Unwanted Variety is Not the Spice of Life
John Kepros MD MBA CPE
Hospital Efficiency, Quality, and Safety Consultant | Medical Communicator | Author | Certified Physician Executive
During my residency in the 1990’s, the Dodge Colt which had faithfully served my transportation needs through college and medical school stopped running. My dad came to the rescue by generously unloading his 1980 Buick Century Limited to my possession.
Despite being 15 years old at the time, the Buick had everything a young single male could have wanted: It was a luxury car. It had a Delco AM/FM radio. It had hubcaps on all four wheels. It was light green. It had carpeted light green floor mats. It had light green velour seats. It had a light green vinyl Landau roof.
Unfortunately it also had come off the assembly line around the time of the quality nadir of American automobile manufacturing.
In his book, Dr. Deming: The American Who Taught the Japanese about Quality, Rafael Aguayo explains that Japanese automobile manufacturers learned sooner than their American counterparts that decreasing the variability of the parts increases the quality of the overall product.
Ford Motor Company, who was manufacturing transmissions in both countries, found customers preferred the quieter and more reliable cars from Japan. When measured, the imported parts were confirmed to have extremely low variability.
Although I did not dissemble my Buick and measure the parts, they were presumably not all that close to ideal. What I did notice, however, was that it couldn’t drive uphill without overheating, at least not with two people in the car. Furthermore, I was now married and no longer needed its power as a girl magnet.
Reducing unwanted variation has since not only been embraced by American car manufacturers but is seen as essential to improving efficiency and quality in healthcare.
Katherine Baicker and Amitabh Chandra have shown in their widely quoted 2004 article, Medicare Spending, the Physician Workforce, and Beneficiaries’ Quality of Care that more spending does not result in higher quality. This means reducing unnecessary variation by standardizing evidence based practices, will likely pay off downstream for the health of our patients.
As might be predicted, the Buick failed at the most inopportune time. I needed to take my wife and newborn son home from Yale New Haven Hospital and it wouldn’t start. I sold it for $50. Neither my wife nor I miss it. Modern automobiles made with uniform parts are the norm now. I hope the same is true of healthcare in the near future.
Chair, WSU Department of Surgery
7 年I had a dodge colt, too. The radiator fan was plastic and melted
Hospital Efficiency, Quality, and Safety Consultant | Medical Communicator | Author | Certified Physician Executive
7 年Agree. The challenge is having physicians recognize this.
Retired consultant , educator and professional speaker for hospital case mgmt practice, utilization review, and care coordination across the Continuum. Recent recipient of CMSA's prestigious Lifetime Achievement Award.
7 年Great commentary, but I'm sure you know that medical practice variability has been an embarrassment to the medical community for decades. But you only have to go back as far as Dr Jack Wennberg & the Dartmouth Atlas, and most recently, Dr. Atul Gawande's classic New Yorker article about McAllen Texas. My point is that despite evidence to the contrary, the 'cowboy' mentality of the medical community has resulted in prescribing excessive, wasteful and potentially harmful interventions without benefit of value. With due respect, its not enough to "hope" for change in the future....its up to you to do something now and as Chief of Staff you can. The question has always been does the Board, C-suite and medical staff leadership have the will to do it.