A peer review of the results of the initial campaign has been accomplished, and Berwick's approach has been commended for leveraging prior efforts, engaging the wisdom of the crowds, building momentum, and accelerating results. The next campaign has now been launched - to mitigate harm to over 5,000,000 lives over the next two years. This goal has been described as 'ambitious, but feasible', and it's apparent with the American Medical Association's adoption of IMI's initiative, that prior, independent efforts towards improvement are now beginning to be aggregated and integrated, so momentum should build quickly; time will tell. Berwick's next campaign is being described in their literature as a learning journey: 'Organizations learn when people learn'. The implication is that we only begun to scratch the surface for potential improvements.

Through changes such as these, the qualiity and costs of health care are finally beginning to be addressed. As such improvements are realized, our ability to expand mediccal care's availability and access will also be realized. But capturing and holding such gains can be as challenging as building momentum around them. Let's just not forget how hard it is to keep those hands clean!

To a great extent, any solution to medical costs must consist of a combination of improvements to how care is delivered, and upstream investments which reduce the need for the incidence of disease itself. Some of these can be initiated through by the primary care physician (such as wellness programs), and others through preventitive medicine. Containing growth in health care costs, as a percentage of total GDP, is unlikely without addressing these underlying root causes, and one of the primary missions of medicine must be to help identify these root causes and help improve the cultural will to act upon them. Health care costs ultimately should only be considered in this broader systems context, for true reform to be possible. The role of govenment may be best focused in that area, rather than attempting reforms to the underlying delivery system itself (where competition and transparency can be more effective agents of change)

Agencies such as the Robert Wood Johnson Foundation, which are funding IHI's efforts, are helping to implement dramatic and needed changes in our health care system, just as the Gates foundation is doing for world-wide health improvement efforts (synergistically, but more effectively, than government-led efforts). Interested parties may be interested in to follow the work of Ed Haiselmeier at the Heritage Foundation, the Center for American Progress, or Grace-Marie Turner at the Galen Institute, to keep track of other efforts at meaningful reform. You could also join the Lean Health Care Network to stay abreast of these and similar developments. To personalize the importance of reforms, you may also want to get information about how effective your practitioners are in practice, and react accordingly.

But don't expect economic windfalls as Congress has promised from the health care reform bill. Much of the suggested savings are dependent upon future changes that Congress will be unlikely to implement. Luckily, private reform efforts such as that described in this article will continue to lead to improvements in patient results, regardless of legislation. Thanks something we can all be thankful for.