To Err is Human” and “Crossing            of our problems is still enormous. Berwick             An escape fire is intentionally set by fire-
the Quality Chasm.” In the latter report,          chafes at the slow pace of change, but he stays     fighters as a survival strategy, in the face
the IOM outlined six areas for improvement:        positive and focused on what’s possible.            of an oncoming blaze. Berwick makes the
safety, effectiveness, patient-centeredness,          The speeches effectively use humor and           metaphor work as he connects his family’s
timeliness, efficiency and equity.                  memorable analogies. In one chapter, “Run           miserable experience in the health care
   Acknowledging how far we are from where         to Space,” Berwick finds lessons for health          system with an analysis of sensemaking
                                                                                                       in organizations.
                                                                                                          Each chapter is introduced and commented
                                                                                                       upon by a colleague of Berwick’s — an im-
                                                                                                       pressive group of health care innovators and
                                                                                                       change agents. The introduction by Frank
                                                                                                       Davidoff is an eloquent book review in itself.
                                                                                                       This is simply an outstanding work. Berwick
                                                                                                       has big dreams for health care that’s humane,
                                                                                                       appropriate and evidence-based, where pro-
                                                                                                       viders are regarded as guests in their patients’
                                                                                                       lives, and patients are in control. The vision is
                                                                                                       achievable with the knowledge and resources
                                                                                                       we have today. All we need is the will and the
                                                                                                       energy to make it happen.
                                                                                                          Jennifer Barlow is manager of the Borgess Library.
                                                                                                       The library serves Borgess Medical Center (Kal-
                                                                                                       amazoo) and affiliated sites throughout southwest
                                                                                                       Michigan. Barlow received her master’s degree in
                                                                                                       library studies from the University of Michigan. ■


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