Would Lean Work in Small MD Practices?
A post here from the “medinnovationblog” site. The first one, linked above, gives a pretty good overview of applications of the Toyota Production System as applied to healthcare.
That first post gives a good “state of the healthcare crisis” summary:
Science and process engineering had better work to reduce costs, or the U.S. health system may be headed for a cost meltdown. If current trends continue, health care as proportion of GDP will rise to 40%, by 2050. That would break our system of financing health through employers, pension funds, and Medicare/Medicaid.
Rather than saying the Canadian system is the model, this blogger talks about lean and Toyota, linking the Sunday NY Times piece on Toyota that we've discussed here.
In physican practices, you need some sort of organizational critical mass to make a Toyota-type philosophy work. True enough, which is why Toyota's approach is being tested in groups with enough size to make it work.
I'm not sure why you need to be “big enough” to make TPS work in any setting. Sure, many of the best lean healthcare examples are in 300+ bed hospitals, but couldn't lean work in a small private practice office? You can reduce waste and improve flow in any setting, right? Continuous improvement works anywhere, right?
Maybe not now, but in a generation or so when survival of small practices is at stake. The Toyota model works on the premise that all participants work together in teams, resources be spent on analyzing systems of care, traditional practice flow patterns by disrupted and changed, processes be standardized, defects be cut to zero, and statistical goals for improvement and safety be routinely met.
Will this approach work among individual “democratic” physicians who entered medicine to “be their own boss.” I have my doubts.
He doesn't really state his case as to why he has doubts. I'll have to ask him in the comments and see if he responds.