Who knows? Maybe someday the Nobel Prize committee will review the evidence and decide that scientifically conceived experiments and programs in clinical process improvement are worthy of their attention. When that day comes, they need only read Peter’s book Safe Patients, Smart Hospitals to find the source material for the award presentation.
But in the meantime, every person involved in the delivery of care in hospitals should read this book. I am not so keen on the subtitle--”How one doctor’s checklist can help us change health care from the inside out”--because that is a highly simplified shorthand for the many lessons contained in the book. Sure, there is the checklist story, first applied to eliminating preventable central line infections. But, as Sullenberger notes, "A checklist alone is not sufficient. What makes it effective are the attitude, behavior and teamwork that go along with the use of it." A checklist applied to an organization that has not engaged in a cultural change that promotes respectful relationships among the clinical staff--described by Peter as a comprehensive unit-based safety program--will fail. Peter’s contribution is explaining how to create such an environment and in telling the story of his successes and failures along the way.
My favorite story is about the CEOs of the Michigan hospitals and how they learned they could help in the statewide effort to eliminate central line infections. One CEO said, “You do not get to be CEO without having answers to questions. Yet I do not have a clue what to do to improve safety. I am not comfortable admitting that.”
Peter admitted that he did not have all the answers either, but that a show of commitment from the CEOs was essential to programmatic success. “What if I made this easy for you? What if we were to send you one simple task for you to do each month, would that help?”
They liked the idea. Our first trial run came when we learned most of the hospitals used an antiseptic solution called Betadine to clean the skin prior to placing a central line . . . [but] chlorhexadine had been proven to be 50 percent more effective at reducing infections. Even though the two cost about the same, only 20% of the hospitals in Michigan stocked chlorhexidine....
We went to the doctors and nurses and encouraged them to change the antiseptic solutions . . . but the staff didn’t know how to make this happen. . . . So we sent all the CEOs a memo asking them to make sure that, within on e month, every hospital stocked chlorhexidine in their central line kits. . . . In one month it was done.
Every hospital can accomplish the kinds of changes described by Peter in this book. But they have to want to. To quote Jim Womack, "Whether you think you can or you think you can't -- you're right."
But accomplishing change is not the same as wishing it were so. Process improvement is a discipline. At one point in the book, Peter expresses frustration at the lack of data collected by several hospitals participating in the improvement program. A colleague says, “This is not how quality is done in this country. Quality is a concept that has never been viewed as research or science. As long as hospitals are doing projects they think will make patients safer, they believe patients are safer.”
Peter makes the case strongly: This is unacceptable. “Quality without science and research is absurd.”
Right. Now let’s get back to that Nobel Prize committee.
