The October 8, 2005 news article from Singapore titled Thinking Out-of-the-Box Helps Alexandra Hospital Reduce Patient Waiting Time starts out "It worked for Toyota cars, so why not for patients at hospitals?" Why not indeed?

According to the article the impact of Lean healthcare on patient flow included productivity improvement by 400% (from 22 to 70 patients seen per hour by a staff of 12) and wait times cut in half. This helped bring the cost of the health screening to $10 per patient (the article does not say what the original cost was). These are typical Lean implementation results.

The article mentions a million dollars of grant money in the Quality Improvement Fund through the Ministry of Health. It's on the table for any of you Lean healthcare consultants out there with time on your hands and an interest in helping out hospitals in Singapore.

What struck me about this article was the seeming ease with which this hospital adopted the "assembly line" concept. I have to confess having much less success at persuading hospitals in the U.S. to take a serious look at TPS. People with the letters M.D. after their name are particularly resistant to being placed, or having their patients placed on any kind of "production line" healthcare.

Let's be patient-centered for just a moment and imagine that healthcare doesn't revolve at all around physicians or their preconceptions of what a healthcare delivery process should be. A supreme example from India is Dr. Govindappa Venkataswamy of Sight Savers International. Dr. Govindappa helps people get their sight back for free. This is done through a "production line" process that performs 130,000 cataract operations per year.

In American English the colloquialism "production line" or "assembly line" is a negative term generally used by artists, craftsmen, designers or knowledge workers to mean work that is impersonal, mechanical or uncreative. To people who think what they do is different each time and impossible to standardize or streamline, or that they need a lot of "mental set up" or thinking time between transactions having their work measured and paced by a production line does not seem like a good idea. This is certainly one way of looking at the world.

When I hear the words "assembly line" I get a warm feeling. Really, I do. This, I am fairly certain, puts me in the minority. Of course I think of the Toyota assembly lines I have seen or production lines at other companies who have applied TPS principles. Seeing a well-designed and well-balanced production line run can be a beautiful thing. Personally, there are very few things I would not want delivered to me via Toyota-style assembly line, product or service.

What's so bad about assembly lines? Nothing, per se. Bad assembly lines are bad if they:

- Cause repetitive stress injuries to workers
- Provide workers with no satisfaction of seeing a complete product
- Are sped up to increase output (increasing the workers' burden)
- Lack "stop the line" authority when problems are found
- Lack work balance (resulting in overproduction or waiting)

In general bad production lines are not designed around the needs of people. Unfortunately the majority of assembly lines in the world today suffer from more than one of these evils. Any tool can be misused or abused. It is still a good tool.

In a previous weblog entry I summarized how Wipro (another firm in India) is using "production line" and TPS principles for Lean Office implementation. Perhaps the English speakers in India and Singapore do not know the negative meaning of "assembly line". Good for them. Maybe they can teach us that production lines are good things again.