Do More of What Already Works

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In 2004, nine hospitals in Michigan began implementing a fresh procedure within their intensive care units (I.C.U.). Almost overnight, healthcare professionals were stunned using its success.

90 days after it began, the task had slice the infection rate of I.C.U. patients by sixty-six percent. Within 1 . 5 years, that one method had saved 75 million dollars in healthcare expenses. On top of that, this single intervention saved the lives greater than 1,500 people in only a year . 5. The strategy was immediately published in a blockbuster paper for the brand new England Journal of Medicine.

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This medical miracle was also simpler you could ever imagine. It had been a checklist.

THE ENERGY of Never Skipping Steps

The checklist strategy implemented at Michigan hospitals was named the Keystone ICU Project. It had been led by your 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 next quote, Gawande explains among the checklists that was used to lessen the chance of infection when installing a central line in an individual (a comparatively common procedure).

On a sheet of plain paper, [Pronovost] plotted out the steps to take order in order to avoid infections when putting a line in. Doctors are likely to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the complete patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site after the line is in. Check, check, check, check, check.

These steps are no-brainers; they have already been known and taught for a long time. So that it seemed silly to create a checklist simply for them. Still, Pronovost asked the nurses in his I.C.U. to see the doctors for per month because they put lines into patients, and record how often they completed each step. In greater than a third of patients, they skipped at least one.

This five-step checklist was the easy solution that Michigan hospitals used to save lots of 1,500 lives. Consider that for an instant. There have been no technical innovations. There have been no pharmaceutical discoveries or cutting-edge procedures. The physicians just stopped skipping steps. They implemented the answers they already had on a far more consistent basis.

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New Solutions vs. Old Solutions

We’ve a tendency to undervalue answers that people have previously discovered. We underutilize old solutions-even if they’re best practices-because they look like something we’ve already considered.

Here’s the problem: “Everybody already knows that” is quite not the same as “Everybody already does that.” Wish solution is well known doesn’t mean it really is utilized.

A lot more critical, wish solution is implemented occasionally, doesn’t mean it really is implemented consistently. Every physician knew the five steps on Peter Pronovost’s checklist, but hardly any did all five steps flawlessly every time.

We assume that new solutions are needed if you want to make real progress, but that isn’t always the case.


This pattern is simply as within our personal lives since it is in corporations and governments. We waste the resources and ideas at our fingertips because they don’t seem new and exciting.

There are various types of behaviors, big and small, which have the opportunity to operate a vehicle progress inside our lives if we just did them with an increase of consistency. Flossing each day. Never missing workouts. Performing fundamental business tasks every day, not just if you have time. Apologizing more regularly. Writing MANY THANKS notes every week.

Of course, these email address details are boring. Mastering the basics isn’t sexy, nonetheless it works. Regardless of what task you will work on, there exists a simple checklist of steps that you could follow right now-basic fundamentals you have known about for years-that can immediately yield results in the event that you just practice them more consistently.

Progress often hides behind boring solutions and underused insights. You don’t need more info. You don’t need an improved strategy. You just should do more of what already works.

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