‘Be like Trojan Mice’ urges Don Berwick at the closing event of the ISC’s first ‘Collaborate’ leadership course.

Rosie Dalton-LucasHead of Programmes - Healthy Place, Public Health, Southwark Council
17 Aug 2023
NHS South East London
SLA - Collaborate

Professor Sir Don Berwick was introduced to our cohort of 30 SEL ICS ‘system leaders’. Berwick or ‘Don’ as we came to know him has been described by some as “iconoclastic,” and by others as “a man able to survey the fragments of a broken health care system and imagine how they could be made whole”. Having spoken at both the opening and closing events of the Collaborate course, our cohort have been lucky to hear him on two occasions, sharing his understanding of improving health care systems around the world. I’ve found it especially intriguing that he has so much respect and hope for the UK’s National Health System in particular.

Don is recognised as a leading authority in health care quality and improvement, and was the founding CEO of the Institute for Healthcare Improvement (IHI). His experience working in the UK, led to him being knighted in 2005 for his work creating new care models in five NHS trusts. In 2010, President Barack Obama appointed him as the Administrator of the Centers for Medicare and Medicaid Services. In 2013, he carried out a review of patient safety on behalf of Prime Minister David Cameron.

Don is clearly a fan of the NHS, and a critic of the inequity apparent in the US health care system. Under Obama he worked hard to advocate adoption of NICE style guidance to reduce waste of funds on unnecessary testing and release resources for investment in services. I’m also encouraged to read in his own IHI blogpost that while he is a physician by training, he appreciates the need to look beyond the medical model and to tackle the wider social determinants: “It is not a smart investment for society to keep running health care as a repair shop without also moving upstream to the real generators of illness, injury, injustice, and disability”.

The real nub of his message to us SEL leaders however, was about guarding against fragmentation and silo working – a struggle faced by healthcare systems around the world, but what solutions does he advocate? As well as a commitment to quality improvement and implementation of the ‘Plan, Do, Study, Act’ cycle for which IHI has done much to promote, Don was also keen to impress the importance of collaboration, to commend our ICS journey of integration, and to ensure the patient voice remains strong and central.

As well as sharing his impressive worldly experience of supporting healthcare systems such as those in Saudi Arabia and Singapore, the mighty Don also relays powerful personal stories. He weaves them through his presentation, recalling the pain of his wife Ann and her own traumatic healthcare journey that he was eye witness to. He shares his frustration about the fragmentation and disorganised system that left his wife waiting 60 hours for emergency treatment when she first became ill.

Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, is also former Administrator of the Centres for Medicare and Medicaid Services.
Professor Sir Don Berwick. Image from Gov.Wales under the terms of the Open Government Licence on the National Archive.

It must have been tough having so much expertise and system knowledge yet when it came to the crunch even Don Berwick was powerless to effect change when it was most critical. System change does not happen fast, but a key message in our training on this course has been to unleash the power of the personal story, and Don does not shy away from using his own personal experience to illustrate and motivate us for system change.

Don left us with some other ‘pictures’ in our minds’ eye to help us as leaders feel empowered in our own little corner of the world here in south east London. One was to see ourselves as part of the same system and not ring fence our own efforts at the expense of others. He had us imagine our ICS as one of 42 canoeists paddling upstream on the same river, with some of us testing out new routes and regrouping later to report back and shape the overall direction.

The collaboration message was loud and clear – “Put it at the top of your professional duties” he urged, and ask partners, patients and colleagues what is it like to be in your shoes? Figure out what are the interdependencies: “What can I do to make your life easier?” and he challenged us to find out where are the win-wins.

The final picture he painted for us to imagine was a slightly comic but beautiful one – “Think of yourselves as Trojan mice. Not horses. Mice.” Because the system is made of people who on the whole don’t like big radical change I guess? Perhaps the agents of change have more luck establishing a new order when they’ve scurried into many different pockets of the system, small enough to go unsuspected but supporting a change of mind-set and practice gradually and simultaneously… almost by stealth.

On behalf of the first Collaborate cohort I would like to say a big thank you to Professor Sir Don Berwick for inspiring us and to all those enabling the Collaborate course to happen – it has been an honour and a pleasure to be part of the first cohort.

So all that remains to be said my little furry friends is… let us all go forth and collaborate!