How modern healthcare draws draws lessons from early 20th century industrialization
Here are some thoughts I had on healthcare’s slide into industrialization. I’d love to hear what you think. It’s been a bit hectic on this end. I made my big move to Austin this week. I forgot just how disruptive it is to change your ‘space.’ But I’m settled in a great property. I’ll also share some pics of my temporary Texas Children’s office. Thanks for reading and I love the feedback. — Bryan
”In an age of advanced technology, inefficiency is the sin against the Holy Ghost.” — Aldous Huxley, forward to Brave New World.
Frederick Winslow Taylor, known as the father of scientific management, was an American mechanical engineer who sought to improve industrial efficiency in the late 19th and early 20th centuries. His methods centered on the systematic and scientific analysis of work processes, measurement of performance, division of work, and the concept of "the one best way" to do a task. The Principles of Scientific Management, published in 1911, was a best-selling business book. He defined industrial efficiency for a generation of businesses dependent on the efficient flow of an assembly line.
Healthcare now is in a similar wave of relentless optimization. And when you look carefully, our emphasis on measurement, analysis, and cycles of improvement seems to draw inspiration from Taylor.
So, how has healthcare become Tayloresque?
1. Scientific Analysis of Clinical Processes
Just as Taylor studied and timed steel workers' movements to maximize efficiency, healthcare institutions are analyzing their own workflows to identify bottlenecks, waste, and opportunities for optimization. In fact, many things in healthcare have been reduced to a process. Examples include the examination of patient flow through the hospital, use of resources, or time spent on administrative tasks. PDSA cycles (the bedrock of quality improvement: plan - do - study - act) swirl into a vortex of efficiency. It seems there’s nothing in care delivery that can evade the clutch of process improvement.
2. Performance Measurement
Taylor emphasized the importance of measuring performance as a basis for improvement. In healthcare, there is a growing focus on quantifiable performance measures like patient outcomes, readmission rates, and satisfaction scores. This data-driven approach enables the identification of areas for improvement, tracks the effectiveness of interventions, and promotes accountability.
Further driving performance measurement is the reality that reimbursement in the U.S. is linked to ‘how well’ we do things.
3. Standardization of Care and Best Practices
Taylor's philosophy of "the one best way" to do a task is mirrored in the development of evidence-based protocols and guidelines. These standardized practices aim to reduce variability in care, thereby enhancing the quality and consistency of outcomes.
4. Division of Work
Taylor promoted the breaking down of tasks into smaller parts that could be performed efficiently by the line worker. Similarly, role delineation is a growing practice in healthcare, where specific tasks are delegated to the most appropriate healthcare professional – it saves time and optimizes resources.
This pervasive culture of improvement and process transformation has been a boon to the healthcare industry. And attention to what we do in the name of making things incrementally better represents a critical generational approach to care.
So what’s our end-point?
But how optimized can we really be? Or how optimized should we be? And are there things we might not want to optimize? The sterilization process of operative instruments can never be too optimized. But shaping the individual pre-op experience of an anxious first-time mother is harder to fashion as an industrialized process.
And can you optimize a nurse or a doctor? Maybe we're watching that experiment play out with record levels of burnout.
I’ve been thinking alot about how we need to be careful about the elevation of efficiency above other parts of the human experience. And I suspect that competitive positioning in healthcare may ultimately come down to some things that are scarce and inefficient.
Process improvement is key to quality care. And no sensible patient would want anything less. But I suspect over time patients will demand connection with imperfect humans. Be it for touch or deeper understanding, intermediation among the machines will define our unique value.
While similarities exist between manufacturing and clinical clinical care, it's important to note the limitations of applying Taylorism to healthcare. Human care is complex and multidimensional. It involves unpredictable human elements that can't be measured or standardized in the same way as industrial processes.
I have more coming on this idea of scarcity in times of abundant access. Stay tuned.
Thanks for reading. And as always, please pass this along….