Tuesday, March 06, 2012

Pronovost and Conway share value and values

Recent columns by two of my heroes warrant your attention.  Peter Pronovost and Jim Conway are both distinguished in that they have gotten things done in the complex environment of hospitals by building physician constituencies.  This is essential.  How often, though, do I hear from hospital people that "our doctors won't agree to that, where "that" is agreeing to evidence-based clinical protocols and hospital process changes?  The two folks don't accept that premise of "won't agree," and they offer hints as to how to get doctors engaged.

Peter's column is entitled "Dreaming the dream."  In it, he explains the social forces behind adoption of protocols that have saved thousands of lives that otherwise would have ended due to hospital acquired infections.  He notes:

Initially, we did not debate whether we could stop these infections. We focused on consistently following those practices shown by evidence to reduce them. We had been complying with those practices just 30 percent of the time. Our clinicians agreed that we would follow a checklist to help ensure 100 percent compliance and then see what happened to our infections. As compliance rose, the rates went to nearly zero, and the doubts disappeared.

Much has been written about the power of checklists to improve safety, and many think that these tools are like an all-powerful magic wand. Yet for a checklist to be effective, it must be supported by social norms and embraced by a community that believes it can make a difference.

Health care needs a revolution, and your patients are asking clinicians to dream the dream and reduce preventable harm. I hope more clinicians believe they can.  

In an article entitled, "Informing the journey, not changing the destination," Jim focuses on the role of patient-family advisory councils in reducing harm and process improvement.  His article is notable for the modesty he asks us to employ as we consider the evidence about the value of such advisory groups.  He seeks physician involvement in this issue by appealing to doctors' intellectual curiosity and love of inquiry when he says:

The healthcare community should be a learning community, asking questions, conducting research, performing tests of change, innovating and more. In the process, results may have us scratching our heads. Do we have the right questions, metrics, samples, or maybe, just maybe, are there mental models, things we believe to be true, that aren’t? 

[O]ur destination is clear—high-quality, safe and continuously improving health and healthcare centered on, and in partnership with, the patient, the family, the public, and their community. Let us inform and adjust our journey, consider all research in a balanced fashion, and yes, be prepared to scratch our heads along the way.

1 comment:

Anonymous said...

Although trained to scientific skepticism in medicine, I have been impressed, as an avid football fan, how the sheer belief of the players that they can win, late in the game against daunting odds, often produces a win despite those odds. Dr. Pronovost's post, which also invokes Susan Boyle, makes a similar point:

" Sometimes we listen to those little voices whispering: You cannot do this. Yet when we overcome the doubts, we are often successful. If we give into those voices, we will surely fail."
I have come to realize the importance of this sheer belief in accomplishing feats in patient safety that, in the mind of the scientific skeptic, would have been deemed impossible.
"Success will .... depend on efforts by clinicians who believe that they can stop harm from occurring and then act to make it happen."