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08/07/2012 11:25 AM
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For your consideration, here is the article link: http://www.newyorker.com/repor...wande?currentPage=all
I first heard about this through an NPR interview with Gawande about the article. http://www.npr.org/2012/08/07/...ealth-care-guidelines
I admit that I was first interested because I am a shareholder of The Cheesecake Factory, but of course I also expected that the author of The Checklist Manifesto would have some interesting things to say. I am also excited whenever I see cross-industry topics--I am quite excited to see learning jump across industry silos.
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08/09/2012 12:22 PM
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Matt,
Great article and thanks for sharing. Having done quite a bit of Lean work in healthcare the last few years, that one really hits at least one nail right on the head.
For me, the most fascinating thing about healthcare relates back to the book "The Machine that Changed the World." In that book, they trace the history of manufacturing through the ages. Basically, we've had three great manufacturing theories / practices: 1) Craft Production, 2) Mass Production, and 3) Lean Production. The book does a great job of showing how the automobile has evolved - and even driven the evolution of - manufacturing through the ages. It also shows how each new evolution improved upon the previous method.
Now here's the interesting part. One doesn't have to look very hard or far in healthcare to come to the inescapable conclusion that much of the system is stuck in Craft Production. Worse yet, some doctors are darn proud of it! With this comes all of the joys, inefficiencies, variability, waste and high costs that craft production has by its very nature. Generally speaking, Mass Production methods dramatically improve on Craft Production. People are starting to realize how making the leap to Lean methods would save even more while at the same time dramatically improving the customer (patient) experience.
Tom
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08/09/2012 12:22 PM
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Hi Matthew
The article is very interesting, though it made me stop and think why it is so much harder to bring standardization into an area such as healthcare, than it is into something like the food industry.
Despite raw materials having minor difference, on the whole a grade of beef or steel is rather homogeneous. That is the one thing that most manufacturers have in common is that inputs have relatively stable properties (and a restaurant kitchen does in fact manufacture a product). Healthcare on the other hand has no choice over the single most important input, the patient (we come with more variation than just about anything else on the face of the planet). Tack on that the input is also the consumer of the service, and you have one of the few industries where that is the case. Generally an input has no say in what it is supposed to become; or how it wants to be treated while being worked on. No one even those of us in the Lean promotion business want to be treated by the medical profession as just another homogeneous input, instead we demand individualized treatment, even if all we are suffering from is a common aliment with one common treatment. So their problem with standardizing starts with the input and consumer being hostile to the concept, and doctors for all their faults understand that part of human nature.
Second issue is that most doctors do not see all their effort to properly treat patients as creating waste; instead they see it as looking out for the health of their patients. Thus if you want to standardize in healthcare you should start from the right point of view, that of improving the treatment of the patient. Doctors like it when patients experience better results due to their work and effort, thus using standardization to achieve that will be viewed in a positive light and they will help develop the standards using hard evidence, not blind wishful thinking. Understand show a doctor the facts and they are quick to accept it, but if all it is; is cost cutting they will fight it tooth and nail because it doesn't look after the patient. Let start by first help those in medicine develop standardization to improve healthcare delivery results, let the improved results deliver the cost savings.
Let us all remember that less drugs being used, shorter hospital stays, and faster recovery times are all better outcomes, they are also all cost savings to the process. Tackling a problem is always easier if you go at it from the right perspective. From the wrong one you drive people to fight change, from the right perspective the demand and create the change themselves.
Robert Drescher
ELSE Inc.
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