Safe Patients, Smart Hospitals

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“The tough-minded and revealing story of a leading doctor’s crusade against medical harm…Fascinating reading.” -Atul Gawande, author of The Checklist Manifesto.

First, do no harm. Doctors, nurses, and clinicians swear by this code of conduct. Yet, medical errors are made every single day-avoidable mistakes that often cost lives. Inspired by two such mistakes, 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.

Safe Patients, Smart Hospitals shows how Dr. Pronovost started a revolution by creating a simple checklist that standardized a common ICU procedure. His reforms are being implemented in all fifty states and have saved hundreds of lives by cutting hospital-acquired infection rates by 70%. Atul Gawande profiled Dr. Pronovost’s reforms in a New Yorker article and his bestselling book The Checklist Manifesto is based upon Dr. Pronovost’s success in patient safety. But Safe Patients, Smart Hospitals is the real story: an inspiring, thought-provoking, accessible insider’s narrative about how doctors and nurses are improving patient care for all Americans, today.”Safe Patients, Smart Hospitals is the tough-minded and revealing story of a leading doctor’s crusade against medical harm. The tale of Peter Pronovost’s journey in patient safety is fascinating reading.”
-Atul Gawande, author of The Checklist Manifesto, Better, and Complications

“No one in America has thought more — and done more — about patient safety than Dr. Pronovost. Safe Patients, Smart Hospitals is the right prescription for American health care.”
-Sherrod Brown, United States Senator (Ohio)

“Dr. Pronovost and Mr. Vohr offer a constructive and compelling case for patient safety and improving health care quality in the United States. Health providers and policy makers would benefit greatly from reading this book.”
-Tom Daschle, former Senator and author of Critical: What We Can Do about the Health-Care Crisis

“Both riveting and important…. Safe Patients, Smart Hospitals gives an excellent overview of changes in hospital practice which, when instituted, profoundly affect rates of serious medical complications and death. A pioneer in the field of patient safety, [Peter Pronovost] has radically altered how modern medicine is practiced.”
-Kay Redfield Jamison, Ph. D., author of An Unquiet Mind and Nothing Was the Same

“A must read for doctors, nurses, administrators and especially the public. Patient safety can only be achieved by everyone being informed and asking questions when…the train is [headed] off the track.”
-Edward D. Miller, M.D., Chief Executive Officer of Johns Hopkins Medicine, Dean of the Johns Hopkins University School of Medicine, and and vice president for medicine of The Johns Hopkins University

“A wonderful, beautifully written book-if every hospital in the country read it and followed Peter’s advice, I believe there would be fewer deaths from medical efforts and we would all benefit. Dr. Pronovost is a true hero, both to many in the healthcare industry and patients as well. Because of his hard work, passion, and brilliance, Peter has made hospitals around the world safer for us all. Safe Patients, Smart Hospitals is a true testament that one person can make a difference.”
-Sorrel King, patient safety advocate and author of Josie’s Story

“Safe Patients, Smart Hospitals reminds us how great change can be wrought by one person with the courage to do the right thing. Dr. Pronovost’s account tells the thrilling story about how–not so long ago–sloppiness and medical arrogance made even the best American hospitals perilous places to spend the night. His remedy: something simple, elegant, convincing.”
-Jean McGarry, professor at The Writing Seminars, Johns Hopkins University and author of seven books of fiction

“Peter Pronovost is a true visionary, whose simple checklist will save many lives and highlight the fact that the simplest answer is often the best, a must- read for all healthcare workers.”
-Patrick Perry, M.P.H, Executive Editor, The Saturday Evening Post

“Captivating and readable, this book takes a hard, honest look at the truth about toxic hospital cultures and the need for addressing culture, teamwork and cooperation. The compelling stories Peter shares illustrate the transformation that occurs when institutions address these issues. I also think the emphasis on improving work environments and respect among all professions involved in patient care clearly impacts nurses’ satisfaction, retention, and the nursing shortage in hospitals.”
-Martha N. Hill, PhD, RN, Dean and Professor of Nursing, Medicine and Public Health at Johns Hopkins University

“A riveting account right from the first page… Safe Patients, Smart Hospitals is a must read for everyone in healthcare including consumers. The authors have covered particularly well the perspectives and challenges of nurses in keeping patients safe. The book is a “good read” for us all.”
-Linda H. Aiken, Ph.D., The Claire M. Fagin Leadership Professor of Nursing and Professor of Sociology, Director, Center for Health Outcomes and Policy Research; University of Pennsylvania

“Dr. Peter Pronovost was first to recognize checklists have power to save lives and save money. We’ve heard about Dr. Pronovost’s checklists from learned journals and from the TV show ‘ER. His innovative ideas promote low cost, low tech solutions that have a high impact.”
-Barbara Mikulski, US Senator (Maryland)

“Having been at Hopkins for over three decades, I have been privileged to witness first- hand enormous advances in patient safety, largely through the efforts of Dr. Peter Pronovost. Through this book, the authors are making life- saving knowledge widely available not only to healthcare providers, but to patients and their loved ones. This book is a long overdue and welcome addition to the body of critically important medical information and it will save lives.”
-Benjamin S. Carson, Sr., M.D., Professor of Neurological Surgery, Oncology, Plastic Surgery, and Pediatrics

“Dr. Pronovost’s engaging book describes his journey to galvanize the healthcare community to eliminate bloodstream infections. It is an excellent case study in leadership, and should be read by anyone trying to lead a change effort.”
-Nolan D. Archibald, Chairman of the Board, President & Chief Executive Officer, The Black & Decker CorporationPETER PRONOVOST, Ph.D, M.D., is a professor at Johns Hopkins University School of Medicine and serves as medical 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 University.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.

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.

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