Here is the entire sentence from which part of this posting's title derives:
"You are stewards of a globally important treasure: the NHS. In its form
and mission, guided by the unwavering charter of universal care,
accessible to all, and free at the point of service, the NHS is a unique
example for all to learn from and emulate."
That quote is from a letter from Dr. Berwick to officials of the NHS as part of the report from the committee he chaired to investigate the egregious treatment of patients at a NHS hospital,the Mid Staffordshire.
See here for Greg Scandlen comments in a blog entry entitled "The Real Don Berwick"
In Scandlen's commentary there is a description of the horrible things to which patients were subjected and excerpts from the committee's report.
I cannot resist one other quote, this one from Paul Krugman.
"In Britain, the government itself runs the hospitals and employs the doctors. We've all heard about how that works in practice .Those stories are false."
The following is from Berwick's book written with the current Vice president of CVS Caremark (Troyen Brennan)
"Today, this isolated relationship[ he is speaking of the physician patient relationship]
is no longer tenable or possible… Traditional medical ethics, based
on the doctor-patient dyad must be reformulated to fit the new mold
of the delivery of health care...Regulation must evolve. Regulating
for improved medical care involves designing appropriate rules with
authority...Health care is being rationalized through critical
pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making.
So how did those appropriate rules with authority work out for those victims of the NHS? Was there too much residual "decentralized decision making"
Maybe one lesson to learn from the NHS tragedy is when no one is accountable or responsible, some really terrible things can happen. Berwick's committee did find that no one was really at fault."NHS staff were not to blame".
OK,one more quote, this time John McEnroe's "you gottta be kidding me"
Another lesson all can learn from the NHS is how incredibly bad their electronic record system worked. See here for a report of what some have called the biggest IH foul up ever.