Type the name Peter Pronovost into Google and try to make it past the “n” before the word “checklist” pops up. That’s because Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, is the “checklist doctor,” widely known for a five-step checklist designed to reduce the incidence of central-line infections and credited by SHM with saving thousands of lives. He was named one of the 100 Most Influential People in the World by Time magazine, and he co-authored a book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out.”
Dr. Pronovost is one of three keynote speakers slated to offer their wisdom and insights to thousands of hospitalists attending HM15, scheduled for March 29-April 1 at the Gaylord National Resort and Convention Center in National Harbor, Md.
And before you ask—yes, he smiles when people call him the “checklist guy.”
“These catheter infections, just to give you an example, they used to kill as many people as breast or prostate cancer in the U.S. This isn’t some trivial public health problem,” Dr. Pronovost says. “This is a public health problem the size of breast or prostate cancer. And we virtually eliminated it, [which is] pretty remarkable about what the potential of this approach is in healthcare. That is just one harm. We have a lot of other things to go still.”
Dr. Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, has titled his HM15 talk, “Taking Quality to the Next Level.” One of his main beliefs is that intrinsically motivated efforts are much more successful than payment carrots or sticks wielded by the Centers for Medicare and Medicaid Services (CMS).
“We tap into this incredibly rich and passionate juice of improvement work,” he says of intrinsic motivation. “Whether it’s through a church or through a club, all of us have felt that when you connect to a community, the energy and the passion that that unleashes. Hospitalists have the wisdom to know what to do and how to do it right, and it’s just so much more effective when you tap into intrinsic motivation.”
His famed checklist was a great start to that, but he says more needs to be done. That work looked at eliminating a single hospital-acquired condition. Now, Dr. Pronovost has reframed the question: Can we eliminate all harms? What if hospitals listed out all harms and then gave each a checklist?
“It quickly gets to well beyond the potential of human memory, because there are about 150 things we have to do,” he says. “So I’m going to be showcasing a new app that we made that gives you real-time compliance with all those checklists. If I’m missing any one of those 150 things, there’s a red box next to the patient’s name, and all I have to go do is click on the red box and see what I’m missing.”
Dr. Pronovost sees that approach as a fundamental shift in how safety is viewed. It can’t be based on “heroism,” when someone remembers to remember something; rather, it needs to be rooted in properly designed systems that leverage technology to achieve desired results.
To look at it another way, consider a conversation Dr. Pronovost had with friends in engineering who previously worked on missions launching satellites into space.
“They said to me, ‘Peter, you guys are thinking about this backwards in healthcare. If we had to put a mission up…it can blow up for 12 reasons. It didn’t blow up for reason No. 1—call it a bloodstream infection—but it did blow up for reasons 2 through 12, do you think we’d be patting ourselves on the back [because] that No. 1 reason didn’t get us?”
In that vein, Dr. Pronovost believes that hospitalists can be a lynchpin in what he calls “change leadership.”
“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions,” he says. “I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”
Richard Quinn is a freelance writer in New Jersey.