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An Executive Checklist

By Peter J. Pronovost, M.D., John Combes, M.D., and Maulik Joshi

Health care leaders must take an active role in building results-oriented patient safety efforts

For too long patient safety and quality efforts have been competitive rather than cooperative, independent rather than interdependent and too focused on efforts rather than results. To effectively execute and evaluate results-driven safety programs requires strong executive leadership. Leaders must keep their teams focused and ensure each team has the resources to implement its program and monitor results.

The Comprehensive Unit-Based Safety Program is being implemented in all 50 states to eliminate central-line associated bloodstream infections. About 250,000 of these infections occur in hospitals each year, and between 30,000 and 62,000 patients who get these infections die as a result. Health & Human Services Secretary Kathleen Sebelius has called on U.S. hospitals to reduce CLABSIs by 75 percent over three years.

For CUSP and other programs, executives can take concrete steps to ensure successful implementation. An executive should be assigned responsibility for each of the following checklist tasks:

Ensure science of safety training for all employees.
Assign a senior leader to become an active member of each team; meet with team on the unit at least monthly.
Create a policy for unit-level accountability; document learning from at least one defect per month.
Foster organizational learning; disseminate learning from defect lessons with the expectation for local adaptation.
Require use of a patient-specific daily goals checklist.
Codify interdisciplinary rounds as standard of practice; support local interpretation based on unit characteristics.
Acknowledge the work of improvement teams: celebrate success through stories in hospital newsletters; and provide opportunities for teams to share with management and other teams.

For eliminating CLABSIs, the executive checklist includes:

Make elimination of CLABSIs an organizational goal; include in strategic plan and develop a coordinated plan.
Provide protected time for CLABSI-reduction team leaders: doctor, nurse, data collector (about 10 percent each).
Monitor hand hygiene no less than quarterly and report performance to all employees and the board.
Make chlorhexidine available in all central-line insertion kits.
Provide line carts so all central-line insertion supplies can be organized in a single place, or pack supplies in complete kits.
In the absence of a critical, life-threatening situation, empower the nurse to stop line placement if there is a breach in protocol during insertions.
Require infection control departments to produce a weekly report of harm (number of people infected each week). Disseminate the report to entire senior leadership team and board. Create a process to investigate each infection and close the loop.
Review CLABSI rates at least quarterly at board meetings.
Post CLABSI rates in units; track time since last infection.

With this checklist, an executive can take an active role in improving the hospital's results-oriented culture of safety.

Peter J. Pronovost, M.D., is professor at Johns Hopkins University School of Medicine. John R. Combes, M.D., is president and COO of the AHA's Center for Healthcare Governance. Maulik S. Joshi is HRET president and AHA senior vice president of research.

This article 1st appeared in the November 2009 issue of HHN Magazine.

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