Observations Out of Hours

What doctors can learn from the factory floor

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1217 (Published 03 March 2010) Cite this as: BMJ 2010;340:c1217
  1. Christopher Martyn, associate editor, BMJ
  1. cmartyn{at}bmj.com

    Lessons from the manufacturing industry about quality and safety cut deeper than we realise

    Although it’s hardly correct to say so, I’d never been entirely convinced by the fashionable idea that doctors have a lot to learn from industry about quality and safety. It was partly an allergic reaction to the jargon—all that stuff about 5S, Six Sigma, lean thinking, and poka-yoke. But it was mainly because the parallels between clinical practice and what goes on during widget manufacture seemed so strained.

    An article in the BMJ last year that compared hospitals to bottling factories analysed it in more depth, pointing out that medicine is characterised by three things that don’t crop up in bottling (BMJ 2009;339:b2727, doi:10.1136/bmj.b2727). One is a high degree of unpredictability: who can say in advance whether an individual patient will respond to the treatment given? Another is ambiguity: do a patient’s symptoms indicate something that needs to be taken seriously or something trivial that requires only reassurance? And third, and probably most important, the people who do the production in medicine (that is, doctors) …

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