Volume 192 - Issue 5
Making cars and making health care: a critical review
Authors: Sarah Winch and Amanda J Henderson
Med J Aust 2010; 192 (5): 295-296. || doi: 10.5694/j.1326-5377.2010.tb03522.x
Published online: 1 March 2010
Published online: 1 March 2010
To the Editor: It is pleasing to see the acknowledgement by contributors of the fundamental premise that the fragmentation of health care may reduce the quality provided, which was a key argument of our article.1 Our aim was to provide space for critical appraisal of “lean thinking” and its application to health care, by questioning the assumed theoretical basis from which this approach is derived and enquiring about the evidence for long-term benefits relating to patient outcomes. We wished to engender discussion and debate rather than provide a systematic review of existing literature. To this end, we think our aim has been achieved.
Returning to the central thesis of our article, we argue that the notion of quality is rapidly being subsumed by quantity (understood as patient throughput and the number of measurable errors). This is reflected in the focus of Ben-Tovim and colleagues on process rather than practice.2 We believe that medicine is grounded in the human condition,3 and thus ideas of quality must relate to patient experience, including harms that are not readily measurable. We acknowledge that health care is becoming more and more complex, and increasingly requires the exercise of practical wisdom that informs clinical reasoning.4 Individual differences between patients mean that each situation has to be considered in its own context. Recognition of this difference provides the opportunity for some of the richness and satisfaction inherent in medicine.
Finally, medicine and health care are far from immune to adopting and repeating the mistakes of other professions and industries. It has been suggested that the continued rationalisation of health care, such as occurs with “lean” approaches, may contribute to the deprofessionalisation of medicine over time.5 In turn, this may promote the “McDonaldization”6 of health care, whereby efficient turnaround becomes the primary goal. We suspect that, while meeting a need at one level, this would provide little long-term satisfaction for health care providers or patients.
References
- Winch S, Henderson AJ. Making cars and making health care: a critical review. Med J Aust 2009; 191: 28-29.
- Ben-Tovim DI, Dougherty ML, O’Connell TJ, McGrath KM. Patient journeys: the process of clinical redesign. Med J Aust 2008; 188 (6 Suppl): S14-S17. 0_CBBBBJGA
- Pellegrino ED. From medical ethics to a moral philosophy of the professions. In: Walter JK, Klein EP, editors. The story of bioethics. Washington, DC: Georgetown University Press, 2003. 0_CBBGHHHA
- Tonelli M. Integrating evidence into clinical practice: an alternative to evidence-based approaches. J Eval Clin Pract 2006; 12: 248–256. 0_CBBBBEFH
- Ritzer G, Walcak D. Rationalisation and deprofessionalisation of physicians. Soc Forces 1988; 67: 1-22. 0_CBBIGEDC
- Ritzer G. The McDonaldization of society: an investigation into the changing character of contemporary social life. Thousand Oaks, Calif: Pine Forge Press, 1996. 0_CBBFDHAE