leadership group at Mindability
found James Clear’s article valuable, as it focused on lifesaving strategies found
in the New England Journal of Medicine. Specifically, Clear reviews the successful
Keystone ICU Project, led by Dr.
Pronovost, while spotlighting why the best practices translated into
saving 1500 lives and how these successes can translate into your daily life.
includes highlights from “Do More of What Already Works”, by James Clear, along with the
reminder that: you don’t necessarily need a better strategy. You just need to
do more of what already works.
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.
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 1500 people in just a year and a half. The strategy was
immediately published in a recognized paper for the New England Journal of Medicine.
miracle was also simpler that you could ever imagine. It was a checklist.
The Power of
Completing Each Step
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.
best-selling book, The Checklist
Manifesto, he describes how Pronovost’s simple checklist could drive
such dramatic results. In the following quote, Gawande explains one of the
checklists that were 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.
five-step checklist was the simple solution that Michigan hospitals used to
save 1500 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.
New Solutions vs. Old Solutions
We have a
tendency to undervalue answers that we have already discovered. We under utilize
old solutions—even if they are best practices—because they seem like something
we have already considered.
problem: “Everybody already knows that” is very different from “Everybody
already does that.” Just because a solution is known doesn’t mean it is
critical, just because a solution is implemented occasionally, doesn’t mean it
is implemented consistently. Every physician knew the five steps on Peter
Pronovost’s checklist, but very few did all five steps flawlessly each time.
that new solutions are needed if we want to make real progress, but that isn’t
always the case.
Use What You Already Have
is just as present in our personal lives as it is in corporations and
governments. We waste the resources and ideas at our fingertips because they
don’t seem new and exciting.
many examples of behaviors, big and small, that have the opportunity to drive
progress in our lives if we just did them with more consistency: Flossing every
day; never missing workouts; performing fundamental business tasks each day -
not just when you have time; apologizing more often and even writing ‘Thank You’
notes each week.
these answers are boring. Mastering the fundamentals isn’t sexy, but it works. The
bottom line: No matter what task you are working on, there is a simple
checklist of steps that you can follow right now that can make a remarkable
can often hide behind boring solutions and underused insights – comments can
deliver powerful insight. As mentioned, you don’t necessarily need a better
strategy. You just need to do more of what already works. To that end, please
let us know if you have a favorite best practice or check list that has helped you
drive results. If so, stay connected with the community by adding your insight to
the comments section below. We are listening.