Safe Patients, Smart Hospitals

by Pronovost, Peter; Vohr, Eric

• ISBN13: 9781594630644
• ISBN10: 159463064X
• Format: Hardcover
• Copyright: 2010-02-18
• Publisher: Hudson st Pr

Summary

The inspiring story of how a leading innovator in patient safety found a simple way to save countless lives. First, do no harm-doctors, nurses and clinicians swear by this code of conduct. Yet in hospitals and doctors' offices across the country, errors are made every single day - avoidable, simple mistakes that often cost lives. Inspired by two medical mistakes that not only ended in unnecessary deaths but hit close to home, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time. Dr. Pronovost began with simple improvements to a common procedure in the ER and ICU units at Johns Hopkins Hospital. Creating an easy five-step checklist based on the most up-to-date research for his fellow doctors and nurses to follow, he hoped that streamlining the procedure itself could slow the rate of infections patients often died from. But what Dr. Pronovost discovered was that doctors and nurses needed more than a checklist: the day-to-day environment needed to be more patient-driven and staff needed to see scientific results in order to know their efforts were a success. After those changes took effect, the units Dr. Pronovost worked with decreased their rate of infection by 70%. Today, all fifty states are implementing Dr. Pronovost's programs, which have the potential to save more lives than any other medical innovation in the past twenty-five years. But his ideas are just the beginning of the changes being made by doctors and nurses across the country making huge leaps to improve patient care. In Safe Patients, Smart Hospitals, Dr. Pronovost shares his own experience, anecdotal stories from his colleagues at Johns Hopkins and other hospitals that have made his approach their own, alongside comprehensive research-showing readers how small changes make a huge difference in patient care. Inspiring and thought provoking, this compelling book shows how one person with a cause really can make a huge difference in our lives.

Author Biography

Peter Pronovost, Ph.D, M.D., is a professor at Johns Hopkins University School of Medicine and serves as medicald director for the Johns Hopkins Center for Innovation in Quality Patient Care.
Eric Vohr was formerly the assistant director of media relations at Johns Hopkins University School of Medicine and he teaches technical writing at Johns Hopkins.

Excerpts

Excerpted from SAFE PATIENTS, SMART HOSPITALS: How One Doctor’s Checklist Can Help Us Change Health Card From the Inside Out by Peter Pronovost, M.D., Ph. D, and Eric Vohr, publishing February 18th, 2010.

Chapter 3

We use checklists to standardize and ensure quality, consistency and safety every day of our lives. Even something as ubiquitous as our morning cup of coffee comes with its own checklist. I found this one on the Starbucks Website:

• Use the right proportions of coffee and water -- 2 tablespoons of coffee for 6 ounces water
• Match the correct grind to the coffee making process -- fine for espresso, medium for drip, coarse for a French press.
• Use good water -- coffee is 98 percent water, so if the water tastes good, the coffee will taste good.
• Make sure the coffee is fresh -- like all natural elements, coffee deteriorates when exposed to light, air and moisture.

As simple as this sounds, coffee is complex -- nowhere near as complex as the human body, but nonetheless complex. One could easily write a 300-page book on how to best transform this scrubby little plant into a delicious, warm, eye-opening beverage. Roast, altitude, soil, sunlight and rainfall, all have effect on the flavor. However, according to Starbucks, when I wake up and prepare my morning fix all I have to worry about are the “four fundamentals,” proportion, grind, water and freshness -- a checklist, if you will.

Successful companies, like Starbucks, have been using checklists for years to ensure quality. Important processes are standardized and consistently performed whether in Baltimore or Beijing. Yet standardization is sorely lacking in health care.

Look at a something as obvious as hand washing. It’s been known in medicine for more than a century that this simple procedure can reduce infections and save lives. Yet doctors do not wash their hands consistently when visiting a patient and there is no standardized procedure in place to ensure they do. They know they are supposed to, but on average they do it 30 percent of the time. Perhaps more alarming, most hospitals do not monitor rates of hand washing and there’s no accountability for this performance. And while people don’t usually die from bad coffee, many patients have likely died from bacteria on a physician’s hands.

Why isn’t hand washing standardized in hospitals – along with thousands of other procedures that are known to save lives? It would be easy to blame doctors, but the bulk of the problem does not lie there. Most physicians care deeply about their work and want nothing but the safest care for their patients. It’s the culture of medicine and the systems within which doctors practice that are at fault. Physicians, including myself, are trained to believe that we don’t need standardization because we don’t make mistakes; we are told that our brains have endless storage capacity and that we have perfect recall of all the thousands of hours of information we’ve learned from medical school and years of practice. Yet we do not. The fact is, just like all other humans, we forget. We are fallible. We do not see systems and we are not trained to improve them.

Furthermore, doctors are also trained to believe that we don’t always have to follow the rules or ask for anyone’s help. We are the smartest people in the world and can figure out any problem on our own. When I was in medical school, I remember specifically being told, “Guidelines are for simple physicians not Hopkins physicians. At Hopkins we know the evidence, we are expert clinicians; we know the nuances of our patients so we do not need guidelines.” I have since realized how dangerous it is to use that statement to train physicians.

It’s true every patient is unique and clear guidelines are often absent or incomplete, making it necessary for doctors to rely on professional judgment to make personal, often independent, decisions about care. When evidence is immature or lacking, our intuition or reasoning is often the best evidence we have. However, we also need to recognize that standardization offers tremendous benefits, especially when evidence is robust. As medical science matures, we must progress from providing care primarily based on intuition, to a place where this independent approach is properly balanced with care based on collective wisdom and proven scientific evidence.

Yet as science continues to propel us into the future at an alarming rate, the culture of medicine dwells solemnly in the past. We do not train clinicians about the value of standardization, we do not train physicians to share knowledge or to improve bad systems that harm patients, we do not train physicians to work as a team organized around the patient and for the most part we do not hold them accountable for their performance or patient outcomes.