Do more of what already works.
I’ve been following an author, named James Clear, for a number of years now. He writes about behavior and habit formation. His articles are full of golden nuggets. His posts are insightful, researched and practical. Here’s a snippet of an article he wrote a while back, that I found myself recalling during a conversation with one of our operations managers recently.
In 2004, nine hospitals in Michigan began implementing a new procedure in their intensive care units (I.C.U.). Almost overnight, healthcare professionals were stunned with its success.
Three months after it began, the procedure had cut the infection rate of I.C.U. patients by sixty-six percent. Within 18 months, this one method had saved 75 million dollars in healthcare expenses. Best of all, this single intervention saved the lives of more than 1,500 people in just a year and a half. The strategy was immediately published in a blockbuster paper for the New England Journal of Medicine.
This medical miracle was also simpler that you could ever imagine. It was a checklist.
The Power of Never Skipping Steps
The checklist strategy implemented at Michigan hospitals was named the Keystone ICU Project. It was led by a physician named Peter Pronovost and later popularized by writer Atul Gawande.
In Gawande’s best-selling book, The Checklist Manifesto (audiobook), he describes how Pronovost’s simple checklist could drive such dramatic results. In the following quote, Gawande explains one of the checklists that was used to reduce the risk of infection when installing a central line in a patient (a relatively common procedure).
On a sheet of plain paper, [Pronovost] plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s 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. Check, check, check, check, check.
These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.
This five-step checklist was the simple solution that Michigan hospitals used to save 1,500 lives. Think about that for a moment. There were no technical innovations. There were no pharmaceutical discoveries or cutting-edge procedures. The physicians just stopped skipping steps. They implemented the answers they already had on a more consistent basis.
James goes on to point out that there is a big difference between “Everybody already knows that” and “Everybody already does that”. We take for granted that all employees are following the letter of the law when executing routine processes. Based on the study cited, there’s a good chance at least a third of them are skipping steps.
Is there a process in your department that can be simplified into 5 steps? Can you post a checklist to improve your performance by 66%?