Nurses hesitate to challenge doctors even when doctors are ordering the wrong drug or operating on the wrong limb.
When it comes to safety, the aviation industry has it down to a science, compelling pilots to go through checklists before takeoff and relying on every crew member, regardless of rank, to work as a team and report dangerous lapses. But in hospitals there is no such fail-safe system, one reason that tens of thousands of American patients annually are harmed or killed by preventable infections, wrong-site surgeries and medication mishaps.
A few years ago, after seeing a toddler die from substandard care, Peter Pronovost, an anesthesiologist and critical-care specialist at Johns Hopkins Hospital in Baltimore, set out to change the way that hospitals function.
Too often, Dr. Pronovost writes, doctors "think they are infallible, communication between nurses and doctors is poor and accountability is virtually non-existent." He notes that doctors aren't trained to listen to nurses, family members or anyone else for that matter. "Medicine operates like a private club of self-styled deities where the entrance requirement is an M.D."
Dr. Pronovost proposes a two-fold strategy for bringing health care closer to the standards of aviation: simple, rigorous checklists designed to deliver proven treatments and procedures; and a cultural makeover aimed at tearing down the traditional hospital hierarchy that makes nurses afraid to challenge doctors even when doctors are ordering the wrong drug or operating on the wrong limb. Hospitals need a collaborative model, Dr. Pronovost says. Members of a medical team need to work like flight crews to redesign flawed systems of care.