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Dr. Seuss' thirteenth book was written in 1957. It was his first entry into the educational market, a book to be sold to schools for classroom use.

Seuss' earlier works had no contractual limitations on size or content. The publishing contracts were drawn up after a complete book was delivered to the publisher. He collected no advance fees, and had no deadlines.

The new book imposed a limitation: Its vocabulary had to be limited to 225 specific words.

It also had a specific goal. Seuss and his publisher wanted to end the "see-spot-run" mediocrity of early childrens' readers. William Spaulding was the director of Houghton Mifflin's educational division. He challenged Seuss: "Write me a story that first-graders can't put down!"

Seuss agreed, but soon became frustrated with the word list.

For a year afterward, Pronovost and his colleagues monitored what happened. The results were so dramatic that they weren't sure whether to believe them: the ten-day line-infection rate went from 11 percent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. The calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

The executives weren't used to venturing into patient territory, and didn't feel they belonged there. In some places, they encountered hostility, but their involvement proved crucial. In the first month, the executives discovered that chlorhexidine soap, shown to reduce line infections, was available in less than a third of the ICUs.