Taking action: aim for zero preventable harm

The first four steps of the SCOTT Protocol are about seeing clearly: knowing where you could fail, watching the trend, getting the right expert, planning for the setback. This one is about the part people skip. Many adults can name at least one thing they should do for their health and haven't done. The screening that's a year overdue. The referral that's been sitting in the portal since spring. Taking action is the step that turns that knowledge into a date on the calendar.

"High reliability organizations take action every day to achieve their benchmark goal of zero preventable harmful events. They constantly weigh the cumulative impact of daily choices and actions." Dr. Scott, from the original SCOTT Protocol

That benchmark comes from health care's own version of high reliability. In a 2013 paper that set out a framework for hospitals working toward it, Mark Chassin of the Joint Commission and his co-author Jerod Loeb put the logic in one line: "Aiming for zero harm is the first step toward achieving it." High reliability organizations, they pointed out, are never satisfied with whatever level of safety they have already reached, and the change starts with leaders who commit to eventually reaching zero patient harm.

Zero is a direction, not a promise

Nobody can promise you zero disease. Dr. Scott says as much in her original slide: "Despite the complex science of risk assessment in medicine, diagnostics rarely reduce the risk of a specific disease or condition to zero. A healthy past doesn't ensure a system free from failure." Your annual physical, she adds, gives your clinician only "a brief snapshot" of your health.

What you can push toward zero is the preventable failure on your side of the ledger. The colonoscopy that never got scheduled. The prescription that ran out in March. The abnormal result nobody followed up because everyone assumed someone else would. These are the small, ordinary holes that line up in James Reason's Swiss cheese model of how harm happens, and almost none of them takes medical training to close. Each one takes a phone call and a date.

Zero on a specific harm is not fantasy, either. In a 2006 study of intensive care units that adopted a short checklist for placing central lines, along with work on safety culture, the median rate of catheter bloodstream infections fell from 2.7 per 1,000 catheter-days to zero within three months, and the drop held for the 18 months the study ran. Nothing about that required new technology. It required doing the known steps every single time, which is the same thing this step asks of you.

The gap between knowing and doing

Look at colorectal cancer screening, which the U.S. Preventive Services Task Force gives its top grade for adults 50 to 75. In 2023, only 67.4 percent of adults 45 to 75 were up to date, according to the CDC's National Health Interview Survey. Among adults 45 to 49, the age group the Task Force added in 2021, it was 37.1 percent. That leaves roughly one adult in three in the screening ages behind on a test the Task Force has recommended for years.

The same survey shows what helps. Adults with a usual place to get care were up to date on colorectal screening 71.5 percent of the time; adults without one, 41.1 percent. Uninsured adults under 65 were up to date only 23.8 percent of the time. Knowledge doesn't close the gap. A relationship does: someone who tracks what you're due for, sends the reminder and writes the order.

Blood pressure tells the same story. Of every 100 American adults with high blood pressure, about 59 have been told, 51 are being treated and only 21 have it under control, measured against the 130/80 threshold in current guidelines. Among non-Hispanic Black adults the condition is more common still: the CDC puts age-adjusted prevalence at 58 percent, the highest of any group. After the first rung, every step down that ladder is a place where somebody knew and the next thing didn't happen.

Become the CEO of your wellness

Dr. Scott's original slide frames that relationship in terms any executive would recognize, and the line sums up her whole protocol.

"By accepting your body, health and wellness as a business, your first action step is to become CEO of your wellness. Your doctor is your COO, who helps support you in achieving your goals. You can outperform your family's health legacy." Dr. Scott, from the original SCOTT Protocol

A chief operating officer runs the operation day to day; a CEO sets direction, reads the reports and holds people to follow-up. In practice, being CEO of your health looks less like heroics and more like housekeeping:

• You set the agenda for each visit, in writing, with your top concern first.
• You keep the records: results, medication list, the dates of your last screenings. If your clinic's portal has them, you still keep your own copy.
• You own the follow-up. When a test is ordered, you ask when and how you'll hear, and you call if you don't.
• You hold a short review with yourself once a month: what's due, what's overdue, what changed.

The last sentence of her quote is the ambitious one. Family history is real information, and the CDC notes that risk rises when more than one close relative has a condition or a relative was diagnosed younger than usual. If a parent or sibling had colorectal cancer before 50, for instance, the CDC suggests asking whether you should start screening earlier or have it more often. That's what outperforming a legacy looks like: using it as an early warning instead of a forecast.

Small choices, added up

"The cumulative impact of daily choices" is not a slogan. Researchers followed more than 120,000 nurses and other health professionals for up to 34 years and tracked five low-risk habits: never smoking, a body mass index between 18.5 and 24.9, at least 30 minutes a day of moderate or vigorous activity, moderate drinking, and a diet in the healthiest 40 percent. People who kept all five were projected to live far longer than those who kept none.

Years of life left at age 50

Projected for U.S. health professionals who kept none of the five low-risk habits, and for those who kept all five.

• None of the five
• All five

Women

Men

20304050 years

Show the numbers

	None of the five	All five	Difference
Women	29.0	43.1	14.0 years
Men	25.5	37.6	12.2 years

Source: Li and colleagues, Circulation, 2018, from the Nurses' Health Study and the Health Professionals Follow-up Study. Observational: it shows an association, not proof that the habits alone caused the difference.

Read the result honestly. This was an observational study, mostly of white health professionals, so it shows a strong association rather than proof that the habits alone did the work. It also predates newer guidance on alcohol: the Dietary Guidelines for Americans, 2025 to 2030 dropped the old daily drink limits and now say simply, "Consume less alcohol for better overall health." And it compares the extremes, all five habits against none. Most people live somewhere in between, which means most people have room to move.

A 2014 CDC analysis made the same point from the other end. Comparing each state with the three states that had the lowest death rates, researchers estimated that a large share of deaths before age 80 were potentially preventable: about 34 percent of heart disease deaths, 33 percent of stroke deaths and 21 percent of cancer deaths in 2008 to 2010. The data are old, and because the causes compete with one another, the percentages can't be added together. The direction hasn't changed.

The cost of waiting

Waiting has a price, and cancer statistics show it most plainly. The National Cancer Institute's SEER program tracks how many people are alive five years after diagnosis, split by how far the cancer had spread when it was found. Pick a cancer and compare.

The pattern is the same for all four. Found while localized, most of these cancers are survivable; found after they reach distant organs, most are not. Screening exists to catch more cancers at the localized stage, which is why an overdue screening belongs at the top of your action list rather than somewhere in the middle.

For Black families the stakes are higher still. The American Cancer Society's 2025 report on cancer in Black Americans found that Black women are 9 percent less likely than white women to be diagnosed with cancer but 10 percent more likely to die of it. Earlier detection is one of the few parts of that gap a single person can act on.

One step, with a date on it

Big health resolutions fail for the same reason big corporate initiatives do: nobody owns the first move. So break the work down to the smallest action that moves anything, usually a phone call, and attach a date. Pick the items that are overdue for you, give each one a deadline you'll actually meet, and print the list. If you aren't sure what you're due for, start with the screening timeline, which lists what the U.S. Preventive Services Task Force recommends by age and sex as of October 2026.

Do one thing on the list today, even if it's the smallest. A booked appointment is worth more than a perfect plan, and the second call is always easier than the first.

That's the whole protocol: see where you could fail, watch the trend, get the right expert, plan for the setback, and act. Then go back to the beginning, because a reliable system never declares itself finished. Start again with self-awareness, or put the steps to work with the field kit.

Last updated October 16, 2026. Guidance cited here was current on that date; clinical guidelines change, so check with your own clinician. See our editorial policy.