Hospitals: The New American Assembly Line


 Over the last 20 years, healthcare in America, especially in tertiary and quaternary care centers, has adopted Lean and Six Sigma assembly line practices to squeeze efficiencies from the healthcare system and their workers. Patients are introduced and one end of the line and emerge intact and improved health, declining or,,,dead. The Lean/Sigma Six models effectively ignore the fact that patients are NOT standardized widgets to be knocked off on an assembly line and nurses are, most definitely, not low skill, interchangeable workers on an assembly line. 

The drive to squeeze efficiencies from the healthcare system has become ever more acute in the wake of the COVID 19 pandemic. Data shows that, even before the pandemic, hospitals had thin operating models. Add to that the toll taken by COVID 19, as hospitals had to halt profitable elective treatments and procedures, and devote hospital resources to caring for those suffering from COVID 19 and those operating margins took a nose dive into negative territory. The net effect of this downward pressure on hospital operating margins was an acceleration of hospital closures, especially in sates and rural areas where expanded Medicaid coverage under the Affordable Care Act was not implemented. 

To deal with this precipitous drop in operating margins, hospital administrators, of large and small facilities, once again began trying to squeeze efficiencies from a system already wrung dry. More and more administrative duties are being forced on to nurses,  and their support staff, taking away from the all important time at the bedside nurses need to adequately and safely, care for patients. These efforts, while nursing administration may have been consulted, came...by and large...have been imposed without consultation with, or consent of, the nurses at the bedside. 

The solution is two fold. The first, is nurses having a seat at the table, along with physicians and other stakeholders in how to best address the fiscal issues and social responsibilities hospitals are facing in the wake of the worst pandemic in America since 1918. And if that means a uinion...so be it. As I keep telling the new nurses coming to our unit,, "You either hang together, or hospital administration will surely hang you separately." The second, broader challenge lies in admitting, once and for all, that "for-profit healthcare" is an oxymoron. Every patient presents with different, unique issues, and dealing with those issues in a wholly mechanistic, assembly line, cookie-cutter fashion will not deliver the best results for patients. It will require the commitment of the healthcare industry in America and the government to move beyond assembly line healthcare, to treat patients holistically and for the individuals that they are. Nurses, therapists and other support staff must have a seat at the table in formulating realistic healthcare policy in America that provides safe, quality, affordable care for everyone, patients and providers alike. 

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