But this success story is beginning to look more complicated: some hospitals have been unable to replicate the impressive results of initial trials. An analysis of more than 200,000 procedures at 101 hospitals in Ontario, Canada, for example, found no significant reductions in complications or deaths after surgical-safety checklists were introduced2. “We see this all the time,” says David Urbach, a surgeon at the University of Toronto who led the Ontario analysis. “A lot of studies that should be a slam dunk don't seem to work in practice.” The stakes are high, because poor use of checklists means that people may be dying unnecessarily.
A cadre of researchers is working to make sense of the discrepancies. They are finding a variety of factors that can influence a checklist's success or failure, ranging from the attitudes of staff to the ways that administrators introduce the tool. The research is part of the growing field of implementation science, which examines why some innovations that work wonderfully in experimental trials tend to fall flat in the real world. The results could help to improve the introduction of other evidence-based programmes, in medicine and beyond.
So if people start cord cutting -- the catch all term for individuals who decide they'd rather not pay for a cable or satellite subscription -- ESPN has by far the most to lose of any channel in the country. ESPN has become the most powerful sports company in the world because just about every single cable and satellite subscriber in the country pays in excess of $6 a month for ESPN. That's despite the fact that only 20% of cable and satellite subscribers would be willing to pay for standalone ESPN according to a 2013 Needham and Company report. As a result, four years ago ESPN netted somewhere in the neighborhood of $7.2 billion a year in subscriber fees when the network boasted 100 million cable and satellite subscribers. But something alarming has taken place in the past four years, the Wall Street Journal reported last week that ESPN has lost over 7 million subscribers. Even more alarmingly, the pace of cord cutting is accelerating, the past year alone has seen ESPN lose over 3 million subscribers. That means in the past four years ESPN's subscriber numbers have declined by 10%, driving down revenue projections.
Stand alone ESPN seeking to produce the same revenue would cost at least $30 a month, or twice what HBO costs and three times what Netflix costs a month. Some sports fans would still consider ESPN to be a bargain at that price, but keep in mind you'd also have to pay for ESPN2 and ESPNU and the SEC Network and FS1 and NBC Sports Network and whatever additional regional cable channels carry your favorite local team's games. The net result would be most sports fans would pay over $100 a month just for sports channels. If you're a dad, like I am, you'd have to pay additionally for kid's channels. Your wife probably watches different channels than you do too, add on those costs too. Pretty soon you're paying more for less. That's why a la carte isn't a great deal for sports fans. In fact, it's a worse deal.