Texas Tech University Health Sciences Center
Collaboration of Health Care and Business

Collaboration of Health Care and Business

There is an interesting article in the January 14 issue of New England Journal of Medicine written by Pamela Hartzband, M.D., and Jerome Groopman, M.D., titled “Medical Taylorism.” If you ever took a management course in college, besides the ubiquitous reference to Abraham Maslow and his “Hierarchy of Needs,” you undoubtedly also heard about Frederick Taylor.  He lived at the turn of the last century and has been called the “father of scientific management” and was an efficiency expert. The characterization is probably unfair, but I and probably most other people think of him as the person who went around with a clipboard and a stopwatch studying, measuring, timing, and trying to standardize most tasks. This behavior does not always make one popular, but he certainly left a legacy in business, which in my opinion, is more positive than negative.

Hartzband and Groopman believe that Toyota’s widely known practices have their genesis in Taylor’s landmark work. Let’s just say they are not impressed, at least in the health care setting, and do not think these techniques lead to the best practice of medicine. They believe that the standardization associated with Taylorism and the Lean practice cannot be applied to many aspects of medicine.

I think it is the “cookie-cutter” approach that they find distasteful. However, they do acknowledge that many aspects of medicine have benefited from Taylor’s principles. For example, they mention adherence to standardized protocols that have reduced hospital infections and encouraged timely treatment of patients with stroke or heart attack.  They make some valid points, including that anything can be taken to an extreme, even good concepts. They think that Taylorism, while full of good intentions, has gone too far.

I think it is good to listen to all voices and I respect their views.  However, much of what TTUHSC and the entire health care industry are trying to do in improving quality involves engaging the patient and standardizing processes.  Have some people been too zealous for the cause?  No doubt.  But, in its ideal and purist sense, Lean is about:
  • Putting the patient first
  • Respecting people
  • Engaging everybody in redesigning systems and continuously improving
  • Solving problems and testing improvements in a scientific way
  • Having a balanced set of goals, putting safety, quality and patient flow first
  • Not blaming individuals for systemic problems
  • Creating a better, less frustrating workplace
  • Improving teamwork and collaboration across silos and discipline

Those concepts are hard to argue against.  However, the critical perspective in the article is also food for thought.

Written by: Brent Magers, CEO