I don't think the reason doctors forget to wash their hands or create full-body sterile fields for inserting central lines is due at all to compensation systems

I don't think the reason doctors forget to wash their hands or create full-body sterile fields for inserting central lines is due at all to compensation systems. They just forget, or they get lazy, or they don't understand how important it is. They're rushed, too. It's human nature. Another, potentially profitable, solution to the problem would be relatively easy using something similar to those new Philips ICU monitors that modularly record pulseox, blood pressure, respiration, etc... When the doctor is about to insert a central line, the nurse can click "central line" and the computer will say, audibly, "wash hands." Then the doctor says "next" and it says "create full-body sterile field. All non-necessary personnel, leave the room now." Then, just before the needle insertion, it asks very quickly "Have you washed your hands, created a sterile field, cleansed with chlorahexadine, and removed all non-necessary personnel?" Again an auditory "yes" will make the machine turn green or something, signifying that the doctor can insert the central line. It will add maybe 10 or 15 seconds to the process, and can have these kinds of flows for every routine procedure. Many doctors would probably consider a machine doing that insulting. But if it saves "thousands" of lives, it's definitely worth it for someone to create a company and build them. I was visiting an ICU for a couple of weeks last month, and I noticed that the nurses almost always do things by memory-- one of them forgot to check the dressing of a central line, and when the doctor asked why, she said she forgot. It says on the piece of paper at her desk that she was supposed to check it, but she doesn't get to sit at her desk very often. There are lots of possibilities for technology to help improve the chances of critical care patients surviving. Like the auditory checklist above, why aren't scheduled things like dressing check/changes, IV fluid refills, and body movement/cleaning automated on some sort of central ICU computer which communicates with nurses using wireless PDAs? The airline Virgin America makes their flight attendants use wireless UMPCs so they are instantly notified when someone orders something from the in-flight entertainment system. When a a patient's IV bag runs out, the nurses PDA can vibrate and the task can be added to a list. Why is this so difficult? It's complicated, expensive, and tedious. But if it saves lives and reduces infection rates, it might pay for itself very quickly. My point is, even though the checklist procedure seems very stupid and simple, it should be integrated with sophisticated technology so it is never accidentally forgotten. I think that's where the future of healthcare is going, especially in critical care. It's too bad there aren't many (any) startups pursuing this field; it's dominated by Siemens and Phillips, and I think that's a reason there's so little innovation in hospital-based systems for patient care. So much money goes into research, as the article points out, but very little goes into implementing the results into practical patient care. That's where technology should come in, not just paper checklists.