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Has Medical Taylorism gone too far?

15 Apr 2016

As people are not cars with parts designed to be replaced after a certain mileage, applying Taylorism or ‘lean’ management to healthcare can be detrimental for both patient and practitioner, says Dr Muiris Houston.

Am I the only one who gets browned off with the modern assumption that there is only one right, safe and efficient way to provide healthcare?

It seems the concept of maximum efficiency has permeated into medicine from industry. The classic example is the Toyota principle of ‘lean’ work management, in which quality of car production improved while waste was eliminated.

Apparently we have a chap called Frederick Taylor to thank. Known as the father of scientific management, he believed that the components of every job should be scientifically studied, measured, timed, and standardised to maximise efficiency and profit. “In the past, the man has been first; in the future, the system must be first,” was his somewhat heart-sinking mantra.

Taylorism has, perhaps unsurprisingly, begun to invade the culture of medicine. I am young (!) enough to have happily practised with paper-based medical records. Along came computerised electronic health records (EHRs), which seemed like an altogether good thing. Wouldn’t patient information be readily available no matter where we saw the patient? And the days of blunders with drug doses and unwanted interactions would surely be soon behind us.

But now the EHR has become an instrument of torture. Want to standardise patient doctor interactions? Design software that makes it mandatory to fill in the answers to specific questions before you can move to the next page of the record. You believe strongly in an open-ended interview style where you don’t interrupt the patient? Sorry, the system isn’t really designed to allow you to record that kind of information…move along now, please.

The EHR was supposed to save time, but I remain to be convinced. If anything it has taken time and attention away from our patients. We become even more aware of the ticking clock and patients are none too impressed.

Taylor’s and Toyota’s manufacturing concepts are difficult to apply to whole facets of healthcare

Taylor’s and Toyota’s manufacturing concepts are difficult to apply to whole facets of healthcare. We are not cars with numbered parts designed to be replaced at certain mileage intervals. With our huge range of genetic, physiological, psychological and cultural differences you couldn’t even begin to streamline us into different marques and models.

Thinking time

Good medical practice requires synthesis and thinking time. The time pressure of Taylorism sets us up for the kind of cognitive errors that result in medical mistakes. And if you are feeling rushed, you are more likely not to consider your patients’ preferences.

Proponents claimed that implementing scientific management in medicine would free doctors, nurses, and others to spend more time with their patients. But if anything, the opposite seems to be happening. It’s part of the burnout recipe we are now all so aware of.

A number of colleagues contemplating early retirement have mentioned the slavery of scientific management as a major reason to consider getting out of medical practice.

Yet what the most impassioned gurus tell you they want from the health system is unhurried time from their doctor or nurse and individualised care rather than tick box medicine. But in my view, this is simply not deliverable.

Mixed messages
I wonder how the current crop of medical students are coping with the mixed messages? Learning about protocol-driven medicine and then having to relearn how to modify and individualise care in the real world. Or having to incorporate the effects of social and cultural contexts, and coping with the diversity of patients’ preferences.

Has Medical Taylorism gone too far? I think so. We may even have reached the stage where we need to protect students and young doctors from its damaging effects so that they feel free to give patients the care they deserve. At the same time we cannot be absolute Luddites — we must acknowledge the limited benefits of efficiency and standardisation.

Until we go back to acknowledging that quality medical care takes time, and that guidelines are there to be bent and sometimes ignored, our broken health service will continue to fracture.

In medicine, men and women must be first, not the system.


Click here to view the full article which appeared in Irish Medical Times: Opinion