The 3rd Era of Health Care - Don Berwick

Having just returned from the Choosing Wisely Canada national meeting in Toronto, I was reflecting on what I learned. There was much inspiration and practical suggestions around implementing and sustaining quality improvement, and some of these learnings will change my practice. 

I was also re-invigorated by the energy of the Students and Trainees Advocating for Resource Stewardship (STARS), and reassured by the Canadian Medical Protective Association's endorsement of the Choosing Wisely campaign.

Dr Dee Mangin delivered a compelling, philosophical keynote to close the conference; she explored the issues driving medicalization and polypharmacy, and offered some hope for taking action against these. There were many reality checks for the audience, and recent research on physician behaviours, publication biases, a society obsessed with risk surprised many. Some of this was very familiar to me from discussions and presentations within the Preventing Overdiagnosis community, but Dr Mangin has a way of explaining things in such a way that their profound nature hits you like a tonne of bricks. (This is a good thing!)

It was clear at the conference that things have to change. But what is that vision, exactly?

One idea that was new to me was that of the "3rd Era of Heath Care," a concept developed by Dr Don Berwick, of the Institute for Healthcare Improvement (IHI). Dr Mangin touched on it and I think it's an idea worth sharing: