Improvements in the Manufacturing Industry versus Health Care Industry
The idea of improving the quality, safety, and processes of healthcare delivery has dominated the relevant literature ever since the dawn of the twenty-first century. At the core of the pertinent calls is the overarching criticism emphasizing that the quality and safety problems experienced in modern healthcare are fundamentally attributable to the lack of standardization of extant processes and healthcare delivery approaches (Wears, 2015). The apparent consensus, in this regard, revolves around the impetus for standardizing healthcare by adopting the process and quality improvement techniques and technologies pioneered by manufacturing industries in their respective efforts towards efficiency gains (Mannion & Exworthy, 2017). Standardized processes and approaches that mimic those of the manufacturing sector when applied to the healthcare context have the potential to realize desired improvements through multiple pathways, including, notably, reducing variations in healthcare delivery, facilitating quality and safety improvements, routinizing evidence-based practice, and bolstering communication and coordination across the healthcare delivery spectrum (Lasalvia & Merges, 2020; McLachlan et al., 2020; Lavelle et al., 2015). Nevertheless, such standardization of processes within the healthcare context is inherently challenging because of technical and philosophical design and implementation difficulties, particularly in relation to the competing imperatives generated by the need for, and demonstrable empirical effectiveness of, personalized or individualized care as opposed to standardized care (Ansmann & Pfaff, 2018; Kriznik et al., 2019). The analysis herein examines the available research literature in support of the potential effectiveness of the standardization of healthcare delivery and finds that such standardization can be especially effective in reducing variations and variability across the healthcare continuum.
As indicated above, the question regarding whether or not standardized processes can really work in the healthcare setting is one that continues to generate robust debate and discussion from divergent perspectives. The philosophy of standardization, defined from its original roots in manufacturing, refers to the framework of guidelines, processes, and agreements to which all concerned stakeholders must adhere to facilitate the achievement of consistent and comparable quality in the end products and services (Wears, 2015). In this regard, the introduction of revolutionary standardization methodologies, techniques, and technologies such as the six sigma approach and the lean and total quality approaches to management have enabled manufacturing industries to achieve significant strides in efficiency and quality (McLachlan et al., 2020). Despite multiple attempts to transfer such gains to healthcare delivery, however, the implementation of standardization within the healthcare context has primarily lagged behind other comparable sectors and industries.
The reluctance characterizing the healthcare context notwithstanding, a robust body of research provides concrete and empirical evidence supporting the effectiveness of standardized healthcare delivery. Notably, the standardization of healthcare is positively correlated with positive gains in tackling a core problem experienced in modern healthcare, namely the challenge of reducing variations and variability in healthcare delivery and healthcare delivery models (Mannion & Exworthy, 2017). Presently, the consistency of multiple dimensions of healthcare delivery, including the pertinent quality, safety, and outcomes of care, is impeded by significant divides not only in the approaches different healthcare and hospital systems utilize in the delivery of care but also variations present even among different departments within the same healthcare and hospital systems (Lasalvia & Merges, 2020). These variations in healthcare delivery are problematic on multiple fronts and for various reasons, but more especially because they are associated with declines in patient safety and inefficient interactions between patients and providers of care (Mannion & Exworthy, 2017). The current state of affairs within the healthcare system is therefore antithetical to the manufacturing sector where industries such as aerospace, automotive, and nuclear have primarily responded to safety crises, for instance, through the standardization of processes to reduce variability hence ensure consistency in the workforces and overall delivery (Lasalvia & Merges, 2020). Therefore, the reduction of variation and variability is a core reason why standardization is imperative in healthcare delivery.
As in the manufacturing context, more specifically, standardization can contribute to the reduction of variability in healthcare in four principal ways. Firstly, it can facilitate the uniformity and compatibility of healthcare delivery models, products, and services through design standards that facilitate the detailed specification and explicit definition of these crucial dimensions of healthcare (Mannion & Exworthy, 2017). An example of this particular contribution of standardization in the healthcare setting is the design and implementation of clinical practice guidelines, which are essentially evidence-based tools such as checklists, protocols, and guidelines “designed to standardize procedures in the expectation that this is the best way to reduce unwanted variation in diagnosis and treatment” (Mannion &Exworthy, 2017). Standardization can also contribute to the reduction of variability in healthcare delivery through terminological standards that can help coordinate disparate care approaches and actions across cultures, time, and distances and otherwise support the stability of meaning in healthcare delivery (Weans, 2015). An empirical example of the effectiveness of such terminological standardization derives from the International Classification of Disease and other related instruments, which have a demonstrable track record of effectiveness in generating communication efficiencies by allowing the creation of common ground across the global healthcare delivery spectrum, and allowing “dense, compact, encoding of complex ideas” (Weans, 2015, p. 90; Mannion & Exworthy, 2017). Thirdly, standardization contributes to the minimization of variations in healthcare delivery through the design and implementation of performance standards that establish outcome specifications for service delivery (McLachlan et al., 2020). Performance standards are notably already operationalized successfully across many contemporary healthcare settings, as in the example of maximum waiting times that are considered an acceptable standard for hospital care access. Procedural standards, fourthly, which specify the performance of steps and precise conduct of processes in healthcare delivery, also constitute another essential contribution of standardization to the minimization of variations in healthcare (Leotsakos et al., 2014). Standardized formal service frameworks, for instance, which are already operationalized in contemporary disease management programs, offer compelling examples of the effective application of procedural standards.
The implementation of standardization within manufacturing industries offers a valuable template for the operationalization of standardized processes within the healthcare context, which is mainly lagging on this front. Critical perspectives of standardization in healthcare delivery primarily tend to question whether such standardization can be empirically effective in healthcare settings, particularly in juxtaposition to the need for personalized and individualized care. Overall, this paper takes the position that standardized processes in healthcare can be, and are already effective, in the healthcare setting as exemplified by the extant contributions of design, terminological, performance, and procedural standards toward the minimization of variability hence quality and safety improvements in healthcare delivery.
Ansmann, L., & Pfaff, H. (2018). Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”. International journal of health policy and management, 7(4), 349–352. https://doi.org/10.15171/ijhpm.2017.95.
Kriznik, N. M., Lamé, G., & Dixon-Woods, M. (2019). Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region. BMJ Open, 9(11), e031771. https://doi.org/10.1136/bmjopen-2019-031771
Lasalvia, L., & Merges, R. (2020). Personalization and standardization: Can we have it all? What Other Industries Can Teach Healthcare. Journal of Precision Medicine| Volume, 6(1). https://www.thejournalofprecisionmedicine.com/the-journal-of-precision-medicine/personalization-and-standardization-can-we-have-it-all/
Lavelle, J., Schast, A., & Keren, R. (2015). Standardizing care processes and improving quality using pathways and continuous quality improvement. Current Treatment Options in Pediatrics, 1(4), 347–358. https://doi.org/10.1007/s40746-015-0026-4
Leotsakos, A., Zheng, H., Croteau, R., Loeb, J. M., Sherman, H., Hoffman, C., Morganstein, L., O’Leary, D., Bruneau, C., Lee, P., Duguid, M., Thomeczek, C., Schrieck-De Loos, E. v. d., & Munier, B. (2014). Standardization in patient safety: The WHO High 5s project. International Journal for Quality in Health Care, 26(2), 109–116. https://doi.org/10.1093/intqhc/mzu010
Mannion, R., & Exworthy, M. (2017). (Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare. International journal of health policy and management, 6(6), 301–304. https://doi.org/10.15171/ijhpm.2017.35
McLachlan, S., Kyrimi, E., Dube, K., Hitman, G., Simmonds, J., & Fenton, N. (2020). Towards standardisation of evidence-based clinical care process specifications. Health Informatics Journal, 146045822090606. https://doi.org/10.1177/1460458220906069
Wears, R. L. (2015). Standardisation and its discontents. Cognition, technology & work (Online), 17(1), 89–94. https://doi.org/10.1007/s10111-014-0299-6.