How Hospitals Can Better Prevent and Cope With Infections

One in 20 people hospitalized each year develop a health care-associated infection. How can hospitals reduce that number?

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"We went to work to change that," Pronovost said.

Hopkins leadership asked every physician to investigate infections as a defect, and cut rates drastically. The academic health system also established a "chain of accountability" that was "owned locally by the doctors and nurses in the clinics," Pronovost explained. (With the help of the American Hospital Association, the program has become a national one.)

Pronovost cautioned that too many hospitals are banking on electronic medical records (EMR) to eradicate errors, but neglect to look at interoperability and workflow issues.

"We mistakenly believe that buying an EMR is going to solve all of our problems," Pronovost said. "What we've done is we've built technologies that don't talk to each other." He likened it to a contractor like Lockheed Martin refusing to send a warning signal from aircraft landing gear to a Boeing system that controls the whole plane. "People will die," Pronovost said.

He said there needs to be a federal mechanism to measure medical harm, much as the Securities and Exchange Commission regulates some forms of financial fraud. "We don't know how many people die needlessly, but we should," he said.

"Finally, we have to make sure this works through professionalism," he continued. Pay-for-quality and the current "regulatory apparatus" have not had large impact, in his opinion. "Intrinsic motivation" is necessary to promote professionalism, Pronovost said.


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