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De-engineering in the NHS

BMJ 1996; 312 doi: (Published 22 June 1996) Cite this as: BMJ 1996;312:1617
  1. C J Dickinson

    In 1986 the Chrysler Corporation of the United States recruited Robert Lutz to be its executive vice president. Later he was appointed president and chief operating officer. In a recent lecture he explained to the Royal Academy of Engineering how he had turned round the fortunes of what had been an ailing and unprofitable corporation by a process of what he described as “re-engineering”—incidentally making its cash reserves exceptionally attractive to predators.

    When he arrived he discovered innumerable “little bureaucratic empires,” chock-full of what he called “redo loops— miscommunications, false starts, doubling back to do again what should have been done right first time because nobody really worked together as a team.” He created four “platform teams” (one for each main vehicle type), each under a single leader. Each was encouraged to help leaders of the other teams in every possible way. Each team was encouraged to view its suppliers as true extensions of the company rather than as “generic interchangeable vendors” whose only purpose in life was to do what they were told to do. “We've totally scrapped the age old system of auctioning off contracts to the lowest bidder. Instead we set what we call a ‘target cost’ for any given part or component, and work closely with trusted, preselected …

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