BMJ  2004;328:1124-1129 (8 May), doi:10.1136/bmj.328.7448.1124

Education and debate

Lessons from developing nations on improving health care

¹ Institute for Healthcare Improvement, 375 Longwood Avenue, Boston, MA 02215, USA dberwick@ihi.org

Evaluation of projects to improve health care in resource poor countries can provide ideas and inspiration to the often stalled efforts in healthcare organisations of wealthy nations

The first 150 words of the full text of this article appear below.

Improvement is, I believe, an inborn human endeavour. My belief arises mostly from watching children. You cannot find a healthy child who does not try to jump higher or run faster. It takes no outside incentive. Children smile when they succeed; they smile to themselves. And so, it is my premise that almost all human organisations contain in their workforce an internal demand to improve their work. It saddens me how few organisations seem to know that, and fewer still act on it. Improvement is not forcing something; it is releasing something.

Nevertheless, improving organisations is not easy. The barriers are many, and those barriers can produce a sense of helplessness and futility. Failing to improve, we feel unfortunate and wish that someone, somewhere, would give us that extra missing resource that we imagine would make change possible. "We want to make care better," goes the complaint, "but they won't . . . [Full text of this article]

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