Monday, January 14, 2013

McDonaldization of Healthcare

McDonaldization is a term coined by George Ritzer, when he wrote about the McDonaldization of Society. Basically, you rationalize a task and break it down into smaller parts to make it more efficient, faster and cheaper. Think of a time when a craftsman took time to manufacture a piece of furniture from start to finish. He would take a piece of oak and measure, cut, plain, chisel, border, stain and a dozen other step to make something of quality. Or a chef making something as simple as a good hamburger, there are a lot of steps. Start with good quality meat you have to grind, form and fry or grill properly. Fresh tomatoes, lettuce, onions and other produce to selected, washed and sliced. And fresh baked buns. Now think the opposite, McDonald's and IKEA. 

To increase production and profits companies turned to the McDonald's or assembly line method. A product comes down the line and a person does one thing. No thinking involved.

Most fast-food places operate this way. Frozen preformed burger, fries and food is delivered from a large factory somewhere. On the same truck comes, pre-chopped lettuce, tomatoes and onions in something that looks like a clear garbage bag. No real cooking going on, only the timers and beeps that tell the worker when everything is ready. One person takes your order and money, one person drops the fries, one person flips the burgers, one person assembles the food, and one person puts it in a bag and gives it to you. Efficiency without deviation or thinking. They even figured out how to have the customers work free, by filling their own drinks and clearing their own tables. IKEA has you pull and assemble you own furniture.

Yes assembly lines have their place and make things cheaper. Can’t imagine making millions of a cars or computers without an assembly line.
Healthcare has been McDonaldized. CEOs and bean counters see patients and care as products to streamline. Get them in and get them out. Like a fancy restaurant, the more times they can turn over a table during a shift, the more money made. Hospitals use beds instead tables. Healthcare has been broken down into small parts, like an assembly line of care. 

In any hospital, on any unit, you cannot avoid hearing the charge nurse, staffing and the shift manager referring to and arguing about the Bed Board. It keeps track of all the hospitals beds and who is in them. We shuffle patients in the hospital 24/7. A doctor orders a bed on a particular full unit, or a new patient needs a bed on the already full specialty unit. The shuffle begins. The people ordering the patients to be moved at midnight never see the patients. The shift manager says take the 35-year-old male on B5 to CVPCU. Then take the new admit to A3, because we are moving a patient from there to the med/surg floor. The ER patient on hold can then go to the neuro ICU, and the semi-stable ICU patient from neuro ICU can go to B5. . . checkmate. 

In the hospital, you will see every specialist there is because nobody deals with the whole person anymore. Chest pain cardiologist, a little confused neurologist and trouble peeing, a urologist or nephrologists will see you. They all specialize, one flips, one assembles and one hands you the order. Try to get a patient discharged and you need 3 different specialists to agree and sign off.

In the hospital, like Target, everything is computerized and bar coded, and we will scan patients, medications, supplies, equipment and staff.

I am in a large clinic now and it is the same. A person will check in, see a nurse for triage, see a practitioner and then the discharge person. If they need labs, pharm, x-rays or behavioral health, they can see from 4-8 people during their visit.  

In some clinics the provider has a set schedule and every 15-minutes they have to see a patient; 10:00, 10:15, 10:30, etc.  Unless you are a new patient and I am doing a complete history and physical, but those are only on Tuesdays. A regularly scheduled visit and you are limited to one problem. If you have another problem, you will need to make another appointment. You came in for a cough I will treat that. So the sore leg or mole you want me to evaluate. Sorry, no time. I will make sure it is not life threatening and can refer you to dermatology or orthopedics.

In my surgical rotations to observe, they have their own unique spins on assembly lines to make things quick and efficient.

Yes, again there are times when it is productive and makes sense to use some of these methods. However, people are not products to be flipped and hurried along to the next station in the assembly line.  


PediNP said...

I really felt this way when I worked at the FQHC. Get 'em in and out. At my new practice, we get 20 mins to see a patient, so we try to address all the issues that arise. But interestingly, after I told a mother of an asthmatic that he would need to see the pulmonologist, that I could not make him better, she asked me if there was any doctors who see you for everything. It kind of threw me off guard...we talked about family practice providers...but I get her point. Welcome to modern medicine...

NP Odyssey said...

Maybe good maybe bad, but the days of the family doctor have gone the way of house calls.

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