"The way some of these projects were set up, they weren't really designed to collect data in a standardized way, and they weren't set up for people to learn in real time. But I suspect that at the end of the day, they will find certain core practices that are really important, and there'll be a lot of emphasis on adapting them in a flexible way," so they work in multiple hospital settings.
"A lot of people wanted to tackle these tough problems at once, and that was a good thing…And at the end of the day we will have some really great lessons people can run with," Goldmann told me.
I asked Pronovost if it might all be worth it if at the very least, all these programs forced hospital leadership and their trustees to take quality improvement more seriously. Yes and no, he says.
One risk is that "it disengages physicians who don't believe there's science behind them, that this is just marketing. The early quality improvement movement had all these hyperbolic 'we are filling the football stadium with all the people whose lives we saved' statements, and that turned physicians away," Pronovost says.
"All of us want to help, not harm patients, so there's an amazingly strong bias that we want the data to get better. We all want the story to be true.
The problem is at the end of the day, if it's not better, [patients] are still dying, and yet we all clap our hands and say look, what a good job we've done."
Is it a case of the emperor having no clothes?
"The emperor may be wearing clothes," Pronovost says, "but you certainly can't say he's wearing a gold robe."