Lessons from Toyota
Engineering principles create value in healthcare settings
BINGHAMTON, NY – Various stakeholders in the healthcare system have talked for years about applying to the healthcare system the engineering concepts that have made manufacturers like Toyota so efficient and successful. While those working in the field have been slow to adopt those concepts, more and more people are seeing the value in doing so.
“We are looking at the possibility of structuring a continuously improving system with the kind of feedback loops that are built into the system quite naturally, as is the case in operations sciences, systems engineering, in manufacturing process, in service industries and a variety of other enterprises,” said Michael McGinnis, MD, senior scholar, Institute of Medicine and executive director of IOM’s Roundtable on Value & Science-Driven Health Care. The roundtable convened a series of workshops that included some on using engineering principles to redesign the healthcare system.
“Some of the key lessons in that report (on the latest engineering workshop) were essentially the observation that many of the shortfalls we see in healthcare right now – medical errors, duplicated services, unjustified variation in patterns of care, health outcomes that are short of expectations – can all be redressed with better systems engineering approaches to the care delivery process,” he said.
Joseph Fortuna, MD, chair, Health Care Division, American Society for Quality, couldn’t agree more, but getting everyone on the same page is going to be and continues to be a challenge, he said. “There are a lot of people who are heavily invested in quality and healthcare being related to medical practices and the way doctors and other providers deliver healthcare, not in the way healthcare is organized or in the way healthcare culture has developed,” he said. “I would submit that there is a culture in healthcare today that probably mitigates against a lot of what we want to be done as a society – team based ain’t part of the vernacular of most docs. Use of continuous improvement as a culture as it exists in Toyota and other places ain’t part of the equation.”
The cultural issue is a tough one, but education and evidence will make the difference, said Mohammad Khasawneh, PhD, associate professor, systems science and industrial engineering and assistant director, health systems, Watson Institute for Systems Excellence (WISE) at Binghamton University.
Khasawneh, his students and colleagues at WISE have been doing projects with healthcare organizations to improve operations and patient experience using engineering principles. Those projects have shown positive results. Using this sort of evidence educationally has an impact. “They see the value and go back to their organization and say, ‘Wait a minute. Why are we not doing what the other organizations are doing?’” Khasawneh said.
To smooth out the cultural bumps, Khasawneh recommends involving people in the process of implementing engineering principles. “Engaging (people) in the process makes the chances of success much higher because they feel that this is not being imposed on them,” he said. “They’re actually part of the solution.”
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