The 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.
The following 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.
In 2004, 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.
Three months 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.
This medical miracle was also simpler that you could ever imagine. It was a checklist.
The Power of Completing Each Step
The 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.
In Gawande’s 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.
This 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.
Here’s the problem: “Everybody already knows that” is very different from “Everybody already does that.” Just because a solution is known doesn’t mean it is utilized.
Even more 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.
We assume that new solutions are needed if we want to make real progress, but that isn’t always the case.
Use What You Already Have
This pattern 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.
There are 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.
Of course, 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 impact.
Although progress 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.