Volume 191 - Issue 7
Making cars and making health care: a critical review
Author: Susan Ieraci
Med J Aust 2009; 191 (7): 414-415. || doi: 10.5694/j.1326-5377.2009.tb02866.x
Published online: 5 October 2009
Published online: 5 October 2009
To the Editor: The authors of the recent MJA article “Making cars and making health care: a critical review”1 have misunderstood the importance of process design in a service as complex as health care delivery. They state that the Toyota “lean thinking” model has been “accepted somewhat uncritically” in health.1 In fact, the opposite is true. Work practices and roles in conservative institutions such as public hospitals have changed minimally over many years. Cutting-edge medical technology is delivered within an archaic work practice model that fosters inefficiency, frustration and unnecessary expense. Inefficient work practices give skilled clinicians less time with their patients — not more.
Like Winch and Henderson, let’s take an example from the surgical field. Years ago, when public hospital beds were relatively accessible, many patients were admitted for “work-up” and spent days in their pyjamas in hospital before planned surgery. The application of the “just in time” principle has led to the huge turnaround to day-of-surgery and day-only admissions — freeing up beds and saving enormous cost as well as many unproductive days for patients. This is only one small example.
Lean thinking is just one model for improving the way in which complex processes are coordinated.2 Far from being “highly stylised and simplistic”, lean thinking is about removing redundant steps and reducing duplication, waiting times and errors. It’s about investing in the talent and skill of trained staff, by maximising the value they add to whatever process they are working on and minimising the extraneous tasks they have to do.3 Managed properly, this can result in faster and better care delivered by happier staff, with more time to “cure and comfort”.1
References
- Winch S, Henderson AJ. Making cars and making health care: a critical review. Med J Aust 2009; 191: 28-29. 0_CHDEBDAH
- Womack JP, Jones DT. Beyond Toyota: how to root out waste and pursue perfection. Harv Bus Rev 1996; Sep-Oct: 140-158. 0_CBBJEDGE
- Morris J, Ieraci S, Bauman A, Mohsin M. Emergency Department Workpractice Review Project: introduction of workpractice model and development of clinical documentation system specifications. Sydney: South Western Sydney Area Health Service, 2001. 0_pgfId-1877789