Safe Patients, Smart Hospitals

How One Doctors Checklist Can Help Us Change Health Care From The Inside Out.

Low-tech, low-cost innovations can have a dramatic impact on patient care and safety. That’s the message of “Safe Patients, Smart Hospitals,” which tells the story of Dr. Peter Pronovost’s crusade to improve patient safety by changing the culture of hospitals and the day-to-day responsibilities of both doctors and nurses.

Inspired by a pair of tragic and ultimately fatal medical mistakes — the misdiagnosis of his father’s cancer and a central line-associated bloodstream infection that resulted in the death of an eighteen-month-old burn victim — Pronovost developed a five-step checklist intended to reduce catheter infections, one that both standardized the catheterization process and empowered independent observers to ensure that none of the steps were skipped or overlooked. To further the prospects for compliance, implementation called for the creation of a central line cart, where all the supplies needed to complete the procedure are stored in one place.

When implemented in Michigan, the checklist lowered the rate of catheter infections by two-thirds (saving thousands of lives and tens of millions of dollars), prompting a rollout of the list — and related reforms — in all 50 states. To what can we attribute this astounding rate of improvement? Pronovost simply accounted for the fact that many hospital errors are due to lack of standardization, poor communication, and a paucity of teamwork between doctors, nurses, and administrators.

While “Safe Patients, Smart Hospitals” is largely encouraging and uplifting, it also illustrates how difficult it can and will be to address the antiquated and toxic culture that prevails in hospitals. In the course of the book, Pronovost relates several alarming and repugnant stories in which a doctor or surgeon prefers to risk a patient’s life rather than have his authority usurped or admit he might be fallible.

As Pronovost notes, culture, and the systems it influences and creates, can have an even larger influence on patient outcomes than a doctor’s skill or any other individual factor. And thanks in part to the culture of perfection among physicians, we still have a long way to go before clinicians are generally able to admit they might be harming patients, and thereby become more receptive to change.