Redesigning health care

Radical redesign is a way to radically improve

A decade or so ago car manufacturers completely transformed the way they made motor cars: they stopped stockpiling components and supplied them “just in time”; they drastically reduced the types of components such as subframes and engines; they worked closely with their suppliers on quality and timeliness instead of beating them down on price; and they eliminated waste by making all workers responsible for quality, not just inspectors. As a result new models took less time to develop, their quality improved, and cars could be made to order for each customer. At the same time productivity improved and costs fell.1 Since then people in health care have realised that their service has a long way to go to match the performance of other manufacturing and service industries. Report after report, from country after country, has documented the size of the gap between the best evidence based care that could be delivered to patients and the care they actually receive. Health systems fail to provide treatments that are known to work, persist in using treatments that don't work, enforce delays, and tolerate high levels of error. Healthcare leaders are now recognising, as car manufacturers did, that the healthcare system needs radically redesigning. 2 3

Such redesign of an important part of the healthcare system—clinical office practice (in UK terms ambulatory care by mainly primary care physicians)—was the focus of a meeting in Atlanta earlier this month. Though the meeting was run by the Boston-based Institute for …