Downsides of standardization in health care

We are approaching the tipping point in hospital provided care. Too many healthcare professionals have fallen in love with standardized medicine and standardized processes.

Don’t get me wrong – these are well intended, well educated, experienced and professional people. I believe they are some of the most intelligent people in the country. They have simply fallen in love with the wrong idea.

Standardization. Standardization is very efficient. Standardization is reliable. In a world where costs are spiraling out of control, standardization makes a lot of sense. I have no quarrel with standardization; when properly applied it has enormous benefits. But standardization has a downside. It stifles thinking. It treats labor (nurses/doctors) like commodities.

Standardization dumbs down the process. It does this in the name of efficiency and cost.

With healthcare becoming such a political animal these days, its easy to see why many leaders would not only strive for standardization, but back it up with statutory power. Pay for performance, meaningful use, et al; a movement of good intentions striving to reduce cost. Clap Clap Clap.

There is a better way to reduce cost. It is 10x more powerful than standardization. Its called innovation. I am not speaking of medical technology innovation, I am speaking of process innovation. The heavy hands of standardization hold back innovation.

If one must follow the standard, then one cannot experiment. If the answer to “Why do we do it this way?” is “Because we are required to by the standard” then we cannot innovate and discover new ways to improve our processes. You can find this phenomenon all over the United States. The nurses on the front lines are openly frustrated following standard processes which they perceive as silly and unnecessary. Too bad.

Sadly, the benefits of standardization have eluded us all. We seem to be getting less efficient, less safe, and less reliable despite the massive investment in information technology, training, and government incentives.

Maybe we need to mix in a little bit of innovation. Maybe we need to let nurses be nurses, let doctors be doctors, let pharmacists be pharmacists. Didn’t we ask them to invest mightily in education? If we trust these people to save our lives, shouldn’t we allow them the luxury of asking “Why?” and even once in a while, asking them “What would you do differently” instead of barking “because the Joint Commission says you have to”.

Who knows where or when the next break-thru idea will emerge. Innovations are deviations from the standard way of doing things. If we find ourselves enforcing arbitrary standards then we systematically drive innovation out of healthcare operations. Can we afford saving money this way?