Oprah, Obama, Putin, Springsteen… and Pronovost

Last week, Time Magazine named the 100 most influential people in the world. Among the luminaries was Dr. Peter Pronovost of Johns Hopkins. I thought it was an inspired choice.

The modern patient safety field has been blessed with a number of important leaders and visionaries. A few examples: Lucian Leape, the Harvard surgeon who introduced the idea of systems thinking to mainstream medicine; Don Berwick, whose passion found form in the Institute for Healthcare Improvement, which has helped thousands of healthcare personnel learn safety skills and implement safety practices; Liam Donaldson, who catalyzed the safety field in the UK and then elevated it to a world stage; and David Bates, whose studies have helped us understand the role of information technology in patient safety.

But the most important leader in safety today is Pronovost, the Hopkins anesthesiologist and critical care physician who has done more than anyone to bring scientific rigor to the study of patient safety practices.

As editor of AHRQ Patient Safety Network, I get paid to review the world’s literature on safety every week, a nice gig. A month does not go by without a Pronovost commentary that helps me think anew about a key issue in safety and quality, or a Pronovost study of the implementation of a new, often novel, safety practice. Of course, the classic was the Michigan Keystone ICU initiative, a project that saved hundreds, perhaps thousands, of lives (and led to Gawande’s marvelous New Yorker article on checklists and the Office of Human Research Protection consent debacle that got me so lathered several months ago).

But I’m just as impressed by Peter’s week-in, week-out production. For example, just in the past 18 months, Peter has authored or co-authored:

  • A thoughtful analysis of the value of root cause analysis (in JAMA)
  • An article on medication errors in Code Blue situations (Jt Comm Journal)
  • A commentary on how organizations can develop a safety scorecard (JAMA)
  • A study of needlestick injuries among surgeons (NEJM)
  • An empirical study of OR briefings (J Am Coll Surgeons)

And that’s just 5 of his 44 articles in 2007-08 – an article every 11.5 days! If you’re keeping score, you can add another JAMA study (a new analysis of Medicare’s no pay for errors policy) later this week. (I have been fortunate to author or co-author half a dozen papers with Peter, including the upcoming JAMA paper).

But numbers aren’t as important as quality and impact. And Peter’s work has both.

How does he do it? Pronovost’s trick is that he can do several very hard things very well simultaneously. His nimble mind is constantly innovating. He is practical enough to know that the best ideas are often the simplest – like goal cards on daily ICU rounds, or a checklist to prevent nosocomial infections. He is sufficiently diplomatic to tiptoe across miles of bureaucratic quicksand. He is focused and organized enough to keep several dozen balls in the air. And he is charismatic enough to be a magnet for collaborators, which serves as a tremendous force multiplier for his ideas.

I know several people with 2 of these traits, and a handful of people with 3. But having all of them is like being the best putter, driver, and iron player while also having the best mind for golf and work ethic.

Yes, he is our Tiger Woods.

Atul Gawande best captured Peter’s magic in his New Yorker article, “The Checklist”:

Forty-two years old, with cropped light-brown hair, tenth-grader looks, and a fluttering, finch-like energy, he is an odd mixture of the nerdy and the messianic…The scientist in him has always made room for the campaigner. People say he is the kind of guy who, even as a trainee, could make you feel you’d saved the world every time you washed your hands properly. “I’ve never seen anybody inspire as he does,” Marty Makary, a Johns Hopkins surgeon, told me. “Partly, he has this contagious, excitable nature. He has a smile that’s tough to match. But he also has a way of making people feel heard. People will come to him with the dumbest ideas, and he’ll endorse them anyway. ‘Oh, I like that, I like that, I like that!’ he’ll say. I’ve watched him, and I still have no idea how deliberate this is. Maybe he really does like every idea. But wait, and you realize: he only acts on the ones he truly believes in.”

Perhaps Peter hasn’t been as influential as the Dalai Lama and Miley Cyrus, but he certainly deserves to be in their company on Time’s Top 100 list. Congratulations, and thanks.


  1. bev M.D. on May 13, 2008 at 1:44 am

    I had never heard of Dr. Pronovost until the recent OHRP debacle, but I agree that he clearly deserves this honor, and it is a miracle that he received it, given the fact that most front line medical practitioners are probably unaware of his work – much less the lay media. Your reference to his paper on root cause analysis especially struck me, with its eminently sensible yet unaccomplished suggestion that there be national cooperation on/dissemination of the methodology and results of RCA’s. Although the Joint Commission has made a few tentative forays in this direction, the potential for outcome improvement and maximization of scarce resources by fully implementing this seems to make it a no-brainer – so why hasn’t it happened yet? Where is the leadership which will make it happen? I believe it must come from the medical societies rather than the hospitals or the Joint Commission. And it should happen sooner rather than later. Five years after the IOM’s report is way too long for us to still be individually struggling with these issues.

    Parenthetically, I also believe that all patient safety-related publications should be made available outside the subscription system (e.g., free) by the journals publishing them. The subscription-only system wastes precious knowledge and resources in this critically important area.

  2. danwalter on May 23, 2008 at 3:53 pm

    Dr. Pronovost is a good guy, but he’s got a huge task in reforming patient safety. I write about Dr. Provonost in story about Johns Hopkins: http://adventuresincardiology.wordpress.com/

    Dr. Wachter, I have always appreciated the work you do in patient safety and I would appreciate any comments you may have on the blog linked above. Many doctors don’t like it at all for obvious reasons, but there are a surprising number who think it should be widely circulated so as to improve patient safety.

    Your thoughts would be appreciated.


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