A New Yorker article (“The Checklist“) recounts Peter Pronovost’s efforts to improve the delivery of medical care. One of his simplest ideas was to invent a 5 step checklist to reduce line infections:
Doctors are supposed to (1) wash their hands with soap, (2) clean the patientâs skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in.
All doctors know these 5 steps, but in the distraction-filled world of the I.C.U., it is very easy for the physician to forget any one of the steps. Dr. Pronovost’s checklist idea has extended to other treatment areas as well. Yet he believes that Americans are still not getting serious about treating medical care as a science.
âThe fundamental problem with the quality of American medicine is that weâve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. Itâs viewed as the art of medicine. Thatâs a mistake, a huge mistake. And from a taxpayerâs perspective itâs outrageous.â? We have a thirty-billion-dollar-a-year National Institutes of Health, he pointed out, which has been a remarkable powerhouse of discovery. But we have no billion-dollar National Institute of Health Care Delivery studying how best to incorporate those discoveries into daily practice.
Checklists are not the solution to every problem.Â A large portion of medicine deals with complex condition with large uncertainties and many disease interactions.Â Further, it may be more difficult for an insurance company to institute checklists than a hospital manager or someone further down the chain of command.Â Nevertheless, standardization in medicine should help to dramatically improve quality.