By November 10, 2009 3 Comments Read More →

Why it Took 15 Years for Common Sense to be Accepted – Medical Journal Article on the Gilbreths in the O.R.

Frank and Lillian Gilbreth: scientific management in the operating room

I sprung $20 for this healthcare journal article about the Gilbreths, thought I’d share a few historical tidbits here. I already knew that Frank Gilbreth was credited with the idea that surgeons shouldn’t waste time digging around looking for their own tools — they needed what Gilbreth called a “surgical caddy” to hand the instruments to them.

scalpel

That created the familiar cliche’ scene on TV and movies of the surgeon putting out their hand and barking “scalpel!!” and getting the instrument almost immediately.

Before this innovation:

“The Gilbreths observed that surgeons spent more time searching for their instruments when operating than actually performing the operation.”

Now there’s a familiar theme in healthcare – often times nurses spend more time on a shift walking and searching for supplies, equipment, information, and medication than they spend on actual bedside patient care. This is something Henry Ford discovered in the 1920’s and it’s a problem today in 2009 in many hospitals (and some are fixing that problem with Lean methods).

The old story gives me a bit of pride as an Industrial Engineer, that engineers have been making a contribution to healthcare process improvement for a long time… well, trying to make an improvement.

What the journal article described was this disturbing detail:

“Gilbreth presented their results on surgical operations and the standarisation of techniques in operating rooms at the meeting of the American Medical Association in 1915. Their recommendations were first ignored by the medical establishment. In 1930, the AMA eventually accepted the Gilbreth’s operating room procedures, recognising the value of motion study.”

Why that 15 year delay? I’m not sure if that will prove reassuring in the least to those of you who have great ideas that aren’t being implemented widely enough (like Dr. Pronovost’s brilliant checklists).

The article also kicks ole’ Frederick Taylor, contrasting his approach to the Gilbreths’. While the Gilbreths arguably had a more humane approach, Taylor’s approach to improvement treated the workers like this:

“One worker was carefully selected and asked to change the way he worked by following the engineer’s directions exactly. ‘We want no back talk… When he tells you to walk, you walk, when he tells you to sit down, you sit down.”

Taylor famously improved productivity, but did so in a way that didn’t come close to the Toyota principle of “Respect for People.” We’re still teaching some managers and engineers to quit separating thinking from doing in the workplace… that everybody must be thinking and must be a process improvement person in the scope of their own work.


Thanks for reading! I’d love to hear your thoughts. Please scroll down to post a comment. Click here to receive posts via email.


Now Available – The updated, expanded, and revised 3rd Edition of Mark Graban’s Shingo Research Award-Winning Book Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. You can buy the book today, including signed copies from the author.

Related Posts Plugin for WordPress, Blogger...
Please consider leaving a comment or sharing this post via social media.

Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

3 Comments on "Why it Took 15 Years for Common Sense to be Accepted – Medical Journal Article on the Gilbreths in the O.R."

Trackback | Comments RSS Feed

  1. Anonymous says:

    I think it was Brent James who said that it takes 18 years for proven best practice to become the industry standard in healthcare.

  2. Mark Graban says:

    Be sure to see this recent NYT article about Dr. Brent James:LINK

Post a Comment

CommentLuv badge