ORLANDO, Fla. — Don Berwick, M.D., kicked off the 19th annual National Patient Safety Foundation Patient Safety Congress with a keynote address urging the audience to act on what's been learned from the past 20 years of the quality-improvement movement.

Berwick, the Institute for Healthcare Improvement's president emeritus and senior fellow, identified seven areas of concern that health care leaders should heed in the effort to continue the progress of the patient safety movement. Excerpts from his talk:

  1. Displacement by other concerns: "As we go to boardrooms around the U.S. and hear what is being discussed, there are two topics: a changing reimbursement system and workforce morale. I personally believe there’s a strong connection between safety and cost reduction, but that conviction hasn’t been firmly established in 20 years."
  2. Illusion of completeness: "There’s an illusion that we’ve worked on safety — 'here are our scores on central line infections, pressure ulcers and here’s what’s happening on medication reconciliation' — on to the next problem. The concept of safety as a box-checking enterprise, where we start and finish, is lethal to patients of the future."
  3. Incentive theory: "Most of the workforce is already trying as hard as it can. Until we become scientists and give up the incentive-oriented approach to safety, we won’t make the systemic progress we have been calling on for years."
  4. Metrics glut: "In pursuit of incentives, we’ve glutted ourselves with metrics. I think we are way beyond a level of toxicity. It's not just safety.  We have to go on a diet."
  5. Separation of safety from quality: "When people say 'quality and safety,' what I hear is 'fruit and bananas.' Quality improvement is the big tent. It’s the enterprise of constant improvement to everything we care about. The quality of my car is dimensional. It has safety, durability and fuel economy and so does health care. I think reuniting our endeavors is crucial to our future. We don’t have the resources to waste on tribalism. We have to think systemically."
  6. System literacy: "We need to become literate about the systemic properties that produce improvement."
  7. Academic attacks: "I’m not sure why, but I deeply regret that academic students who position themselves outside the safety movement have all too often become critics. Until our academic brethren join in the progression of safety instead of positioning themselves as critics of the good-hearted work going on, they’ll be riding the breaks."

“We have to remove the chaos,” said Berwick, who also served as administrator for the Centers for Medicare & Medicaid Services. “We know how to do it, we’ve made progress. In the next 20 years, I don’t think we should be able to say we’ve learned what we need to know, I think we need to say, now what do we need to do?”