Checklist Redux: NIH Blocks Improvement

You may recall our 12/9/07 post on the “Stupid Little Checklist” described in a New Yorker article by Brigham & Women’s Dr. Atul Gawande. Briefly, Dr. Peter Pronovost at Johns Hopkins has pioneered use of a simple “checklist” to attain dramatic improvements in safety and quality. Read Gawande’s article and feel your jaw drop.

Today, Gawande has an op-ed article the New York Times describing how bureaucratic intervention at the National Institutes for Health has stopped the project cold — click here:

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

Testing a checklist for infection prevention, however, is not the same as testing an experimental drug — and neither are like-minded efforts now under way to reduce pneumonia in hospitals, improve the consistency of stroke and heart attack treatment and increase flu vaccination rates. Such organizational research work, new to medicine, aims to cement minimum standards and ensure they are followed, not to discover new therapies. This work is different from drug testing not merely because it poses lower risks, but because a failure to carry it out poses a vastly greater risk to people’s lives.

We’re not knee-jerk anti-bureaucrats here. But it sure as heck looks like someone at NIH is in the wrong job. Let’s hope Gawande’s op-ed lights a fire in the right place.

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