Sunday, August 1, 2010

"The Henry Ford of Heart Surgery"

I am not quite sure what to make of the video report on the BBC News Web site entitled "India's 'production line' heart hospital." It is sure to provoke some very strong reactions; but, whether those reactions are positive or negative, the basic message of the report deserves attention. That message is that one can significantly reduce the price of quality health care (in this particular case quality heart surgery) by organizing the overall operation as an assembly line. In this report the emphasis is on having each line worker doing the part of the operation at which he (I did not see any "she" examples) is most expert; so I wonder whether or not there may also be a factor of designing the line and assigning workers to it by following some of Frederick Taylor's principles of "scientific management."

The most important question to ask is whether the site visited by the BBC is successful because of its production line organization or whether the success is due to some overlooked factor. (Note that, for now, I am willing to accept the claim that this is a successful facility. That claim is clearly subject to refutation. The health care of coronary patients is about more than giving them successful surgery. The report says nothing about what has happened to any of these patients after surgery and asking whether any crucial elements of the health care process may have been neglected as a result of looking only at making the surgery more efficient.) The reason I am skeptical about attributing any success to the production line is that the production line itself is based on Taylor's assumption that "scientific management" is about the management of unskilled labor. It thus overlooks the extent to which the very nature of the work can be alienating, particularly when workers bring more skills than they are allowed to exercise; and it overlooks the extent to which serious instances of social pathology may arise in workplaces that impose such alienating practices.

Another reason for my being skeptical is that we have been down this road before with another profession that demands highly skilled workers. That is the profession of education; and, as I have previously written, Raymond Callahan wrote a trenchant analysis of the deleterious impact that Taylorism had on the course (I cannot say "progress") of education in the United States during the twentieth century. Borrowing from the title of Callahan's book, his argument may be summarized by the proposition that American education suffered at the hands of policy makers who succumbed to Taylor's "cult of efficiency." There is an important parallel with health care here. Health care practices are, for the most part, determined by similar policy makers who know little (if anything) about what the practitioners actually do, just as most education policy makers have spent an equally minimal amount of time trying to teach in a public school classroom.

With this as context, do we really want to hitch the future of health care to a single datum? Can anyone blame me for asking whether or not the success of this particular example may be due to some factor that has gone unnoticed because all eyes have been dazzled by the surface feature of the assembly line? Before we start drinking the next batch of Kool-Aid in large quantities, we must first ask whether or not this system is as good as it seems; and, if it really is that good, we need to apply a bit more rigor in analyzing why it is good.

No comments: