Q&A with Peter Pronovost, Part 1: “We Need to Evolve from Being Reactive to Being Proactive.”

When most people hear the name Peter Pronovost, they think about checklists, and for good reason. Nearly two decades ago, Dr. Pronovost developed a set of steps to eliminate infections from catheter lines, an innovation that helped save thousands of lives while also transforming the delivery of care. Now, he’s leverage that same approach to improve value.

And although Pronovost still believes checklists are an essential tool in providing quality patient care, what’s just as important — particularly as healthcare shifts to a value-based model — is changing the narrative. Recently, he spoke with healthsystemCIO about the three-part strategy he’s using to drive a new narrative at University Hospitals, where he has served as Chief Clinical Transformation Officer since 2018. He also talked about the data model they’re using to develop a more holistic view of the patient, how his team has leveraged technology to care for patients during the pandemic, why value means much more than just cutting costs, and the three characteristics that are necessary for successfully driving change.

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Key Takeaways



* The same step-based strategy that helped dramatically lower readmissions and reduce Medicare spend can be applied to improve value across healthcare.

* Checklists for quality are important, “but we also have to focus on every component of value, meaning quality of care, the experience patients have, and the cost of care.”

* The main driver of getting to zero is getting clinicians to tell a different story, replacing “these infections are inevitable” with “these infections are preventable, and I’m capable of doing something about it.”

* A key component in improving care is building an enabling infrastructure in which standard assessment tools are used, feedback is collected and incorporated, and all areas of care are represented.

* University Hospitals’ goal is for 80 percent of patients to be home. “There are fewer complications, it’s much cheaper,” and with Covid, it can be “a matter of life and death.”



Q&A with Dr. Peter Pronovost

Gamble:  A lot of people know you for the work you’ve done with patient safety and leveraging checklists to reduce catheter bloodstream infections. 

Pronovost:  Yes.  It’s funny you say that, because I envision the work that I’m doing now as phase two. We used checklists to reduce individual harms like catheter infections to a great deal of success. And actually, I would call it checklists with a management system, because it wasn’t just a checklist.

Now, And now we’re broadening that lens to eliminate defects in value across the continuum of care and a similar approach that we did before is we try to define these defects — such as not complying with the checklist, make them visible and then change the health system to make sure we reduce or eliminate them.

That approach, as you read in the article, was pretty wildly successful. We saw about a 9 percent reduction in Medicare spend from year to year with very clear reductions in defects, such as more than people going home rather than to skilled nursing facilities, and lower readmissions. It’s quite hopeful that this approach, just like it worked for central line-associated bloodstream infections (CLABSI), is a very valid approach to work for improving value in healthcare.

 

Gamble:  What made you so interested in improving value? Was it was a particular incident or it was just seeing where things were headed in healthcare?

Pronovost:  It was more about where things are headed,