Peter Pronovost, M.D.: “Science has been finding new genes, science has been finding new drugs, science has not been delivering care very wisely.”

Scientific research has greatly advanced medical therapies in recent years, but that same scientific rigor has not been applied to the delivery of those therapies, resulting in a system that often fails to deliver its promise.

“We have not been good at making sure we deliver health outcomes our consumers want. We have not embraced the science of measuring quality, and we need to,” Peter Pronovost M.D., Ph.D., said when he delivered the ATS President’s Lecture on Tuesday, May 18.

Dr. Pronovost, a renowned professor at Johns Hopkins University School of Medicine’s Bloomberg School of Public Health and School of Nursing, said that national quality and safety measures for healthcare are flawed.

“We made national policy with an exceedingly superficial understanding of the problem. We made national policy with absolutely no pilot testing of whether these interventions work, and we made national policy with virtually no monitoring plan to tell us if it really made a difference,” he said. “Science has been finding new genes, science has been finding new drugs, science has not been delivering care very wisely.”

Quality and safety measures have not found the “sweet spot between being scientifically sound and feasible,” Dr. Pronovost said. “My sense is that most of what we’ve done with quality and safety has erred on the feasible side and has been really weak on the science.”

To illustrate his point, he recounted his recent discussion with a man whose family has a history of Marfan’s syndrome that took the lives of his mother and brother when they were young, but whose grandchildren may avoid shortened lives because of increased knowledge of Marfan’s. The man’s daughter had surgery on her aorta that may lengthen her life, but she is still danger.

“We have made remarkable advances in science, but this young lady may die from an infection, and part of the reason is we have not invested in healthcare delivery,” Dr. Pronovost said.

This effort to improve healthcare delivery “began ignobly,” he said, when a young girl died from a catheter infection, and her mother asked him four years later if the procedure had become more safe in the interim.

Dr. Pronovost said he had no good answer to the question, and so he eventually began a program to eliminate central line infections at Johns Hopkins. Part of the effort included asking nurses to make sure doctors followed through on procedures established to reduce infections, but the nurses said they did not want to police the doctors.

“The doctors said, ‘There is no way a nurse could question me in public and make me look like I don’t know something,'” he said. “What was striking was that nobody debated the evidence about whether we should do these things. What we debated was the hierarchy of the culture.”

“I pulled the staff together and said ‘Is it tenable that we harm patients at our hospital?’ and everyone said ‘no.’ I said, ‘Do you agree that we ought to do these things?’ and everyone said ‘yes,'” Dr. Pronovost said. “Doctors, we have permission to make mistakes. We’re human, we’re going to forget. But we don’t have permission to needlessly put patients at risk.”

That effort to reduce central line infections was a success at Johns Hopkins, and it has spread across the nation, greatly reducing infection rates, Dr. Pronovost said. He urged academic centers to join the effort and called on the ATS to help lead the effort to improve quality and safety.

“Now is the time for the ATS to really get behind the science of healthcare delivery,” he said. “You are undoubtedly the leaders in critical care science, and we have to have a broader view of science, a science that doesn’t just end with developing new knowledge, but a science that includes making sure we improve the health of our patients.”

“Now is the time that we start being accountable for the outcomes that we produce,” Dr. Pronovost concluded. “That is something that we, frankly, have not done…this push for regulatory oversight of us is not going away.”