Emory University’s Cookbook Medicine and Standardized Care
Emory’s recent quality initiatives are striving to plug the holes in the Swiss cheese by borrowing a page from an unlikely source—a car manufacturer. Specifically, Emory is adopting the LEAN process-improvement program originally developed by Toyota. In a nutshell, LEAN is a philosophy committed to customer service, elimination of waste, and continuous improvement. It provides tools to intentionally and thoughtfully design processes to meet these goals.
“The manufacturing industry has done a great job in pioneering many of these principles,” says Hal Jones, director of quality support services for Emory Healthcare. “For example, those of us who are prone to locking our keys in the car are grateful to car companies for building processes that now make that virtually impossible. We, in health care, need to learn to do the same thing—to build processes that make it virtually impossible not to do the right thing.”
To follow the LEAN model, health care needs to standardize processes as much as possible, quite a switch for an industry built on autonomy and individual accountability. “This philosophy definitely goes against the grain of what many of us have learned over the years,” says Bornstein. “Also, critics say health care is not the same as making cars or widgets. That is absolutely true. Patients are individuals. But there can be some similarities between making cars and treating patients. If, for example, we decide that every patient who meets certain criteria should get a flu shot, then we can use manufacturing and”Any doctor in our system can give you a personal example of the electronic prescription writer catching a medication error that was about to be made.” says Penny Castellano, CQO of The Emory Clinic production principles to achieve that goal. And we can reach a higher success rate with that approach than if we wait until we see each patient and then decide on the fly.”
Also, I find that there is a real lack of accountability. In my case after calling the clinic every day this week while my doctor has been considering a potentially life-threatening medical problem nobody seems to be able to tell me why the test to confirm this condition has still not been ordered after I’d been told it would be, then that it was, and then that it would be by somebody else.
My safety and my life seems to take a back seat to all the immaterial and robotic policies Emory has in place, and continuity of care gets lost in the shuffle.
While staff draw lots as to who will act in a situation veering dangerously close to catastrophe, the patient with their unique human variables is not served.
This is a prime example of why one cannot run a human healthcare facility like you run an auto assembly line.
Car parts can be replaced. There is a point after which human parts cannot.