HL20: Martin Makary, MD—Pushing to Improve Transparency and Quality Standards

Cheryl Clark, for HealthLeaders Media , December 17, 2013

Makary is an author of the 2012 book Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care and more than 150 scientific papers on topics including technical improvements in surgical techniques and physician behaviors, such as how often they acknowledge errors and report adverse events.

He's accomplished all this since he realized during graduate school 15 years ago—where Harvard patient safety advocate Lucian Leape was his professor—that quality and honesty in healthcare needed scrutiny and improvement.

Arriving at Johns Hopkins in 2004, he watched colleague Peter Pronovost, MD, now senior vice president for patient safety and quality, develop a checklist for the intensive care unit that reduced hospital-acquired bloodstream infections associated with placement of central line catheters.

"Based on Dr. Pronovost's experience with checklists in the ICU," Makary says, "he suggested we develop a checklist for general surgical procedures in the OR," which started with just a few key items to prevent errors.

By allowing all members of the surgical team to introduce themselves before the procedure and indicate their roles, "we could create a sense of dignity" and empower anyone on the team to "speak up when they see something that doesn't look right." Also in the checklist is a pause or a time-out, a period for discussion about expectations and potential problems that might be encountered, and at the end of the surgery a time for debriefing to discuss lessons for future cases.

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