He introduced an intensive care checklist protocol that during an 18-month period saved 1500 lives and $100 million in the State of Michigan.[4] According to surgeon Atul Gawande in The New Yorker, Pronovost's "work has already saved more lives than that of any laboratory scientist in the past decade."[5] In 2008 Time magazine named Pronovost among the 100 most influential people in the world.[6] That same year, Pronovost was awarded a MacArthur Fellowship.[1]
Pronovost's book Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out was released in February 2010.[7]
In 2003 he founded the Quality and Safety Research Group. Pronovost has published over 800 articles and chapters on patient safety and advises the World Health Organization on improving patient safety through WHO's World Alliance for Patient Safety.[11]
He started studying hospital-acquired infections in 2001, concluding that a simple 5 item check-list protocol would greatly reduce infections when inserting a central venous catheter;[12]
Doctors should:
Wash their hands with soap.
Clean the patient's skin with chlorhexidine antiseptic.
Put sterile drapes over the entire patient.
Wear a sterile mask, hat, gown and gloves.
Put a sterile dressing over the catheter site.
In the Keystone Initiative, a 2003 study by a collection of Michigan hospitals and health organizations, the median rate of infections at a typical ICU dropped from 2.7 per 1,000 patients to zero after three months.[13] The Keystone Initiative published its results in the December, 2006 New England Journal of Medicine.[14] In the first three months of the project, the infection rate in Michigan's ICUs decreased by sixty-six per cent. In the Initiative's first eighteen months, they estimated that 1500 lives and $100 million were saved. These results were sustained for almost four years.[5]
Several reasons may explain why a simple checklist protocol is not more widely adapted:[15]
Many physicians do not like being monitored by nurses or otherwise being forced to follow a checklist;
A wish to avoid standardized tasks and bureaucracy; and
A focus by researchers on "more exciting" issues such as disease biology and new treatment therapies.
The fundamental problem with the quality of American medicine is that we’ve 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 ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.
Recent work
In 2013, Pronovost co-founded Doctella, a startup that provides surgical checklists for patients to improve patient engagement, patient safety, and lead to better health outcomes.[16]
Also in 2013, Pronovost advocated for a system of alcohol and drug testing for doctors in a Journal of the American Medical Association article.[17][18]
He has participated in an online course, or MOOC, from Johns Hopkins provided via Coursera.[19]
In January 2018, he announced that he would be taking a position at United HealthCare. Shortly after taking the position he was promoted to Chief Medical Officer. Within weeks of taking this position, his departure from the position and the company was confirmed, although no reason was given.
In October 2018, he joined University Hospitals as Chief Quality and Clinical Transformation Officer, adding value across the entire health system.[20]
In 2020, Pronovost and colleagues at University Hospitals introduced an estimate that defects in value contribute to over $1 trillion in wasteful spending.[21] Pronovost, along with William Padula, David Dietz and Hanke Zheng further developed the framework for specialty care to illustrate that by investing in centers of excellence, health systems would otherwise spend pennies on the dollar over wasteful spending on value defects.[22]
Honors
In 2008, he was named in Time magazine's 100 most influential people in the world, and was also named a MacArthur Fellow.[5] In 2011, Pronovost was recognized for his outstanding professional achievement and commitment to service with election to membership in the Institute of Medicine, one of the highest honors in the fields of health and medicine.[23] On March 28, 2013, he was named a Gilman Scholar at Johns Hopkins University.[24]
^Cuong Pham, Julius; Pronovost, Peter J.; Skipper, Gregory E (May 22, 2013). "Identification of Physician Impairment". Journal of the American Medical Association. 309 (20): 2101–2. doi:10.1001/jama.2013.4635. PMID23629590.
^Pronovost PJ, Urwin JW, Beck E, et al. Making a Dent in the Trillion-Dollar Problem: Toward Zero Defects. NEJM Catalyst, 2021;2(1). doi:10.1056/CAT.19.1064
^Dietz DW, Padula WV, Zheng H, Pronovost PJ. Costs of Defects in Surgical Care: A Call to Eliminate Defects in Value. NEJM Catalyst, 3 November 2021; doi: 10.1056/CAT.21.0305
