Tag Archives: Lean Methodology

Sound Familiar?

I am reading a really interesting book entitled Team of Teams written by (naturally) a team, which includes retired United States Army General Stanley McChrystal. McChrystal, you may recall, was the commander of US and coalition forces in Afghanistan before he got sacked for comments he and his staff made to a reporter for Rolling Stone. Prior to taking command, he served as the head of US Special Forces in Iraq during the Sunni insurgency, and this book is about how he and his deputies restructured that “Task Force” to meet the unprecedented challenge they faced.

Early in the book, he discusses the rise of “efficiency” as an organizing principle for industry and, by extension, other forms of human endeavor. He tells the story of Frederick W. Taylor who, late in the 19th century, introduced the idea of organizing activities in a factory so that the workers could produce “more, faster, with less.” Taylor also popularized the means of doing so by standardizing processes to reduce wasted time and effort and by optimizing each element of production. He was, one could say, the Lean production maven of his day. Here’s the passage from McChrystal’s book that really caught my attention, describing Taylor’s experience in a factory in 1874:

Taylor became fascinated by the contrast between the scientific precision of the machines in the shop and the remarkably unscientific processes that connected the humans to those beautiful contraptions. Although the industrial revolution has ushered in a new era of technology, the management structures that held everything in place had not changed since the days of artisans, small shops, and guilds: knowledge was largely rule of thumb, acquired through tips and tricks that would trickle down to aspiring craftsmen over the course of a long apprenticeship.

That transformation from artisanal workshop to organized enterprise, and from “tips and tricks” learned through apprenticeship to standardized work that can be specified and taught, sounds to me exactly like what medicine is going through today.  In fact, the changes in medical practice that have been advocated as the pathway to better, less expensive care have been described using the very same language.

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The Future of Medical Practice

I had the opportunity last week to talk and learn about the future of office-based medical practice. The occasion was my participation in a panel discussion sponsored by a manufacturer of equipment for medical offices. A professional facilitator conducted a day-long interactive interview of 6 panelists, strategically selected from non-competing health care markets across the country. We talked about what was going on nationally, regionally and in our own organizations in order to provide a context for the sponsor’s strategic planning.

Much of what we talked about centered on the transition from “volume to value,” the catch-phrase for the movement away from fee-for-service to some form of quality-based payment system. The content of the discussion reminded me of the saying that “the future is already here, it’s just not distributed evenly yet.” Physician leaders from west-coast organizations described a landscape of capitated payments and “accountable care” that we talk a lot about but have not yet lived in a significant way. A representative of an institution in Boston spoke of a more highly consolidated provider community. Those stories were interesting, but not entirely novel. Here are a few things that were:

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