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How a lowly checklist changed the game

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Peter Pronovost, a doctor in the intensive care unit (ICU) at Johns Hopkins University Hospital in Baltimore, noticed that in the pressure of the moment, most doctors overlooked basic guidelines to keep bacteria out of intravenous lines.

Believing there had to be a way to prevent some of the 80,000 line infections per year plaguing U.S. hospitals, Pronovost set up a five-step checklist that all doctors must follow when inserting central lines: 1. Wash your hands. 2. Clean your patient’s skin with the antiseptic chlorhexidine. 3. Put sterile drapes over the patient’s whole body. 4. Wear a sterile mask, hat, gown and gloves. 5. Put a sterile cover where you inserted the line.

To back up every doctor, Pronovost began by posting a nurse with the checklist as a prod. Some of the doctors felt insulted by such a simple procedure. You can bet there was resistance.

But from 2001 to 2002, the hospital’s infection rate dropped from 11 a day to zero. When Michigan then required the checklist in ICUs statewide, line infections also fell to virtually zero, accounting for an estimated 1,500 saved lives.

So why isn’t this basic procedure in place nationwide? Easy. It takes leaders to overcome resistance, even when the solution is simple.

Bottom line: How much power could you add to your game by taking five steps to ensure against failure?

—Adapted from “Medical Breakthrough ’08: Lifesaving Hospital Checklist,” Tara Conry, Reader’s Digest.

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