Whither the Pittsburgh Regional Healthcare Initiative without Paul O'Neill at its helm? It's a question with implications for Pittsburgh's physical and mental well-being.

PRHI, co-founded by Mr. O'Neill in 1997, tackles vexing medical problems with an approach that is not sexy or splashy. Rather than searching for a cure to cancer or building a fancy treatment wing, the group borrows the philosophy from companies like Toyota and Alcoa that no detail is too small: Are gloves stocked properly? Are wheelchairs cleaned regularly? Are hospital beds numbered consistently?

Along the way, Mr. O'Neill, the former U.S. Treasury secretary and former Alcoa CEO, became a national expert -- and crusader -- for systemic changes in hospitals. According to Mr. O'Neill, details often thought of as minor can make a major difference. "If we did things we already know on a consistent basis, we could reduce the cost of medical care by 50 percent," he said. Those changes can also save lives. The federal Centers for Disease Control report that a staggering 100,000 people die each year from hospital-acquired infections, many of which are preventable.

Working with individual doctors at various hospitals, PRHI has had some notable successes. Deaths at Allegheny General Hospital from "central line" bloodstream infections fell from 19 to zero in one year. At the veterans hospital in Oakland, doctors were able to reduce antibiotic-resistant staph infections from 12 to zero after implementing PRHI procedures.

But those successes have not been replicated on a large scale. Despite the obvious potential for savings in costs and lives, the group has been unable to make progress in the community at large. Mr. O'Neill described doctors who were unwilling to slow down and write legibly, businesses that were too worried about the effect on their bottom line and hospitals that were reluctant to report damaging data. Specifically, he cited reluctance by the University of Pittsburgh Medical Center to embrace PRHI's ideas as one reason for his resignation from the UPMC board last September. (UPMC has said it carefully polices itself.)

In a move he said was borne not out of finances but frustration, Mr. O'Neill is giving up his formal title at PRHI to start a for-profit hospital consulting company. "If people think [the advice is] free, that's what they think it's worth," he said recently. "... If people pay for it, they'll act on it."

With Mr. O'Neill focusing on the for-profit company, ex-Alcoa executive Paul L. Perreiah will take over as managing director of PRHI. We can only hope that the group will continue to make progress without Mr. O'Neill's leadership. It would be a shame for the initiative to founder in an area where Pittsburgh can truly shine.