Word: pronovost
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That's quite different from the initial federal response to Pronovost's lists. In 2003 Pronovost persuaded the state of Michigan to use three of his checklists in its intensive-care units. He worked with hospitals to overcome resistance from the staff to what appeared to be "more paperwork." He published the results of that study in the New England Journal of Medicine: a 66% reduction in infections and an estimated $175 million saved by not having to treat them...
Although having the checklist on hand improved compliance by surgical teams - 57% of the teams involved in the study carried out all six checklist items, up from 34% before the study began - there were many teams that did not adhere completely to the list. That's why Dr. Peter Pronovost, who won a MacArthur "genius" award for creating the concept of medical checklists and studying them in intensive-care units, remains skeptical of the study's remarkable results. "I wish checklists were Harry Potter's magic wand, but they're not," he says. "The behavior changed trivially, not enough...
Gawande disagrees with Pronovost's critique. "There's a synergy between the items on the checklist," he says. "Any one thing at any given time might not add up to much, but the net effect of all of it put together - especially making for more effective teamwork - matters...
...federal Office for Human Research Protections (OHRP) did not approve. After Pronovost was profiled in the New Yorker by Gawande in 2007, OHRP shut down data collection for the checklist study, claiming that it amounted to research being done without patients' informed consent. But the ensuing media attention spurred Congress to intervene, and Pronovost's program was allowed to continue and expand...
Gawande and Pronovost agree that checklists can be faulty and that they need to be studied carefully before and during implementation. "Safety should be a patient's right," says Pronovost. "If you are going to ask doctors to give up their autonomy and accept these standards, they have to be based on sound science and implemented wisely...