When someone hears the name Peter Pronovost, they think of checklists.
Specifically, they think of the patient safety checklist he launched at Johns Hopkins Hospital after the tragic death of a young patient from a catheter infection in 2001. The checklist helped ensure healthcare workers were consistently following basic protocols, like washing their hands. It has helped reduce hospital-acquired infections due to catheters by 85% since 1999.
Pronovost, M.D., who recently began a gig as University Hospitals’ chief clinical transformation officer after a brief stint at UnitedHealthcare, has a new mission: to help change the narrative of healthcare organizations to believe that, even as a high-risk industry, zero patient deaths are actually possible.
“Words matter. They matter deeply because they create how we feel, those feelings generate stories that we tell and those stories drive how we behave,” Pronovost said, speaking at the Patient Safety Movement summit over the weekend.
So he told a story about his own trip to one of the U.S. military’s massive aircraft carriers. On board, as he spoke with an admiral on the ship, he met a man who was in charge of sweeping the deck. “I asked that gentleman what job he does,” Pronovost said. “He stood up tall and proud, looked me in the eye and said, ‘Sir, I help the planes take off and land safely to serve the mission of the United States.’ I said, ‘Whoa, that’s a guy connected to his purpose.’"
Pronovost asked the same question of an environmental services worker at a hospital. The man looked down sheepishly, Pronovost said. "‘I clean the rooms,’ he said. He didn’t say, ‘I’m an infection prevention specialist.'”
Those two stories make perfect sense in the context of what happened with his checklist, he said. When the idea of having a goal of zero hospital infections was first unveiled, people thought he was crazy.
“Clinician in this training just accepted that sometimes, when you care for sick people, little girls will die,” Pronovost said. “We accepted harm as inevitable. “
But some organizations that used the checklist were able to reach zero infections while others weren’t. What made the difference? Those hospitals’ leaders declared a goal of zero infections and created an enabling infrastructure including project management, training, data and feedback to make it easier for clinicians to be successful, Pronovost said.
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“They transparently reported results and had clear accountability,” Pronovost said. “If you had an infection, someone asked why.”
Studying the topic further, Pronovost partnered with anthropologists to interview hundreds of clinicians to help understand what happened at a deeper level at the successful hospitals.
“What we found was profound. You could see in their eyes what they believed in their hearts: They started telling a new story,” he said. “When we started, they said, 'These infections are inevitable … I’m powerless to stop it.' They got to zero when they told a new narrative.”