Too many of them still seem to think that 4 years of pre-med, 4 years of med school, and 2 to 4 years of internship makes them infallible; when all it really does is make them incredibly focused and good at some things, and incredibly blind to the rest of the world.
I've been pushing for checklist use of best practices for nearly a decade now. It has been an uphill fight the whole way. You literally have to convince them one at a time as they usually blow off anything shown to them in seminars and meetings; unless it's from a close friend and peer.
Now I'll be the first to admit a checklist won't work for every situation. But it will work for the vast majority of them. When it doesn't, the physician must justify the deviation with a real, commonly and professionally acceptable reason. And they need to adhere to the rest of the checklist apart from the necessary deviations.
Checklists work.
This is exciting news, and personally gratifying, as I have been following the checklist story for almost three years. (Reporters like stories that become important and turn out well.)
Back then Dr. Peter Pronovost of Johns Hopkins was getting incredible pushback on this simple idea, that a checklist like those used by airline pilots be run to prevent hospital infections.
Then Pronovost got a MacArthur Genius grant. And now the University of Michigan has proven, in a study to be published later this month in the British Medical Journal, that checklists not only reduce infections to near-zero, but continue doing so years after they are implemented.
The checklist was implemented in 100 hospitals, along with physician training and new, standardized supply carts controlled for one-time use.
Hospital infections have become an epidemic, with 80,000 American victims each year, almost half of whom die, and a total cost of $3 billion. The CDC estimates 10-20% of hospital patients get some infection each year.
Pronovost has now proven this can be virtually eliminated, at a cost of near zero.
Another result of the checklist is a culture change, Pronovost said:
Nurses question doctors who don’t wash their hands or use the checklist diligently. It means clinicians no longer thinking central-line infections are inevitable. They now believe these infections are preventable and they are creating a culture where they are.
Why did Pronovost get such pushback? Power.
Doctors are accustomed to managing their workplace. They are the authority. Nurses and clinicians are just helpers. But give these people a checklist, and suddenly they can have power over the doctor. If the doctor proceeds against the checklist, an underling can tell him (or her) to do what is right.
Pronovost got his genius grant the same year as Regina Benjamin, now the nation’s Surgeon General.
Pronovost’s book on the checklist revolution, Safe Patients, Smart Hospitals, will be released in two weeks. Amazon is taking orders now.
