6 Comments

This is SO TRUE! This is a great example of how, from 50,000 feet, something can seem like a great idea. "Systematic process improvement in healthcare? Sounds great!" But if you believe that every patient - and therefore every patient scenario - is unique, mass standardization sounds a lot less great. Thanks as always for the great insight!

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This is an important and subtle question. On the one hand, I think these kinds of processes are why, for example, it is much more difficult to make a critical error in the intensive care unit as a physician today than it was a generation ago. There is almost always at least one if not multiple people checking to make sure you didn’t make a mistake, e.g. the pharmacist pages you and asks if you really meant to give 1000 mg of a medication to a patient instead of 100 mg, because you just made a typo on your order.

It seems that another consideration is that it is much more easy to systematize a product that leaves the factory completed as opposed to systematizing a process of live human interaction. Someday in the future, when physicians are hopefully no longer needed as a profession, this will cease to be such an issue. But this is a speculative view on my part of course.

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I think it's possible to have the best of both worlds. It just takes the administrative will to make it happen. I was in the hospital a few years ago and had a cardiac cath done. A guy showed up at my room with a wheelchair and put a warmed blanket on me. I will always remember how nice that felt. He wheeled me through a very large and complicated hospital to exactly the right place at exactly the right time. They got me on a bed with another warmed blanket and prepped me for the procedure. I was wheeled into the cath lab and met the most competent people I can ever remember (and a third warmed blanket). I signed the consent form and they went into action. It was like some kind of complex dance. No wasted motion. Same experience to recovery and back to my room. It seemed like they'd done this thousands of times and had streamlined the process almost to perfection, yet through it all, I felt very, very cared for.

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Fine article. The perception, at least, is that healthcare has become Taylorist in the worst ways--mechanistic, dehumanizing, process above all. Like Charlie Chaplin in "Modern Times": https://www.youtube.com/watch?v=6n9ESFJTnHs

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I'm guilty of being part of the medico-optimization-industrial complex. Like the cardiac cath example below, I agree there are parts of Taylorism that can continue to benefit our bloated, inefficient, swiss-cheese healthcare system. I also agree that human caring, if we are not careful, can be lost. I do NOT believe burnout is related to over-optimization; we are far from that. We are burning out from expectations unmoored from front-line reality: 20% nurse vacancy rate, uncompensated evening response to inbasket messages, burdensome billing and compliance regulations manifested as hatred of the EHR. Taylorism (and policy changes) should help a great deal. Once we get down to "no human needed to put a patient through best practice care at the hospital or at home" then we can think, we've gone too far and need to re-introduce human caring. We are still far away from that.

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