What’s the difference between a hospital and a bottling factory?

Morton and Cornwell describe a comparison of hospital services with a
bottling factory, and highlight the floors in management tools with
relation to the unpredictability of patient response.1 Most patients who
walk into a GP or Hospital referral are there to establish a diagnosis
(like abdominal pain, blurred vision) which makes some of the lean
management and six sigma tools difficult to utilise as it needs the
intuitive nature of a clinicians to establish it. However, there are a
significant number of things that we do in primary care and secondary care
that have clear process and implementing these tools can add substantial
value to the process (like cataract surgery, hernia repair) as they are
more precise and predictable. The patient pathway from presentation to
diagnosis is complex, requiring multiple different primary and secondary
care organizations, medical staff and resources. Although it is true that
a patient’s response is unpredictable, there are many complex steps
involved in the patient pathway; the appointment booking, waiting time,
medical note availability, time to investigations and treatment. The
complex pathway and processes required to deliver healthcare services are
frequently a source of frustration to both patients and clinicians.2 It is
the unpredictable nature and inconsistency of these processes that
highlights the need for a systematic and effective solution. Unnecessary
delays, misplaced information and breakdown in hospital processes are
continually highlighted in measures of the patient experience. Efficiency
is often used in the context of cost-saving, however it is also inherent
to the quality of services. Management tools such as lean thinking3 and
six sigma offer a proven opportunity to improve inconsistencies in current
practise and offer long-term solutions to real improvements in quality of
care. Understandably critics are right when they say “patients are not
bottles”, however healthcare is a highly complex organization with a
myriad of complex processes, and management tools offer us a framework to
improve patient’s quality of care.

1. Morton A, Cornwell J. What's the difference between a hospital and
a bottling factory. BMJ 2009;339:428-29.

2. Gainsbury S. Missing: the notes of more than a million outpatients.
Health Service Journal 2008 (http://www.hsj.co.uk/missing-the-notes-of-
more-than-a-million-outpatients/1388893.article):[Accessed 22nd August
2009].

3. Kim CS, Spahlinger DA, Kin JM, Billi JE. Lean health care: what can
hospitals learn from a world-class automaker? J Hosp Med 2006;1(3):191-9.

Competing interests:
None declared