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Ten years ago at Johns Hopkins, my team began adapting aviation checklists to medicine. In 2006 we published a landmark paper in the New England Journal of Medicine detailing how we used checklists to nearly eliminate infections, not just in one hospital, but throughout the entire state of Michigan. We are now spreading that program to every hospital in the United States. Today, I am heartened by the growing use of checklists in hospitals, and flattered to see that leading medical journalists, such as Atul Gawande, are supporting our work and helping us spread the word.

And who wouldn't love the story: a checklist, a simple inexpensive tool, eliminates infections and save lives? Though this makes compelling journalism, it does not make good science. Checklists, though important, are only part of the Michigan story.

When Congressman Henry Waxman asked hospitals across the 50 states if they were using the checklist, I told him that we should also ask: are the hospitals measuring results? And, if so, what are they? I wanted to know whether patients were really safer. At many hospitals our first blood stream infection checklist failed because doctors didn't use it. And when nurses tried to remind doctors, they were ignored, or berated. Many were reluctant to speak up. In order to achieve the results we wanted, we had to change the way teams worked together and improve communication. Until a junior nurse can correct a senior physician who forgot to use the checklist, until that conversation goes well, we will continue to harm patients. In most U.S hospitals, that conversation does not go well.

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The following is from Safe Patients, Smart Hospitals. A longer excerpt is available on the book page.

"The idea of a checklist really started to make sense to me when I was preparing to attend a seminar on patient safety and medical errors in Salzburg, Austria. Among the long lists of experts on safety, I saw that James Reason would also be attending the seminar. On the flight over, I read Reason's book Managing the Risks of Organizational Accidents, which contained detailed information about aviation safety programs--specifically the use of checklists to improve safety.

Though familiar with the idea of using checklists in aviation, I had never really examined the theory. I was captivated. The parallels between aviation and medicine were striking. Decision, control and inevitably the safety of passengers and patients were regulated to one individual--in aviation, pilots; in medicine, doctors. Both professionals were expected to master complicated equipment and science that was constantly evolving and changing and in both arenas, errors could easily result in death.

But there were also significant differences between medicine and aviation. In aviation the general acceptance that humans are fallible was fundamental to the checklist's success. Once this truth had been universally accepted, the industry was able to design systems that could prevent or catch inevitable errors before they caused harm, or to minimize the harm from errors that were not identified.

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Peter Pronovost, Ph.D., M.D., (pictured, left) and Eric Vohr (pictured, right) are guest bloggers during the week of February 22nd. If you have any questions for Peter Pronovost or Eric Vohr, add a comment to any of their posts. Here is some more information about Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out:

Read an excerpt from the book and view the authors' tour dates.

The inspiring story of how a leading innovator in patient safety found a simple way to save countless lives.

First, do no harm-doctors, nurses and clinicians swear by this code of conduct. Yet in hospitals and doctors' offices across the country, errors are made every single day - avoidable, simple mistakes that often cost lives. Inspired by two medical mistakes that not only ended in unnecessary deaths but hit close to home, Dr. Peter Pronovost made it his personal mission to improve patient safety and make preventable deaths a thing of the past, one hospital at a time.

Dr. Pronovost began with simple improvements to a common procedure in the ER and ICU units at Johns Hopkins Hospital. Creating an easy five-step checklist based on the most up-to-date research for his fellow doctors and nurses to follow, he hoped that streamlining the procedure itself could slow the rate of infections patients often died from.