About 4 minutes into the video (or you can read the transcript). Dr. Kim does a nice job of summing up the reasons behind the lack of systems engineering and systems thinking in healthcare. He also offers up Lean and Six Sigma as part of the solution.
Dr. Kim explains that medicine has focused on the next technological leap — an innovation strategy searching for a home run instead of a process strategy that’s also focusing on fundamentals of care delivery and looking for incremental improvements. He says:
My own particular take on it is that I think for many, many years, we’ve been working under the fantasy that if we come up with new drugs and new treatments, we’re done.
The rest of the system will take care of itself. In my view, the rocket science in health and health care is how we deliver it. And unfortunately, there’s not a single medical school that I know of that actually teaches the delivery of health care as one of the essential sciences
Bill Moyers asks him about the complexity of health care and Dr. Kim says:
Well, just think about a single patient. So a patient comes into the hospital. There’s a judgment made the minute that patient walks into the emergency room about how sick that person is. And then there are relays of information from the triage nurse to the physician, from the physician to the other physician, who comes on the shift.
From them to the ward team, that takes over that patient. There’s so many just transfers of information. You know, we haven’t looked at that transfer of information the way that, for example, Southwest Airlines has. Apparently they do it better than any other company in the world.
Moyers asks if Southwest uses computers to do this, implying that the fix in healthcare would be technological. Dr. Kim says, no it’s a matter of process.
He says quite a bit more that’s worth checking out (including the idea that we tolerate, even celebrate inefficiency in healthcare because people mean so well). I won’t quote it all, but here is the final comment that certainly caught my attention:
Folks in the Dartmouth Institute have developed techniques that borrow from industry, that borrow from, for example, the Toyota production system models, Six Sigma, these great management tools, and try to bring them to the hospital.
It’s great to see Dr. Kim’s leadership in this area!
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