Do You Know More Than a Hospital CEO About…


If you're a regular reader of my Lean Blog, you might know more about preventing Hospital Acquired Infections than many healthcare CEOs do, says a report in the Washington Post: “Hospital infection deaths caused by ignorance and neglect, survey finds.

The idea that simple checklists can help prevent infections is a topic we've covered here a lot, so I won't repeat everything that's been written, but the “CEOs not being aware” angle of the WaPo article is intriguing / frustrating. Hat tip to Paul Levy's blog post on this subject and the three people who emailed the article to me yesterday (thanks!).

The article recounts how checklists work and the benefits. Many infections are indeed preventable, including oft-deadly central line infections:

An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs — which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.

Before we get to the CEOs, there are complaints from infection control officers (a parallel to the Quality Department for those of you in manufacturing… can you farm out quality to a department or is it top management's responsibility, as Dr. Deming would have said?).

Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.

I guess training takes time and money, but how much money does it really take? Since the ROI (if you have to think that way) is positive on preventing infections, isn't that time and training a good investment in addition to being the best thing for the patients?

What role do CEOs play, since they don't touch patients?

When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.

“If anyone in that chain of accountability doesn't work, you won't get your [infection] rates down,” he said. “But it's the hospital's senior leadership that is ultimately responsible.

Yes, it's about culture and leadership… back to Deming again.

So why don't CEOs get more involved? Dr. Pronovost argues that many of them are, you could argue, clueless about the issue.

Pronovost said part of the problem was that many hospital chief executives aren't even aware of their institution's bloodstream infection rates, let alone how easily they could bring them down.

How do CEOs not know about this?

After I posted this on Twitter yesterday, my friend @pujalords (a former Toyota guy)  wrote in multiple tweets:

maybe it's because they don't want to know the real infection rates, so it's easier to plead ignorance….or perhaps it's because they don't have meaningful incentives around patient quality outcomes… generic explanation is that hospital execs (as most execs) likely don't spend time “on the floor” i.e., poor gemba mindset.

Great points. So what do we do? If too many hospital CEOs aren't aware, how can you help? Maybe everyone needs to print this article and hand deliver to your local hospital CEO, even if you work there?? Or, go green and email it to them.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Where I work (Barnes-Jewish Hospital in St. Louis) our CEO is VERY aware of our BSI rate and various other metrics, as is the entire management team. He sends out a monthly “performance chart” with colors indicating our performance for the previous month, and the projected YTD rate (red=bad, green=good, in statistically significant terms).

    He is also dedicated to gemba walking. He has time cleared from his schedule to round in the hospital, sometimes with other VPs, sometimes not.

    So, I think not every CEO can be generally dumped into the “unaware” bucket. Maybe we have an outlier of the CEOs, but here at Barnes-Jewish, we are transparent about what’s going on.

  2. Sarah, you’re right and I agree with you. It depends on the exact definition of Pronovost’s “many” in his quote.

    Thankfully there are more lean thinking CEOs out there at organizations like yours, ThedaCare, Virginia Mason, Beth Israel Deaconess, etc. It’s a growing list.

    Thanks for sharing a positive counter example!

  3. It’s interesting that, in the Health Leaders version of this story, Dr. Pronovost makes a comparison to Toyota:

    Failure In Central Line Infection Prevention, Survey Says –

    “Pronovost says the problem was miniscule compared to that which caused by faulty brake systems in Toyota cars: “Many of you probably saw the CEO of Toyota publicly apologize (because) four people died a year for five years needlessly, for a total of 20. Those deaths were tragic and he should apologize.”

    “But we know that in the U.S. alone, 30,000 to 31,000 people die a year from central line-associated bloodstream infections every year, and we have the technology that virtually eliminates that. And to have 75% of these (respondents) say they don’t have accountability is alarming. What it speaks to me is an accountability failure in healthcare,” says Pronovost.”

  4. Part of the problem is the way central line infections are reported–usually in terms of XXX per thousand line days. That tells you how many days of infection existed. It does not tell you how many people got infections, who they were, or what happened to them (did they die or end up in a nursing home due to infection?)

    I served briefly on the “Quality” committee on my local hospital board, and asked if we could please have the monthly CLAB data not as XXX per thousand line days, but as number of people, what were their names, what pathogens did they contract, and what was their outcome. My one supporter was a retired MD. The rest of the “Quality” folks hounded me off the board.

    Still, it’s that “in your face” number that Rick Shannon used at Allegheny General to get his work going. Long before Pronovost, he reduced central line infections to zero within 90 days in his units. (I describe Rick’s work in my book, The Pittsburgh Way to Efficient Healthcare.) It really IS possible!

    Mark’s note: book link is

  5. Naida:

    I’m with you! It’s a question of the voice of the customer, not a performance measure.

    Sometimes we report metrics two ways – as a percentage, for example, so it is scaled to current activity, and in units/dollars/ etc., to give the human impact. I can’t think of a more important time to include a raw count of incidence (with names attached) than when a life has been lost. How else can you hear the voice of that customer, if you don’t at least repeat their name?

    On the flip side, addressing the same concept but in a positive way, we visited a lean deployment at the Letterkenny Army Depot in Pennsylvania a while back, where vehicle armor and armor kits to protect troops in Iraq and Afganistan are assembled. Customer satisfaction wasn’t only expressed as an impersonal metric. There were emails from troops on the frontline, printed and hanging in the workcells, saying (for example) “Thank you, Letterkenny, you saved my life again today”. The smiling face, finger pointed at the hole and the burn marks where the R.P.G. had struck in one attached picture, was moving and inspiring to the people working there. It was a testament to the power of bringing the voice of the customer directly into the workplace.

    Of course, we grow plants. Pretty mundane by comparison! But we do express losses both as percentages and dollars and names, and we strive to get the faces and voices of our individual customers into the workcells, alongside objective measures of performance.


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