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

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First, do no harm. Doctors, nurses, and clinicians swear by this code of conduct. Yet, medical errors are made every single day-avoidable mistakes that often cost lives. Inspired by two such mistakes, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time. Safe Patients, Smart Hospi First, do no harm. Doctors, nurses, and clinicians swear by this code of conduct. Yet, medical errors are made every single day-avoidable mistakes that often cost lives. Inspired by two such mistakes, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time. Safe Patients, Smart Hospitals shows how Dr. Pronovost started a revolution by creating a simple checklist that standardized a common ICU procedure. His reforms are being implemented in all fifty states and have saved hundreds of lives by cutting hospital-acquired infection rates by 70%. Atul Gawande profiled Dr. Pronovost's reforms in a New Yorker article and his bestselling book The Checklist Manifesto is based upon Dr. Pronovost's success in patient safety. But Safe Patients, Smart Hospitals is the real story: an inspiring, thought-provoking, accessible insider's narrative about how doctors and nurses are improving patient care for all Americans, today.


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First, do no harm. Doctors, nurses, and clinicians swear by this code of conduct. Yet, medical errors are made every single day-avoidable mistakes that often cost lives. Inspired by two such mistakes, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time. Safe Patients, Smart Hospi First, do no harm. Doctors, nurses, and clinicians swear by this code of conduct. Yet, medical errors are made every single day-avoidable mistakes that often cost lives. Inspired by two such mistakes, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time. Safe Patients, Smart Hospitals shows how Dr. Pronovost started a revolution by creating a simple checklist that standardized a common ICU procedure. His reforms are being implemented in all fifty states and have saved hundreds of lives by cutting hospital-acquired infection rates by 70%. Atul Gawande profiled Dr. Pronovost's reforms in a New Yorker article and his bestselling book The Checklist Manifesto is based upon Dr. Pronovost's success in patient safety. But Safe Patients, Smart Hospitals is the real story: an inspiring, thought-provoking, accessible insider's narrative about how doctors and nurses are improving patient care for all Americans, today.

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

  1. 4 out of 5

    Jack

    Such a shame. Pronovost is clearly a master, and the man perhaps most responsible for the current visibility of quantitatively robust patient safety work, and the revival of the checklist as a useful tool. But this book is schlock. It feels cobbled together, sometimes out of of press clippings where they didn't even both to change the tense of the verbs. Large chunks are inconceivably self-congratulatory, or spent extolling Hopkins as the "Greatest Hospital Ever." We learn almost nothing about t Such a shame. Pronovost is clearly a master, and the man perhaps most responsible for the current visibility of quantitatively robust patient safety work, and the revival of the checklist as a useful tool. But this book is schlock. It feels cobbled together, sometimes out of of press clippings where they didn't even both to change the tense of the verbs. Large chunks are inconceivably self-congratulatory, or spent extolling Hopkins as the "Greatest Hospital Ever." We learn almost nothing about the process and challenge of developing interesting ideas. We learn little about the content of the ideas. It's just sad. If you want to learn more about why Checklists are a good thing, go read Atul Gawande's The Checklist Manifesto. If you want to read intellectual autobiography, I still like Watson's The Double Helix. I'm not sure what role this book has, except as an example of smart people writing bad books.

  2. 4 out of 5

    Sharil

    This review has been hidden because it contains spoilers. To view it, click here. This book starts with a very compelling story of how a child dies as a result of flawed communication systems within a hospital. Gripping - but I have to keep putting it down because I get so mad. The last half of the book was about changing systems and culture. Not as engaging as the personal stories at the beginning.

  3. 4 out of 5

    Book

    Safe Patients, Smart Hospitals: How One Doctor’s Checklist can Help us Change Health Care from the Inside Out by Peter Pronovost, Ph.D., and Eric Vohr “Safe Patients, Smart Hospitals" is an important, and revealing quest to improve our health care system by reducing preventable mistakes. Dr. Pronovost takes the reader on journey from inside John Hopkins Hospital and shows us how checklists and cultural changes contributed to significant improvements to patient care. This insightful 304-page book Safe Patients, Smart Hospitals: How One Doctor’s Checklist can Help us Change Health Care from the Inside Out by Peter Pronovost, Ph.D., and Eric Vohr “Safe Patients, Smart Hospitals" is an important, and revealing quest to improve our health care system by reducing preventable mistakes. Dr. Pronovost takes the reader on journey from inside John Hopkins Hospital and shows us how checklists and cultural changes contributed to significant improvements to patient care. This insightful 304-page book includes ten unnamed chapters and a conclusion. Positives: 1. An accessible book on hospital administration. Presents an insightful overview of significant changes in patient care. A behind-the-scenes look. 2. Dr. Pronovost knows and cares an important combination that is felt throughout the book and an essential quality to a health care provider. 3. The power of putting a name to a patient. “There is no question you need to provide proof for your theories. But without the story, without emotion, there is no context, it’s just words.” 4. It all starts by identifying the problems. “One of the problems with health care that I knew was harming patients was the lack of a good mechanism for getting proven treatments to the bedside where they can improve care.” There are a number of countless examples throughout the book. 5. Ingenious idea of simple checklists that captured the most important bits of knowledge on a need basis. Simple, effective and once the culture has changed much easier to enforce and be accountable. 6. Preventing infections. “Conversely, these catheters present a risk. It’s estimated that the national mean rate of infections from central line catheters is four infections per thousand catheter days (a catheter day is one day that one patient has a catheter).” 7. Amazing facts, “That means each year roughly eighty thousand patients become infected as a result of placing central lines, and thirty thousand to sixty thousand die, at a cost of up to $3 billion nationally.” 8. Makes it perfectly clear that the lack of standards are hurting the industry and thus patients. “This lack of standardization is entirely unacceptable and dangerous to patients, yet it happens every day, across the country and around the world. It’s obvious that everyone should receive the same evidence-based training, yet there is no system in place to guarantee all doctors will learn how to do it correctly. “ 9. Dr. Pronovost narrates in great detail how he helped prevent central line infections. “Our plan was to include what we thought was a manageable number of key steps for doctors and nurses to follow to ensure patients did not get infections from catheters.” 10. Great quotes and practices that apply to many disciplines, “We also need to increase the efficiency with which we gather and share knowledge.” 11. The TRIP (Translating Research Into Practice) model and its four key principles. “With this in mind we structured the TRIP model using four key principles (for central line infections): 1. Summarize evidence into checklists. 2. Identify and mitigate local barriers to implementation. 3. Measure performance. 4. Ensure all patients reliably receive the intervention.” 12. A principle I live by at work, “Measurement is one of the most important aspects of our work. We are scientists and the cornerstone of science is measurement. Without hard scientific proof, we can’t be sure something actually works.” Had to share. 13. I really enjoyed learning about the-behind-the-scenes dynamics at hospitals. “Operating rooms are also exceedingly hierarchical. They have a pecking order that is stronger and stricter than the marines. The operating room is a world of ritual and privilege, a world of special favors for the elite.” 14. Addressing culture. “What we needed was a program that focused primarily on this local culture, a program that worked at the unit level to help train physicians, nurses, and other staff to work together effectively as a team.” 15. One of the great attributes of Dr. Pronovost is his ability to make his goals clear, “The goal of CUSP is to improve communication, teamwork, and culture in these individual units so they can focus more efficiently on the primary goal, improving patient outcomes.” “Since the overarching goal in CUSP is to improve culture and learn from mistakes, the point here is not only to fix system problems, but also to fix teamwork problems by improving communication and cooperation. The idea is to create a culture of positivity and hope.” 16. Safety is a science. “In the science of safety training, we share stories of real patient harm, like the Josie King tragedy.” 17. Explains how he expanded his findings and new practices to other hospitals and countries. “Word got out about our work in Spain and other countries started to express interest. The World Health Organization’s Patient Safety Program was already supporting our work in Spain so we asked them to help us implement the program across Europe and the world.” 18. Federal recognition and support. “Our efforts in Michigan and Washington had gotten the attention of the new secretary of Health and Human Services, Kathleen Sebelius. Referring to our work, she called for a 75 percent reduction in ICU bloodstream infections within three years in all U.S. hospitals.” 19. The need for oversight, “As a result of this absence of oversight on safety reporting, hospitals advertise erroneous and misleading information on Web sites, in glossy brochures, on billboards, and on TV. There is no assurance of the accuracy of their claims, because the measurement of quality in health care is neither standardized nor consistently reliable.” 20. Excellent closing chapter that summarizes the practices demonstrated in this book through four fictitious cases. “Let’s examine four relatively common diseases that likely touch everyone’s life either personally or through a loved one—cancer, mental illness, heart disease, and stroke. With each of these diseases I will try to demonstrate patient safety efforts have either directly or indirectly made the patient experience better from admission to discharge to outpatient care.” Negatives: 1. As an industrial engineer and one that has made a living from improving processes I was hoping for more technical insights. I understand that this book was written for the masses and such things may have interrupted the main flow of the book but that’s what appendices are for. Examples of process flow charts, organizational charts, graphs, etc…would have been of keen interest to some of us in administrative roles. 2. Surprisingly, poor editing. A book of such importance deserved better treatment. 3. Repetitive. 4. The narrative is accessible but at times dry. 5. No formal bibliography. 6. No notes or links to source material. 7. It always makes me cringe when subject-matter experts go out of their field of expertise to make erroneous comments about other fields. Dr. Pronovost made some comments regarding the housing bubble that wasn’t really the complete picture. That being said, his comments regarding the aviation industry were accurate. Culture and the dogmatic respect of authority as in the Korean culture were factors that lead to more mishaps. In summary, this is a must-read for hospital administrators and for anyone interested in how hospitals take care of patients. Fascinating subject material and such an important topic. Kudos to Dr. Pronovost for having the drive and vision of making a significant change for how hospitals are run all over the world. His simple but ingenious checklists, and the changing of a culture has resulted in many lives saved. His contributions to improved patient care far exceeds any shortcomings the book has. Too important not to read, I highly recommend it. Further recommendations: “Healing America” by T.R. Reid, “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America” by Otis Webb Brawley, M.D. with Paul Goldberg, “Landmark: The Inside Story of America's New Health-Care Law-The Affordable Care Act-and What It Means for Us All” by The Washington Post Staff, “Overtreated” by Shannon Brownlee, “Overdiagnosed” by H. Gilbert Welsh, “Overdosed America” by John Abramson, “Selling Sickness” by Ray Moynihan, “Unaccountable” by Marty Makary, M.D., “Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It” by David Goldhill, “Sick” by Jonathan Cohn, “Complications: A Surgeon's Notes on an Imperfect Science” by Atul Gawande, and “Every Patient Tells A Story” by Lisa Sanders, M.D..

  4. 4 out of 5

    Prachi

    Preventable medical errors are more common than reported. Doctors are human beings, and thus fallible. They commit errors even if they are experts in their fields. Sometimes, these errors can be life-threatening. In this book, Dr. Peter Pronovost- a world-renowned patient safety champion- takes us through the journey of designing and implementing the very first medical checklist. This book will tell everything (“what, when, where, how, and why”) for the checklist implementation process. The auth Preventable medical errors are more common than reported. Doctors are human beings, and thus fallible. They commit errors even if they are experts in their fields. Sometimes, these errors can be life-threatening. In this book, Dr. Peter Pronovost- a world-renowned patient safety champion- takes us through the journey of designing and implementing the very first medical checklist. This book will tell everything (“what, when, where, how, and why”) for the checklist implementation process. The author has described everything by sharing his personal & professional experiences. This includes all the minor & major barriers and issues faced by him and how he resolved those step-by-step. Few concepts are explained several times as author is narrating how he accomplished the safety improvement goals over a period or years, so you might find a few repetitions. Major takeaways are: Condense knowledge into checklists using both ‘tacit’ and ‘explicit’ knowledge. Understand the local culture and transform it if needed and should be backed with evidence and patience. Communication is a major roadblock in healthcare. Measurement is one of the most essential elements to bring positive change. Attempt to involve senior leaders and executives in the initiatives. Use the knowledge wealth of front-line workers. They see what decision-makers cannot and so their tremendous knowledge should not be disregarded. This book is a must-read for everyone who is related to the field of hospital healthcare. Note: If anyone is interested in having detailed notes of this book, please contact me and I will share a copy of my notes with you. >https://aninquisitivepen.wordpress.co...

  5. 4 out of 5

    Leena Khan

    What a shame. Almost an autobiographical account of gratuitous self-admiration. You might be able to pick out the few interesting take home messages and ignore the self-love of Peter Pronovost, medical hero of the 21st century, but it was tiring and tedious.

  6. 5 out of 5

    Danielle

    This book is written by the doctor at Johns Hopkins University who established the checklist as a way to increase patient safety. I originally became aware of this book because my book club read Josie's Story and met with the author Sorrel King who mentioned the publication of this book. The death of Josie King due to a preventable medical error and Sorrel King's fight to increase patient safety was what led Pronovost to develop his checklist methodology. The book relates the incidents surroundi This book is written by the doctor at Johns Hopkins University who established the checklist as a way to increase patient safety. I originally became aware of this book because my book club read Josie's Story and met with the author Sorrel King who mentioned the publication of this book. The death of Josie King due to a preventable medical error and Sorrel King's fight to increase patient safety was what led Pronovost to develop his checklist methodology. The book relates the incidents surrounding Josie's death and how he became involved in the fight for patient safety protocols. It details its adoption by the state of Michigan and why he has had such difficulty instituting it elsewhere including in his home state of Maryland. It is an area that I find extremely interesting so I enjoyed the book, although he is not the best writer in the world. I am looking forward to reading Atul Gawande's Checklist Manifesto, which covers Pronovost's efforts as well as other efforts at patient safety.

  7. 5 out of 5

    Rhonda Sue

    Good information and interesting read. The author and doctor at Johns Hopkins was able to institute a system or program to improve patient safety and reduce and eliminate central line infections. This is similar to other programs and systems that change culture in the hospital. Although this one focused on central line infections, more real life stories would have made the book more powerful. It's amazing to me that healthcare workers and docs still refuse to wash their hands before handling pat Good information and interesting read. The author and doctor at Johns Hopkins was able to institute a system or program to improve patient safety and reduce and eliminate central line infections. This is similar to other programs and systems that change culture in the hospital. Although this one focused on central line infections, more real life stories would have made the book more powerful. It's amazing to me that healthcare workers and docs still refuse to wash their hands before handling patients. Where is Ignatz Semmelweis when you need him? Sadly, with many medical books as here, the authors and clinicians are cheerleaders for liberalism. It takes away from the message in the book.

  8. 5 out of 5

    Samantha Nemeth

    I can't recommend this book enough! Once I was accepted to grad school for public health, I went to the bookstore and this book caught my eye. It has since shaped my interests in the field and what I want to do career-wise. Dr. Pronovost breaks down seemingly complicated patient care to simple checklist items that are tracked to improve patient safety in hospitals. While a certain amount of infections were assumed to be par for the course in hospitals, he proved them wrong and has taken his chec I can't recommend this book enough! Once I was accepted to grad school for public health, I went to the bookstore and this book caught my eye. It has since shaped my interests in the field and what I want to do career-wise. Dr. Pronovost breaks down seemingly complicated patient care to simple checklist items that are tracked to improve patient safety in hospitals. While a certain amount of infections were assumed to be par for the course in hospitals, he proved them wrong and has taken his checklists and more importantly awareness and change to hospitals across the country.

  9. 5 out of 5

    Harry Lane

    Clearly an important topic, presented in layman's language. The anecdotal material regarding the prevalence of hubris among doctors was striking. Much of Pronovost's work implicitly addresses this issue. One thing that struck me was Pronovost's insistence that mistakes be referred to as "defects" to eliminate the personal blame element and emphasize the systemic failure. Yet, he himself uses the term "error" exclusively in the remainder of the book. Clearly an important topic, presented in layman's language. The anecdotal material regarding the prevalence of hubris among doctors was striking. Much of Pronovost's work implicitly addresses this issue. One thing that struck me was Pronovost's insistence that mistakes be referred to as "defects" to eliminate the personal blame element and emphasize the systemic failure. Yet, he himself uses the term "error" exclusively in the remainder of the book.

  10. 5 out of 5

    Jessie

    Okay, so a book about hospital administration should be super boring- right? It should be, except that its so shocking to read about all the medical errors Pronovost describes, and then even more shocking to read how incredibly simple-seeming and effective many of the preventative steps he has been a leader in implementing actually are.

  11. 5 out of 5

    Bologna_frog

    I really respect Pronovost's work and successes. This book details developing story of his pursuit of increased medical error reporting and improvements. Too much play-by-play action for me, like a memoir. I was looking for more analysis, less story. I really respect Pronovost's work and successes. This book details developing story of his pursuit of increased medical error reporting and improvements. Too much play-by-play action for me, like a memoir. I was looking for more analysis, less story.

  12. 4 out of 5

    Marni

    Easy to read. As some other reviewers noted, it was perhaps not vigorously edited -- phrases/concepts are repeated. I noticed this particularly towards the end. Still, an interesting read, and valuable for anyone who wants to reduce mistakes in any sort of workplace, not just hospitals.

  13. 4 out of 5

    David

    The author seems a little too pleased with himself, but a good book if you can look past the sense of self satisfaction. The checklist manifesto is a better version of the same story.

  14. 5 out of 5

    Jack Po

    Should be required reading for anyone doing medicine, especially hospital administration!

  15. 4 out of 5

    Walker*Management*Library

    Recommended by Professor Timothy Vogus

  16. 5 out of 5

    Rebecca

    reading for school

  17. 4 out of 5

    Clarissa Lister

    Inspiring--how a vision can be turned into a reality.

  18. 4 out of 5

    Jane

    The guy invented a checklist. Actually it scares me to think that medical care is managed so poorly.

  19. 5 out of 5

    Kevin Acton

    Interesting perspective on politics and opperations in hospitals. Also show failings of the US Health Care system.

  20. 4 out of 5

    Elizabeth Roughead

  21. 5 out of 5

    John S Sorovetz

  22. 5 out of 5

    Blair

  23. 4 out of 5

    Sally

  24. 5 out of 5

    Susan Keady

  25. 5 out of 5

    Mary Parsille

  26. 5 out of 5

    Carolina Baldwin

  27. 4 out of 5

    Paul Nagy

  28. 5 out of 5

    Tom Mcclelland

  29. 4 out of 5

    Amanda

  30. 5 out of 5

    Roger

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