Fixing health care from the inside, today

Harv Bus Rev. 2005 Sep;83(9):78-91, 158.


Today, you are about as safe in a U.S. hospital as you would be parachuting off a bridge or a building. But it doesn't have to be that way. Right now, some hospitals are making enormous short-term improvements, with no legislation or market reconfiguration and little or no capital investment. Instead of waiting for sweeping changes in market mechanisms, these institutions are taking an operations approach to patient care. In case after detailed case, the article describes how doctors, nurses, technicians, and managers are radically increasing the effectiveness of patient care and dramatically lowering its cost by applying the same capabilities in operations design and improvement that drive the famous Toyota Production System. They are removing ambiguity in the output, responsibilities, connections, and methods of their work processes. These changes-which can be done in the course of an ordinary workday, sometimes in a matter of hours-are designed to make the following crystal clear: Which patient gets which procedure (output); Who does which aspect of the job (responsibility); Exactly which signals are used to indicate that the work should begin (connection); and Precisely how each step is carried out (method). Equally important, managers are being transformed from rescuers who arrive with ready-made solutions into problem solvers who help colleagues learn the experimental method. Thus, these hospitals are breaking free of the work-around culture that routinely obscures the root causes of so many problems, creates so much waste, and leads to so many unnecessary deaths.

MeSH terms

  • Health Care Reform*
  • Health Facilities / standards*
  • Health Facility Administration
  • Health Knowledge, Attitudes, Practice
  • Total Quality Management / methods*
  • United States