Quality Management

Clinical Guideline Development

Build To Order - BTO:

A few aspects of medicine were massed produced and turned into a production line. The most obvious being biochemistry and pathology where large central laboratories are the obvious solution to ever an increasing demand. The collection of samples is still labour intensive but from that stage on, in some areas, the machines take over and together with computer connections will readily deliver the result direct to the doctor or even the patient if this were to be allowed.

In many respects medicine lost out on the stage of industrialisation and continues to try to deliver a bespoke service at huge cost to a dissatisfied customer base.

Technology may actually be about to move us into the next stage; that is a tailor made bespoke suit that should cost thousands of pounds for the same or little more than the mass-produced suit in the local department store.

Even the areas that have put in production lines may well be overtaken by the development of the biochip with its surface covered in thousands of sensors to give Near Patient Biochemistry NPB.

The real challenge however is to emulate the likes of Dell Computers where the customer is able to order their requirement and have it delivered within 2 or 3 days all by the Internet. Dell in some ways is misleading, as the choice available, when you really study the advert, is quite limited. All that happens is that there are a few basic models, which are then customised to by the addition of more hardware or software. The real challenge of medicine is then to accommodate to the astronomically huge number of variations in ways that reduce the mishaps and keep the cost manageable.

One response to this problem may well be the setting up of specialist units to deal with a small number of problems. We see this most markedly in surgery where after the Bristol mess there will surely be only a handful of units in the UK offering paediatric cardiac surgery. It seems probable that such things as hip replacements could be concentrated and be amenable to both quality improvement and cost reduction by limiting the alternatives available and heavy standardisation. Clearly the medical assessment before surgery and rehabilitation after the first few days needs to be handled probably in a near patient setting.

Very much these changes are about both the heavy use of computers and other new technology and the ability of both patients and doctors to move to new concepts of care. A programme of information, understanding and support must accompany these changes.
This is an area that is developing rapidly and deserves further thought.

RefsSpecial report mass customisation, The Economist July 14th 2001 p 79-81