I am a big proponent of standardization. In fact, I often call it “my one-string banjo”. When I made the move from the aerospace industry to healthcare, I was appalled at the lack of standardization and resistance to it. I have been quoted as saying, “there are 7 CRNA’s performing the process 9 different ways”, because not even one person does it the same from one time to the next!
There are many opportunities for standardization in healthcare. But that does not mean “cookbook medicine”. I would never think, even for a minute, that I can (or want) to dictate how a physician treats a disease, or how a surgeon performs an operation. They are highly-trained, caring experts, who try to make the best use of the evidence they have to cure their patients. Every patient is different, because every human body is different. Therefore, physicians should be allowed, even encouraged to always make the best decision for the patient right in front of them, not for “the majority” of patients.
The opportunities for standardization in healthcare that I focus on and I encourage my teams to focus on are in the processes that happen before or after that physician is treating that patient, and in the systems that support those processes. There is so much waste (transportation, inventory, motion, waiting, over-processing, over-production and defects – “TIM WOOD”) in these processes that they account for 30%, or even more, of the total healthcare expenditures in the United States, or about $1 Trillion!
Standardization can help eliminate some of this waste by honing in on the variability and mistakes that generally plague most of these processes.
NEVERTHELESS, standardizing just for the sake of standardizing is just as bad as resisting it! In a recent Value Stream Map exercise looking at opportunities to reduce waste for cataracts surgery, a team was questioning why they performed a certain step during room turnover between two cases of cataracts surgery. That step in particular did not make sense for cataracts surgeries. As we (I was facilitating the VSM exercise) kept prodding into this issue, it finally came out that “about five years ago, they said, ‘we are standardizing everything, so you will do this step for all surgeries’, regardless of the type of surgery”. I cringed, took a deep breath, and allowed the team to continue down their continuous pursuit of perfection. They proposed to eliminate that step and, after a few short weeks, the change was approved and that is now the “new standard”. Eliminating that step saves between six to eight minutes of turnover time, which can amount to more than two extra cases per day of surgery!
When I heard the explanation about why they performed this step, it was as if somebody took the name of “standardization” in vain! I love standardization, I preach it every day, but I also always say that Lean concepts are not earth-shattering; they are based on common sense. So, when somebody intentionally adds a step that adds no value to a process in the name of standardization, I take offense!
This is not standardization. This is perhaps laziness for not wanting to spend the time understanding the process and assess what adds value and what does not. It is a lack of common sense or, at the very minimum, it is ignorance of the core concepts of value and waste. It is a lack of respect for the people performing these processes and it is NOT Lean!
Therefore, I say to you, standardization is a beautiful thing. It is never about telling a physician how to treat a patient or how to perform a surgery. It is never about blindly doing a set of steps with complete disregard of whether they add value or not. It is about documenting and communicating the best, fastest, safest way we have of performing a process today, so we can improve upon it tomorrow.
Have you heard or seen the name of standardization taken in vain?