Michigan Hospitals Cut VAP Rates 70% Using Checklists


Here's a great story from my home state where I grew up, Michigan: “Hospital checklist helps pneumonia rates tumble by 70%.”

From the article:

Ventilator-associated pneumonia rates plummeted 70% at Michigan hospitals when physicians and other medical staff members improved communication and followed a checklist designed to prevent lethal lung infections.

Hospital staffs in more than 100 intensive care units in Michigan were able to maintain that lowered rate during the 2 ½ years that researchers tracked data, according to a study published online Feb. 17 in  Infection Control and Hospital Epidemiology.

With nearly 250,000 U.S. patients developing ventilator-associated pneumonia annually, reductions like this on a national scale could reduce health care costs by millions, researchers said. It also could prevent the vast majority of the 36,000 deaths linked to such infections each year.

The article highlights the “paradigm shift” of no longer assuming that such pneumonia cases are somehow inevitable.

To prevent pneumonia, medical staff members follow a simple 5-step checklist:

  • Elevate the head of the bed to more than 30 degrees to prevent bacteria from migrating into the lungs.
  • Give antacids or proton pump inhibitors to prevent stomach ulcers.
  • Provide anticoagulants to prevent blood clots.
  • Reduce sedation so patients could follow commands.
  • Assess readiness to remove the breathing tube on a daily basis.

The article makes the excellent point that this effort as primarily about culture and teamwork, not just the presence of a checklist. It's a direct parallel to the lessons of Lean and “standardized work.” The article rightly puts communication before the checklist.

The research is sponsored by the federal AHRQ and involves Dr. Peter Pronovost from Johns Hopkins, author of  the book Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.

How do we shift success stories like this from regional to national to global? Is your healthcare system using these proven methods? What are the barriers to getting people to try them or sustain them? If you're outside of healthcare, what are you doing in your community to help encourage these practices? What can we do?

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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. That is an amazing result that you have highlighted. It is hard to believe that merely a checklist could lead to such improved results. I think you are right that it is the team work and also probably the added attention given to preventing VAPs by the ICU teams and administration that lead to the results.

  2. Hi Mark,

    This kind of gives me chills down my spine!

    I have to admit that for many years I never even thought about Lean in Healthcare. Now it is mainstream and saving so many lives. It may even be appropriately called the “Decade of Lean Healthcare.”

    You are one of the key leaders in Lean Healthcare and I think I speak for most all LeanBloggers when I say we are grateful for all you do for the Lean community!

    Keep up the great work and innovation. There is truly a place in history for your visionary efforts. It must be very satisfying knowing your actions and talents are literally saving lives on a daily basis!

    All the Best,



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