The 1999 release of the Institute of Medicine's report To Err is Human: Building a Safer Health System alerted the public to the dangers associated with hospital care. Don Berwick, MD, president and CEO of the Institute for Healthcare Improvement (IHI), took the report to heart. A charismatic cheerleader for patient safety, he has been helping hospitals change the way they operate-challenging them, inspiring them, even cajoling them into making changes.

And he isn't content using only one way to accomplish this. The 2003 IHI initiative Transforming Care at the Bedside (see AJN Reports, April 2005) is being implemented at the unit level, while another (see Pursuing Perfection: Health Care for the 21st Century, page 27) is an ambitious project to redesign systems of care delivery in hospitals.

FIGURE. The IHI launched a bus tour in September 2005 to promote its 100,000 Lives Campaign, an initiative designed to reduce deaths in hospitals by encouraging the implementation of several key interventions. Here, Don Berwick, president and CEO of the IHI (on the bus) and colleagues Joseph McCannon, 100,000 Lives Campaign manager, and Alexi Nazem, national field manager for the campaign, are arriving at Metropolitan Hospital in New York City, where 36 hospitals have joined the campaign. For more information on the campaign, go to

And in the ongoing 100,000 Lives Campaign, he challenges hospitals to implement specific measures that have been proven to reduce errors or patient mortality rates. These include deployment of "rapid response teams" when a patient's condition declines; reliable, evidence-based care for myocardial infarction; medication reconciliation to prevent adverse drug events; clearly articulated steps to prevent central-line and surgical-site infections; and science-based methods to prevent ventilator-associated pneumonia.

The initiative's stated goal is to save 100,000 lives by June 14, 2006. To accomplish this, Berwick originally calculated that he needed 2,300 hospitals to sign on.

"Enrollment has exceeded expectations," Berwick says. "We have more than 2,700 hospitals committed to implementing at least one safety measure." The most common measures taken by the hospitals are the creation of rapid response teams and the reduction of hospital-acquired infections; medication reconciliation is the toughest measure to implement, Berwick says, because it involves multiple hospital departments and processes.

Berwick says real change can happen in a system only when those at the top-who can remove obstacles and provide support and stewardship-and those on the front line come together. "Cooperation throughout the entire hospital work-force is key," he says.

"Nursing," adds Berwick, "is at the heart of change-nurses can make it happen without others, but it won't happen without nurses."

Berwick attributes his success to timing and to "a social movement now underway-everyone is frustrated with health care." And nurses, he says, "get it" more than anyone else. (For more information on IHI and its programs, go to http://www.ihi.org/ihi.)