At Johns Hopkins Hospital in the early 2000s, something deeply unsettling was happening. Patients were dying from preventable infections during surgery. These were not careless doctors. They were highly trained specialists at one of the best hospitals in the world. Everyone knew the rules.

A young ICU doctor, Peter Pronovost—blonde hair with a smile fit for a dentist’s commercial—noticed that under pressure, basic steps were sometimes skipped. So, he came up with a laughably simple solution— a checklist.

Step 1: Wash hands,
Step 2: Clean the patient’s skin,
Step 3: Use full sterile barriers,
Step 4: drape the patient, and
Step 5: apply a sterile dressing.

There was nothing new or unknown about this checklist. However, it reduced infections to near zero and prevented hundreds of deaths. The secret was in the system around it. Nurses were authorised to stop a procedure if any step was missed. Even senior doctors could be stopped. No hierarchy. No egos. Just a system, enforced without exception.

The results were remarkable. When the same checklist was later implemented across hospitals in Michigan, bloodstream infections similarly dropped dramatically, and thousands of lives were saved.

No new technology.
No additional training.
Just a simple system put in place and followed without exception.

The lesson extends far beyond medicine. In business, founders and leaders leave too much to discretion. Payments are made on the fly, meetings are called willy-nilly, and leaders make decisions to demonstrate power and control, rather than to protect and support systems.

The results become cash flow problems, confusion among team members, and endlessly putting out fires—one crisis after another. Peter Pronovost and Johns Hopkins Hospital teach us that the solution does not require training, huge investments or restructuring. The miracle of a checklist, enforced by systems, is the solution.

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