I give a lot of lean overview presentations to healthcare audiences. While I talk mostly about the application of lean concepts to healthcare (problem solving, improving flow, leveling workloads, reducing waste… pretty universal concepts), I do acknowledge that lean comes from the manufacturing world.
It doesn't happen often, but sometimes a person raises an objection:
“We don't want assembly line medicine.”
When I hear that, I think, “Wow, manufacturing has a real image problem.”
The connotations behind that objective are:
- We don't want to ignore quality
- We don't want to ignore safety
- We don't want to focus on efficiency at the expense of everything else
Well, of course lean DOES focus on safety and quality. Lean does NOT focus on efficiency on top of everything else.
When people make that comment, I think they're really saying “We don't want non-lean assembly line medicine.” When people think of “assembly line”, they must be thinking of the famous I Love Lucy episode with the candy factory line.
They must be thinking of Charlie Chaplin's movie Modern Times
People think of dehumanizing, awful examples. When done right, assembly lines aren't bad or dehumanizing. Healthcare could really use a lot of “assembly line” thinking — or “lean assembly line practices”:
- Align all of the value adding steps so they are physically close and in line with each other
- Align the value adding steps so they flow
- Align the value adding steps so there aren't delays
- Make sure the value added steps are done right the first time
- Make sure that the process is improved continuously, with input from all employees
When you think of “assembly lines” in that way, what's wrong with “assembly line medicine.” Medicine, by its nature, will always be more like Dell (each item built is pretty unique) as opposed to a line where thousands of identical products are cranked out.
When you google “assembly line medicine,” about half of the references on the first page are positive and about half are negative. Well, maybe more than half negative. Interesting, huh?
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I’ve not seen the Chaplin clip before, but it sure reminds me of the saying “if all you have is a hammer, everything starts to look like a nail.” Or something like that.
That’s often how Lean Tools are applied as you know. Sometimes a 5S program “IS” the sum total of Lean in a company as they make everything, (every improvement or initiative,) part of that program.
Thanks for sharing!
Yesterday I was lecturing / Presenting on Lean to a group doing a masters in clinical governance and this came up. Specifically they said “….but its not about having the shortest length of stay is a patients re-admitted”. The response was where have we said that we should compromise what we do to increase either productivity, reduce cost or speed up through put? Its a common misconception that when you say we want to improve efficiency people seem to read between the lines and think that what you are actually saying is “we want to reduce quality”. Its odd that you can say one thing and they simply hear another……..
Yes, you’re right that reducing length of stay isn’t good if the patient is going to come right back the next day or week. Lean thinking wouldn’t try to push patients out the door faster than the doctors say. But… once the discharge order is in, you need to eliminate delays that keep the patient there longer than necessary.
What always fascinates me with the Healthcare/Medicine field is the claim they are not or do not want “assembly line medicine/p&p’s”. If the majority of them took an honest view of their operations and actually toured a well set-up and run assembly line they would realize that once you put aside the emotional part of it, that is all they are is an assembly line. My example for this would be a typical day in the OR…from the PAT visit, to day of surgery; from Pre-op, to surgery room, changeover of OR room, to PACU, to bed floor. May not be the traditional “assembly line” but in alot of respects it is.
I agree with what jwdt said; hospitals are assembly lines. When medicine is brought from scattered sites (peoples’ homes, stand-alone practices, etc.) into a hospital, it’s the same as when craftsmen go to work in factories(like during the industrial revolution).
Those who object to the use of “assembly line medicine” should be made aware that they already practice it, but in a non-lean way. Then, maybe they would see Lean from a different perspective.
There’s a lot to like about the attention to quality in assembly line systems. How many people would want a hand made car?
I started a doctor rating website, http://www.DrScore.com. One of the principles underlying the project was to give doctors a way to assess patients’ perceptions of service quality so that the doctor could work to enhance the quality of care.
Medical care is at least as important as the manufactured items we purchase. We ought to be devoting systematic quality assessment and improvement programs.
[…] See what I wrote about “assembly line medicine” in 2006. […]