Sunday, June 22, 2008

What Medicine Can Learn From Business - Comarow on Quality (

What Medicine Can Learn From Business - Comarow on Quality ( "The Best Practice—How the New Quality Movement Is Transforming Medicine, to be published next month, is in part an account of the shock wave the 1999 IOM report sent through hospital boardrooms and clinics and in part a recitation of remedies that enlightened healthcare organizations are putting in place. The book, by journalist Charles Kenney, isn't nearly as wonkish as its title suggests. It's a great read, as exemplified by a passage describing a visit to Japan a few years ago by top administrators at Virginia Mason Medical Center in Seattle, to see if Toyota's vaunted management and production techniques could work at the hospital.

During the visit, a team led by Virginia Mason's chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

'Who waits there?' the sensei asked.

'Patients,' said the chief of medicine.

'What are they waiting for?'

'The doctor.'

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

"You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?" He paused and let the question hang in the air. "Aren't you ashamed?"

Many doctors seem to take perverse pride in how full their waiting rooms are; and how many weeks in advance their appointments are booked. To me, this just spells poor time management ! But as long as patients feel they are helpless and need to be patient, doctors will continue ill-treating patients.

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