I loved the TV show, “The Office.” It starred Michael Scott (played by Steve Carrell), a bumbling boss of a paper company who continuously and hilariously shared is inane “wisdom” with others. In one of my favorite episodes, Michael was invited to be a guest lecturer at a business school. He was trying to teach the students about business when he uttered the following line:
“There are four kinds of business: tourism, food service, railroads and sales. And hospitals slash manufacturing. And air travel.”
If you count more than four types of businesses in that sentence, you are really “with it.” Today is going to be a good day for you! If you find the grouping of hospitals/manufacturing into one business type to be odd, then I am right there with you. But I wonder if sometimes, in our efforts to improve the patient experience, we might act as if hospitals and manufacturing are more alike than they really are.
One of the biggest goals in manufacturing is to get to as close as zero defects as possible. In assembly line-type manufacturing, that means you take the work from the previous station, which should look exactly the same every time, then apply the same manufacturing process to it…every time. If everyone along the assembly line does their work exactly the way they are supposed to without fail, then you should have virtually zero products that don’t meet standards by the end. But what if the products put out by Station B in our assembly line varies each time? If you are working in Station C and you follow your scripted work process and don’t adapt to what you receive, then the errors in those products will continue to be passed along.
The big reason health care is not and never will be like manufacturing is that our patients come in with different needs, different expectations, different experiences, different behaviors, different levels of knowledge…you get the gist. The only thing consistent in service is patient variability. The healthcare organizations that will “produce” the most satisfied patients in the future won’t be known for their consistency in using a particular script or best practice, but for their front-line staff’s freedom and ability to adapt to whatever physical, mental, social, emotional, or spiritual condition the patient arrives in.
The future leading organizations of the patient experience will reject the task-based manufacturing approach to improvement and move toward a goal-oriented, principle-based method of improvement. Scripts like AIDET will be replaced with specific goals like reducing patient anxiety and others. For patient anxiety as an example, staff will receive training that helps them to identify the variety of reasons patients get anxious. Staff will learn tools and ideas that emphasize adaptability over consistency, empowerment over conformity, and reflection over auditing. They will be masters at meeting patients where they are and finding the right solution for their particular circumstances. The best organizations for the patient experience will learn from others’ best practices, but will insist that they can do it better. And they will do it better than any “manufacturing” hospital out there.
Sorry Michael Scott, hospitals and manufacturing just aren’t the same.