THE UNDERRATED CHECKLIST: FIVE STEPS TO SAVE LIVES
The idea of having to go through a checklist in your job may sound a little demeaning. That type of thinking is why Dr. Peter Pronovost of Johns Hopkins University School of Medicine ran into opposition when he proposed a five-step checklist that would not only save money, but savelives. In the United States, hospital-acquired infections affect 1 in 10 patients, killing 90,000 of them and costing as much as $11 billion each year.Many of those infections are acquired when an IV line delivering medication becomes infected. Dr. Pronovost’s checklist is simple and straightforward, including steps such as: Doctors must wash their hands before inserting an IV, and the patient’s skin must be cleaned with antiseptic at the point of the insertion. When Michigan hospitals put the checklist into practice, they not only saved over $175 million in eighteen months because they didn’t have to treat infections, but they saved nearly 1,500 lives!
Such impressive evidence would seem to convert even the
toughest critic of checklists, but the hospitals found the same truth that many trainers face: employees don’t always comply with rules that are for their own good or for the good of others. They need to be convinced. It turns out that doctors are just as stubborn as pro- duction employees who refuse to wear safety goggles or a hard hat. Dr. Pronovost found that doctors don’t like being told what to do. They especially resented being reminded of the checklist by the nurses who were put in charge of managing the checklists. The orga- nizational culture of the hospitals, including the roles of doctors and nurses, got in the way of patient safety. Dr. Pronovost learned to overcome the resistance by bringing both doctors and nurses
together in training and appealing to their common concern for patient health. He asked, “Would you ever intentionally allow a patient’s health to be harmed in your presence?” They’d say “Of course...
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