Frank's blog

Leaning (on) our healthcare system

I usually do not reblog or comment on other people’s articles, however, the blog by Dr. Patricia Gabow and Ken Snyder in response to “Medical Taylorism” struck a chord with me. I have recently spent a lot of time in hospitals and witnessed disrespect for processes and people, staff as well as patients.

The health care system is divided into many departments e.g. emergency, radiology, pathology, and cardiology. The patient is pushed from one area to another. The healthcare system seems optimised for the ‘silos’ rather than the patient’s journey.

Lean is all about respect for every individual, and listening to the voice of the customer, i.e. the patient’s journey. In my experience, implementing Lean is about removing silo-based batch processing, and instead, creating a continuous flow of value adding. Hence, Lean focuses initially on what happens in-between the value adding processes in an effort to remove this waste.

Putting this into the context of the two articles below, the focus in healthcare need not be on reducing the doctor-patient interaction. From the patient’s point of view, the consultation is a value adding step. The emphasis should be on reducing the patient’s wasted time before and after the consultation, as well as in-between the silos i.e. treatments.

I hope you enjoy the two articles. As a member of Shingo Executive Advisory Board, I fully support the holistic approach of Patty and Ken’s response.

- Frank, CEO -


“Medical Taylorism:” An Article that Does a Huge Disservice to Needed Healthcare Transformation

Dr. Patricia Gabow and Ken Snyder

The article, “Medical Taylorism,”[1] by Pamela Hartzband, M.D. and Jerome Groopman, M.D., in the New England Journal of Medicine, reflects a major misunderstanding of the principles and practice of the Toyota Production System, or Lean as it is often called. Specifically, the article appears to conflate poor implementation with the underlying principles. Several commentators, including many from the Lean community, have weighed in on this debate, but more needs to be said given healthcare’s need for transformation and the powerful solution that Lean offers in this transformation.

Principles

Doctors Hartzband and Groopman are feeling pain due to their experiences. We sympathize with their pain. Too often, whether in healthcare or other settings, we see poor implementations of Lean. These poor implementations are almost always due to failure to follow the principles of operational excellence.

In this discussion about Lean in healthcare, there are some specific principles that deserve emphasis. In citing these principles, we will adopt the terminology used in the Shingo Model.™[2]

  • Seek Perfection
  • Respect Every Individual
  • Control Quality at the Source
  • Embrace Scientific Thinking
  • Create Constancy of Purpose

It is unfortunate that many who implement Lean seem to forget these core principles. It is hard to imagine any set of principles which would more closely align with the needs of healthcare and commitment to the population’s well-being than these principles.

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Medical Taylorism

Pamela Hartzband, M.D., and Jerome Groopman, M.D.

Frederick Taylor, a son of Philadelphia aristocrats who lived at the turn of the last century, became known as the “father of scientific management” — the original “efficiency expert.” He believed that the components of every job could and should be scientifically studied, measured, timed, and standardized to maximize efficiency and profit. Central to Taylor’s system is the notion that there is one best way to do every task and that it is the manager’s responsibility to ensure that no worker deviates from it. “In the past, the man has been first; in the future, the system must be first,” Taylor asserted.

Toyota, inspired by these principles of “Taylorism,” successfully applied them to the manufacture of cars, thereby improving quality, eliminating waste, and cutting costs. As health care comes under increasing economic pressure to achieve these same goals, Taylorism has begun permeating the culture of medicine.

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  • Shingo Institute, Logan, UT, USA
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