Intended for healthcare professionals


Shift focus from treatment to encouraging health, safety guru tells conference

BMJ 2014; 348 doi: (Published 15 April 2014) Cite this as: BMJ 2014;348:g2755
  1. Richard Hurley
  1. 1Paris

Healthcare professionals and institutions should radically change their priorities to encourage wellbeing rather than simply respond to illness, an expert in patient safety has told a conference on healthcare quality.

“Let’s embark on an audacious and courageous pursuit of wellbeing,” said Donald Berwick, who recently reviewed patient safety in the NHS.1 He was speaking on 10 April at the 19th annual International Forum on Quality and Safety in Healthcare, held in Paris.

The World Health Organization considers health “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity,” Berwick reminded delegates, emphasising the importance of kindness, generosity, love, mindfulness, and social connectedness to health. “If you want to feel well, give,” he said.

Berwick cited John Harrison, who in the early 1700s revolutionised naval navigation by making a clock that could be used to measure longitude. Harrison had relied on a series of improvements until the fourth prototype was good enough to use. Berwick compared this process to the “plan, do, study, act” method popular in improvement science today.

Berwick also said that the placebo effect needed to be harnessed to improve health, and he mentioned the ideas of several proponents of holism, including the Dalai Lama.

“What will all this mean to cardiologists and nurses?” he asked, before setting out a six point action plan, which included “Reconsider your own concept of health,” “Take account of healing tools you and your patients have that lie outside the boundaries of the healthcare system,” and “Bring systems thinking to the pursuit of wellbeing.”

Berwick’s review of patient safety in the NHS, commissioned by the UK government, was published last year after Robert Francis QC’s report analysed the breakdown in care standards at Mid Staffordshire Hospital NHS Foundation Trust. He is trained as a medical doctor and is president emeritus and senior fellow of the non-profit making Institute for Healthcare Excellence, which seeks to encourage better healthcare worldwide and which organised the forum jointly with the BMJ group. Berwick, a Democrat, is hoping to become governor of Massachusetts in elections on 4 November, and healthcare is a key part of his campaign.

More than 3000 guests from at least 75 countries attended the conference, whose message was, “Strive for excellence, seek value, spark a revolution.”

The forum acknowledged sponsorship from for-profit companies, including the finance company KPMG, and non-profit organisations such as the Health Foundation. Next year’s forum is due to be held in London, with the theme of wellness.

At the end of Berwick’s session The BMJ’s editor in chief, Fiona Godlee, who chaired the session, warned delegates to desist from going to the top of the Arc de Triomphe to be photographed bearing placards for fear that they might be mistaken for unauthorised protestors and arrested. Forum delegates had been encouraged to make photographic pledges with signs describing what they intended to do to improve healthcare quality after the conference.

The forum also saw the launch of GetUpGetBetter, dubbed “the first ever international healthcare quality competition.” See


Cite this as: BMJ 2014;348:g2755



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