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Two Revolutions

June 25, 2010
by Mark Hagland
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Clinical informaticists are at the center of twin revolutions that are transforming the healthcare industry
Mark hagland
Mark Hagland

I've been reading lately about Henry Ford's development of the assembly line for car manufacturing, which was in the process of being evolved forward a century ago now (1908-1915). What has since become so ubiquitous as to be invisible to those of us living in the 21st century was far from automatic when it was first created in its full form by the Ford Motor Company. Instead, a very large number of disparate elements had to be brought together in order to create what we now think of as a unified process of assembly line manufacturing. Indeed, it took centuries for the concept to come to fruition, after centuries of bits and pieces of the whole picture had gradually emerged piecemeal.

And touring an auto manufacturing plant can be a fascinating experience. I took just such a tour in 2007, while I was working on my first book, Paradox and Imperatives in Health Care (co-authored with my colleague, Jeff Bauer, Ph.D.). I traveled to Georgetown, Ky. (just outside Lexington), to observe the workings of the Toyota assembly plant there. I specifically chose Toyota because of the strong impact the Toyota Production System (TPS) was beginning to have in healthcare. Since then, of course, we've learned of some tragic shortcuts that Toyota's leaders had been making regarding the safety of some of their own auto technology. But the core of TPS, as a performance improvement methodology, is as applicable to virtually any industry now as it was a few years ago, and is certainly transferable to healthcare.

In fact, if there was a single thing that most impressed me at the Georgetown plant, it was this: every single process at that plant was completely thought through and rationalized, down to the minutest operational and workflow details. And it is that conscious application of thought to every sub-process, embedded in a continuous performance improvement approach to everything, that has captured the attention of healthcare leaders.

The reality is that the healthcare industry, both in the U.S. and globally, is just now beginning the kind of Industrial Revolution - the systematization, rationalization, and standardization of processes, and the elimination of unnecessary levels of production errors (which in the healthcare context are often tragically fatal) that other industries went through decades ago. It is very, very difficult work, which is one of the major reasons why such improvement work has been the exception rather than the rule to date.

Healthcare is now going through its Information Age Revolution at the same time that it is engaged in its first Industrial Revolution. No wonder it all feels so challenging.

One of the elements in all this that is emerging most clearly is this: clinical informaticists are turning out to be absolute nexus figures in the clinical transformation that must take place to create the healthcare of the future. On pp. 8-13, you'll hear from clinical informaticist leaders nationwide on the revolutions they are leading in their individual institutions that are changing everything about how their patient care organizations work. And as challenging as everything is, it is also obviously a very exciting time to be in healthcare. Just ask the clinical informaticists, who are on the front lines of this double revolution. As they were wont to say back in Paris in 1789, “Aux barricades, citoyens!” Of course, in this 21st-century healthcare version of the French Revolution, there is no violence, and everyone can be a winner. May the smartest revolutionaries lead us all forward!

Mark Hagland, Editor-in-Chief Healthcare Informatics 2010 July;27(7):6