"Other than media pressure (when a newspaper tackled CLABSI with a front page stories) there has been no other sanction. No regulatory role. No economic incentive to improve," Pronovost said. "It sure seemed like there needed to be something stronger that would say to a hospital, 'You know, you're a little above the average, or you're 10 times the national average. What are you going to do about it?' "
"CLABSI is one of the most accurately measured outcome indicators—a canary in the coal mine for quality—because we see that when hospitals focus their efforts, they can make dramatic reductions in these infections."
It is, he said, "a bellweather for where the country needs to go in paying for outcomes" instead of process measures.
Referring to a 750-hospital cooperative effort funded by the federal Agency for Healthcare Research and Quality, Pronovost talked about how hospitals proved that if they try, they can improve.
"Even in hospitals that were already hitting the benchmark, with rates of 1.1 or 1.5, many were able to cut them in half or more," Pronovost told me. "Now, whole states have CLABSI rates (averages) less than 1."
But even as some hospitals showed success, others appear stymied.
"We've also seen a number of hospitals that started out high, but didn't come down, and the public ought to be aware of that," Pronovost warned. "It simply says there's not enough leadership attention being paid to this."