Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out

Fantastic book, well worth a read.

I thought that this monograph would be a review of Pronovosts' pioneering work on checklists as a tool for quality improvement and safety for patients in a healthcare environment. It is much more. Pronovost, the scientist physician, and Vohr the scribe have produced a compelling volume on the culture of the system and how it must change. It is a good read with insights based upon experience and suggestions as to what works and what doesn't. If you provide or receive healthcare it will interest you. Particularly, physicians, nurses and administrators will find it helpful.

Expected better quality printing.

Un classique à lire

Years ago a politician lost the presidential election by not focusing on the real issue--the economy. Here we see in Dr. Pronovost's book we see it's not the checklist, it's the culture of medicine that has created this problem. Checklists are instruments that may help change that culture.Pronovost opens with the story of Josie King A 11/2 yr old baby who survives a long ordeal after sustaining severe burns only to die from a preventable central line infection. Mrs. King begins a crusade to prevent this from happening to anyone else's child. Two years later, nothing had been done. She is introduced to Dr. Pronovost who had made it his mission to improve patient care.Together with John's Hopkins administrators they put in place a system which includes changing the hierarchical structure of care of this deeply entrenched medical system which now not only included checklists, but also empowered nurses, better trains residents to work as a health care team and enforces standards of care.The practice of medicine has become unnecessarily complicated with a glut of information, most of which is superfluous, with everyone's hand in the health care pie resulting in a diffusion of responsibility, a lack of accountability, and failure of prioritization, add a touch of arrogance and entitlement, salt with physician persecution complex and stir. Together this is an incredibly noxious brew that is poisonous to all involved in the unhealthy careless system that plagues the practice of medicine today.What a checklist does when properly implemented is to provide structure and establish priorities. It also creates a group of people who feel personally empowered to be dedicated to one ethos, "the patient must come first."Dr. Pronovost takes us through this process from Johns Hopkins where incorporation of these principles with involvement at all levels from patient and family, to nurses, to residents and M.D.'s reduced the rate of catheter infection to almost zero to the state of Michigan where it was implemented throughout the state.Very important here was his process as well as the process of the institutions. The beginning of the book is captivating, the middle is very sluggish (hence the 4 stars) and the reader almost drowns in a sea of acronyms (a glossary would be helpful in the next edition) and the end picks up.This book is a must read for all health care professionals. Checklists work. Nonetheless, when Doctors Without Borders operating in some of the most disparate circumstances on earth with very sick patients with none of the modern technology and barebones surgical instrumentation can have a perioperative mortality equivalent to that in modern hospitals, we must truly examine what is really necessary for quality patient care.Cudos to Dr. Pronovost for his role in this process. In a parallel universe Dr Gwande was going through the same process. The reader is encouraged to read The Checklist Manifesto. The Checklist Manifesto: How to Get Things Right  Hopefully, these physicians will be key to right the badly listing ship of medical care in the U.S. The Checklist Manifesto: How to Get Things Right