The New Health Dialogue

When our parents told us (repeatedly...) to wash our hands, they were right.

When Peter Pronovost, M.D., Ph.D., of Johns Hopkins told doctors and nurses in Michigan ICUs to wash their hands, he was so right that the hospitals saved an estimated $200 million and more than 1,500 lives. Dr. Pronovost's hand-washing edict was part of a simple five-step checklist to decrease catheter-related blood infections—an effort initiatied by the Michigan Health and Hospital Association.

Provonost's story was one of many provocative points made by surgeon-author Atul Gawande, M.D., M.P.H., during his talk yesterday at the Center for American Progress. Gawande's real-life examples cemented for us the strong connections between cost and quality as we strive for comprehensive reform in our health care system. (Gawande wrote about Provonost in a New Yorker article about checklists a few months ago. Unfortunately, privacy concerns interrupted this otherwise huge success story. The NIH Office for Human Research Protections ruled that issuing these checklists without patients' informed consent (consent for a checklist?) were violating scientific ethics, but it later came to its senses and reversed itself).

Gawande, who is the Associate Director of Brigham and Women's Hospital Center for Surgery and Public Health, spoke of the need to bridge the gap between policy and the patient experience.

Calling the reform of the health care delivery system "the most ambitious endeavor man has ever undertaken," Dr. Gawande claimed that we have finally reached a point where the failure to implement current knowledge has become more of a challenge than the simple lack of knowledge was for past generations.

But developing a checklist, or adopting safety measures like putting bar codes on sponges used in surgery, are just examples of what needs to be done. Dr. Gawande believes we need an infrastructure to fix a fragmented system of care where there's not always profit in finding a solution. He outlined three goals:

• Innovation: Currently we do a great job developing the next catheter, or stent, or biologic, but we do a poor job of finding ways to improve the processes of medical care.
• Dissemination: Because of a lack of investment and a lack of data, we have pockets of innovation, such as the checklists in Michigan ICUs, but our method of sharing best practices are inadequate.
• Surveillance: We need an infrastructure that can not only disseminate such information but can monitor what works best for who and where, to ensure that achievements in quality continue.

As Dr. Gawande said, it's a tall order. But if we can land a man on the moon, split the atom, and decode the human genome, we can ensure quality in health care. We can start, as our parents told us, by washing our hands.