I came across a very interesting blog on WebMD describing the effects of money and insurance on the practice of medicine in the United States. The author, Dr. Ira Kirschenbaum, seemed somewhat pessimistic on the future of American medicine and the potential brain drain due to poor reimbursement. He wrote:
“The great sadness of the death of the smaller [medical] groups is that they were the backbone of service and dedication that made American medicine great. Without these groups, we are becoming a bit more of an assembly line of medical practice.”1
But Is Assembly-Line Medicine Necessarily a Bad Thing?
While there was much to affirm and to deny in his article, the negative view he had of “assembly-line” medical practice caught my interest. Perhaps there is a public perception that assembly-line care is inherently bad. Part of the problem may be the idea that assembly line care is inherently inhumane or impersonal.
Yet, the assembly line has done much to improve manufacturing. How many of us would prefer to buy our microwave oven, refrigerator or toaster from an individual who made the appliance by hand as opposed to purchasing one made on an assembly line?
Of course, medical care is different from a toaster. While all toasters on a given assembly line are the same, patients and their medical problems are not all the same.
But that doesn’t mean we can’t apply some of the lessons learned from manufacturing to improve patient care.
Step-by-Step Excellence at Dell Computers
Dell Computers recently opened a plant here in Winston-Salem. I had the opportunity to tour the plant with the chief engineer. They custom build each computer to the customer’s specifications, and there are a gazillion different possible permutations. Yet they try to optimize every single step of the manufacturing process. They are fanatical about making each step the best it can be. Is it unreasonable to think that service providers couldn’t benefit from that kind of thinking?
Virginia Mason Medical Center’s Inspiration
Established in 1920, Virginia Mason Medical Center began as an 80-bed hospital with six physician offices. The founders — James Tate Mason, M.D., John M. Blackford, M.D., and Maurice Dwyer, M.D. — envisioned “a single place where patients could receive comprehensive medical care, a one-stop shopping place for virtually any medical problem or need.”2
Given the topic of this editorial, it may not surprise you that an update to this vision for Virginia Mason’s approach to cancer treatment — as noted in a Washingtonpost.com article — was inspired by what many consider to be the ultimate automaker.
“The inspiration for Virginia Mason’s newfound approach to cancer care came from a most unlikely source: the assembly line at Toyota Motor Corp. Like the Japanese automaker’s plants, the glistening new cancer center here was designed around themes of high quality, super-efficiency and putting the customer first. Errors are embraced as learning opportunities, and every one of Virginia Mason’s 5,000 employees is encouraged to offer ideas. According to hospital executives and some industry analysts, the management principles that made Toyota the world’s most successful car company could have similar results at Virginia Mason.”3
What We Can Learn about Practicing Medicine from Manufacturing
Doctors are devoted to their patients, and medicine is a service business. These are not contradictory statements. Medical care is at least as important as the manufactured items we purchase. We ought to be devoting efforts to systematic quality assessment and improvement programs. Incorporating the best of assembly line optimization thinking could be good for our patients.
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
I came across a very interesting blog on WebMD describing the effects of money and insurance on the practice of medicine in the United States. The author, Dr. Ira Kirschenbaum, seemed somewhat pessimistic on the future of American medicine and the potential brain drain due to poor reimbursement. He wrote:
“The great sadness of the death of the smaller [medical] groups is that they were the backbone of service and dedication that made American medicine great. Without these groups, we are becoming a bit more of an assembly line of medical practice.”1
But Is Assembly-Line Medicine Necessarily a Bad Thing?
While there was much to affirm and to deny in his article, the negative view he had of “assembly-line” medical practice caught my interest. Perhaps there is a public perception that assembly-line care is inherently bad. Part of the problem may be the idea that assembly line care is inherently inhumane or impersonal.
Yet, the assembly line has done much to improve manufacturing. How many of us would prefer to buy our microwave oven, refrigerator or toaster from an individual who made the appliance by hand as opposed to purchasing one made on an assembly line?
Of course, medical care is different from a toaster. While all toasters on a given assembly line are the same, patients and their medical problems are not all the same.
But that doesn’t mean we can’t apply some of the lessons learned from manufacturing to improve patient care.
Step-by-Step Excellence at Dell Computers
Dell Computers recently opened a plant here in Winston-Salem. I had the opportunity to tour the plant with the chief engineer. They custom build each computer to the customer’s specifications, and there are a gazillion different possible permutations. Yet they try to optimize every single step of the manufacturing process. They are fanatical about making each step the best it can be. Is it unreasonable to think that service providers couldn’t benefit from that kind of thinking?
Virginia Mason Medical Center’s Inspiration
Established in 1920, Virginia Mason Medical Center began as an 80-bed hospital with six physician offices. The founders — James Tate Mason, M.D., John M. Blackford, M.D., and Maurice Dwyer, M.D. — envisioned “a single place where patients could receive comprehensive medical care, a one-stop shopping place for virtually any medical problem or need.”2
Given the topic of this editorial, it may not surprise you that an update to this vision for Virginia Mason’s approach to cancer treatment — as noted in a Washingtonpost.com article — was inspired by what many consider to be the ultimate automaker.
“The inspiration for Virginia Mason’s newfound approach to cancer care came from a most unlikely source: the assembly line at Toyota Motor Corp. Like the Japanese automaker’s plants, the glistening new cancer center here was designed around themes of high quality, super-efficiency and putting the customer first. Errors are embraced as learning opportunities, and every one of Virginia Mason’s 5,000 employees is encouraged to offer ideas. According to hospital executives and some industry analysts, the management principles that made Toyota the world’s most successful car company could have similar results at Virginia Mason.”3
What We Can Learn about Practicing Medicine from Manufacturing
Doctors are devoted to their patients, and medicine is a service business. These are not contradictory statements. Medical care is at least as important as the manufactured items we purchase. We ought to be devoting efforts to systematic quality assessment and improvement programs. Incorporating the best of assembly line optimization thinking could be good for our patients.
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
I came across a very interesting blog on WebMD describing the effects of money and insurance on the practice of medicine in the United States. The author, Dr. Ira Kirschenbaum, seemed somewhat pessimistic on the future of American medicine and the potential brain drain due to poor reimbursement. He wrote:
“The great sadness of the death of the smaller [medical] groups is that they were the backbone of service and dedication that made American medicine great. Without these groups, we are becoming a bit more of an assembly line of medical practice.”1
But Is Assembly-Line Medicine Necessarily a Bad Thing?
While there was much to affirm and to deny in his article, the negative view he had of “assembly-line” medical practice caught my interest. Perhaps there is a public perception that assembly-line care is inherently bad. Part of the problem may be the idea that assembly line care is inherently inhumane or impersonal.
Yet, the assembly line has done much to improve manufacturing. How many of us would prefer to buy our microwave oven, refrigerator or toaster from an individual who made the appliance by hand as opposed to purchasing one made on an assembly line?
Of course, medical care is different from a toaster. While all toasters on a given assembly line are the same, patients and their medical problems are not all the same.
But that doesn’t mean we can’t apply some of the lessons learned from manufacturing to improve patient care.
Step-by-Step Excellence at Dell Computers
Dell Computers recently opened a plant here in Winston-Salem. I had the opportunity to tour the plant with the chief engineer. They custom build each computer to the customer’s specifications, and there are a gazillion different possible permutations. Yet they try to optimize every single step of the manufacturing process. They are fanatical about making each step the best it can be. Is it unreasonable to think that service providers couldn’t benefit from that kind of thinking?
Virginia Mason Medical Center’s Inspiration
Established in 1920, Virginia Mason Medical Center began as an 80-bed hospital with six physician offices. The founders — James Tate Mason, M.D., John M. Blackford, M.D., and Maurice Dwyer, M.D. — envisioned “a single place where patients could receive comprehensive medical care, a one-stop shopping place for virtually any medical problem or need.”2
Given the topic of this editorial, it may not surprise you that an update to this vision for Virginia Mason’s approach to cancer treatment — as noted in a Washingtonpost.com article — was inspired by what many consider to be the ultimate automaker.
“The inspiration for Virginia Mason’s newfound approach to cancer care came from a most unlikely source: the assembly line at Toyota Motor Corp. Like the Japanese automaker’s plants, the glistening new cancer center here was designed around themes of high quality, super-efficiency and putting the customer first. Errors are embraced as learning opportunities, and every one of Virginia Mason’s 5,000 employees is encouraged to offer ideas. According to hospital executives and some industry analysts, the management principles that made Toyota the world’s most successful car company could have similar results at Virginia Mason.”3
What We Can Learn about Practicing Medicine from Manufacturing
Doctors are devoted to their patients, and medicine is a service business. These are not contradictory statements. Medical care is at least as important as the manufactured items we purchase. We ought to be devoting efforts to systematic quality assessment and improvement programs. Incorporating the best of assembly line optimization thinking could be good for our patients.
Steven R. Feldman, M.D., Ph.D.
Chief Medical Editor
