‘It is almost magic in their eyes’ photoQ&A with doctor who created infection-prevention checklist

Issue/Volume: Posted: 3:46 p.m. Saturday, April 27, 2013

4/27/2013Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins University School of Medicine, has become well-known at hospitals nationwide for developing a proven method of reducing deadly infections associated with central lines. His checklist and changes to hospital culture led to astounding decreases in these infections in a landmark study conducted in Michigan. The protocol is now being used across the U.S. He recently spoke with the AJC’s Carrie Teegardin by phone. This is an edited transcript of his remarks.

Q. What first made you challenge the conventional wisdom that most hospital infections were not preventable?

A. What really made it happen was a little girl, Josie King, died in my hospital at 18 months of a catheter infection, and she looked hauntingly like my daughter. She died on my birthday. Her mother, an amazing woman, Sorrel King, was working with the hospital, and she came to me [months later] and looked me in the eye and said, “Could you tell me my daughter would be less likely to die now than a year ago?” In many senses, I made excuses: “Well, I’m doing this, I’m doing that.” And she cut me off and said, “Peter, I don’t care what you’re doing. That’s your job. Just get your infection rates down.” It was really an epiphany for me, truly like a Paul on the Road to Damascus. And I said, “Sorrel, I can’t give you an answer, but you deserve one and I will.” And that’s what really drove it. I started looking at Hopkins’ rates and our rates were sky high and it was really humbling and I said, “I don’t want to be killing little girls.”

Q. Tell us more about how your program changed the culture in hospitals?

A. We changed the social norms from “these infections are inevitable,” which was the common mental model. It was my own mental model when I started as a doc and I was causing these infections. It changed to say, “Not only are they preventable, but I am empowered to do something about it.” Many clinicians are completely disempowered and they feel like they are a cog in the wheel and say, “I’m just a nurse or a doc. Who am I to think I can change it?” What we have seen is, it is almost magic in their eyes when that switch goes off and they say, “I get it. I could actually do this.” It’s that belief system that either holds them back or launches dramatic improvements.

Q. What’s the strongest motivator to get hospitals to improve?

A. The federal government’s main approach to improving quality has been pay for performance, in other words an economic model, [and] there is essentially no data that it works. What I call extrinsic motivations — either pay for performance or public reporting [the practice in many states of requiring hospitals to provide a public accounting of their infection rates] — haven’t really realized improvements. The project we led was all intrinsic motivations. That is not to say pay for performance and public reporting don’t have a role but I think it has to supplement, not supplant, intrinsic motivations. If you have the tribe believing this is a big problem and we can solve it, then pay for performance or public reporting is like gasoline on it. It will accelerate it. If the tribe doesn’t believe they can solve it, if you haven’t garnered that intrinsic motivation, you can do all the pay for performance you want and that won’t translate into measurable improvements.

Q. What’s the most important factor in improving patient safety?

A. There’s a famous physician who was kind of the father of quality improvement, and when he was on his deathbed he was interviewed. “OK, what’s the secret of quality now that you have devoted your life to it and you have been a patient?” He said the secret of quality is love: if you have love you change the system. It may sound corny but it’s true — love your patients, love your colleagues, love your profession. The magic is not in the checklist.