What Medicine Can Learn From Business

It has been 14 years since Betsy Lehman, then the Boston Globe's chief medical columnist, died of a massive chemotherapy overdose at Dana-Farber Cancer Institute. Her case seized headlines, but oft-cited statistics from the Institute of Medicine suggest that from 44,000 to 98,000 hospital patients die every year the way she did, because of safety lapses and incompetent care, meaning a toll since the publication of the IOM report in 1999 of perhaps 400,000 to 900,000 people—or from roughly the population of Oakland, Calif., to that of Detroit. The IOM estimate is highly questionable, representing assorted leaps of faith from selected studies, but if the actual count were 300,000 or 100,000, how much less horrifying would that be?

Attention has been paid. The Best Practice—How the New Quality Movement Is Transforming Medicine, to be published next month, is in part an account of the shock wave the 1999 IOM report sent through hospital boardrooms and clinics and in part a recitation of remedies that enlightened healthcare organizations are putting in place. The book, by journalist Charles Kenney, isn't nearly as wonkish as its title suggests. It's a great read, as exemplified by a passage describing a visit to Japan a few years ago by top administrators at Virginia Mason Medical Center in Seattle, to see if Toyota's vaunted management and production techniques could work at the hospital.

During the visit, a team led by Virginia Mason's chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

"Who waits there?" the sensei asked.

"Patients," said the chief of medicine.

"What are they waiting for?"

"The doctor."

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

"You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?" He paused and let the question hang in the air. "Aren't you ashamed?"

It was a transforming moment for the chief of medicine. When he returned to Seattle, he began rethinking the multitude of ways in which patients and providers interact. Caring for patients is value-added time. Hours spent in waiting rooms, he concluded, are a production issue. There have been countless such moments in recent years. Not enough of them, but a start. Requiring all hospital CEOs, board members, and clinical administrators to read this book might help propel the hospital self-help movement a little faster toward the goal of killing as few patients as possible.