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Articles summary Health Care ManagementKaissi 2012
‘‘Learning’’ From Other Industries: Lessons and Challenges for Health Care Organizations
Although it is true that health care has several distinguishing characteristics that set it apart, analysts
both within and outside the industry point to several similarities with other fields and suggest
opportunities for health care to learn from other industries. Applications from other industries have
been described in the literature, but the transfer of learning at health care industry level has not
been examined. This article investigates health care learning from other industries in the recent
decade, focusing on aviation, high-reliability organizations, car manufacturing, tele-communication,
car racing, entertainment, and retail; evidence suggests that most innovative practices originate
with these fields. The diffusion of innovations from other industries appears to start with a few early
adopter organizations (hospitals and health systems) and influential other organizations pushing for
the innovations. Once the trend becomes accepted, consultants and copying behavior seem to
contribute to its spread across the industry. An important question to explore is whether the
applications in the early adopter organizations are different (in terms of their effectiveness) from
those in the rest of the industry.
Purposes and methods
The purpose of this article was to review the evidence on health care ‘‘learning’’ from other
industries. This article will contribute to the health care management literature by providing a
thorough summary of the types of innovations that health care organizations have adopted from
other industries and therefore can serve as a guide to better understand what innovations work and
what innovations do not work and under what circumstances.
Challenges HC has to cope with are a demographic shift, the pace of technological innovations,
changing expectations, financial pressures and a health crisis. Improvement in this industry is needed
which is why we look at the following industries to potentially learn from this: We focus on aviation,
high-reliability organizations (HROs), car manufacturing, telecommunication, car racing,
entertainment, and retail because evidence suggests that most innovative practices originate from
these fields.
Kaissi: What HC can learn from other industries
Aviation Safety Improvement though focus on systems and cultures, rather than
blaming individuals
Car manufacturing Lean for performance improvement,
Professional silos vs workflow entire process
Telecommunication Six Sigma,
Careful not to overhaul existing QI initiatives
Hospitality Patient experience
Hotel-like room service
If Disney Ran Your hospital
Car racing Reducing waiting times
,Wiersinga & Levi (2016)
What Other Industries Can Learn From Health Care
This Viewpoint discusses the ideals and values that other industries can learn from health care
organizations. In the past 2 decades, opinion leaders from every industry, such as aviation, car
manufacturing, hospitality, and retail, have tried to tell hospital executives what health care
organizations could learn from their business to address current challenges. Not surprisingly, health
care management consulting has become a multi-billion–dollar market, with annual growth rates in
the double digits.
First, create value that goes beyond short-term gain. Prioritizing short-term gain at the expense of
creating long-term value can be costly. Medical professionals have learned to create value that goes
beyond short-term gain.
Second, create client relationships based on trust. The relationship between the physician and
patient is a prime illustration of a long-standing client relationship, grounded in a basic trust that the
physician will advise what is best for the patient. In this respect, learning how to communicate
honestly and increase transparency — within the limits of the agreements that are determined by
the patient or client and not by the physician or corporation— is instrumental.
Third, always seek the evidence, and follow it. Managers are often under intense pressure to make
decisions in the presence of incomplete information and uncertainty. As a coping strategy, managers
often rely on their experience, intuition, or conventional wisdom, none of which is necessarily
relevant. The quality of decision making by executive scan be enhanced by the explicit use of current
and best-available evidence in management. A physician’s clinical knowledge, skills, and expertise are
integrated with the best-available external clinical evidence from systematic research. Evidence-
based medicine has the potential to lead the way to evidence-based management that uses evidence
for decisions, changes, and common practices.
Fourth, create a truly stimulating working environment. People are crucial for creating a
competitive advantage, but many executives struggle to keep their work-forces motivated. In health
care, compassion (mededogenheid) and altruism (onzelfzuchtigheid) are powerful sources of
motivation. They can serve as prime examples of organizations that use their culture and their
people as the real and enduring (blijvende) sources of success.
Fifth, embrace lifelong learning as a core value. Medical professionals have learned to continuously
reinvent themselves to stay up-to-date and ahead of new or reemerging challenges. Ongoing,
voluntary, and self-motivated lifelong learning has been a key feature of medicine even before the
term continuous medical education was coined. Learning organizations create, acquire, and transfer
knowledge by cultivating open discussion and broadly oriented thinking. Fast adaptation to the
unpredictable can outsmart potential competitors.
,Pfeffer & Sutton (2006)
Evidence-Based Management
A bold new way of thinking has taken the medical establishment by storm in the past decade: the
idea that decisions in medical care should be based on the latest and best knowledge of what
actually works. Dr. David Sackett, the individual most associated with evidence-based
medicine, defines it as “the conscientious, explicit and judicious use of current best evidence in
making decisions about the care of individual patients.”
What Makes It Hard to Be Evidence Based?
There’s too much evidence.
There’s not enough good evidence. Despite the existence of “data, data everywhere,” managers still
find themselves parched for reliable guidance.
The evidence doesn’t quite apply. Often, managers are confronted with half-truths—advice that is
true some of the time, under certain conditions.
People are trying to mislead you. Because it’s so hard to distinguish good advice from bad, managers
are constantly enticed to believe in and implement flawed business practices. A big part of the
problem is consultants, who are always rewarded for getting work, only sometimes rewarded for doing
good work, and hardly ever rewarded for evaluating whether they have actually improved things. (Worst
of all, if a client’s problems are only partly solved, that leads to more work for the consulting firm!)
You are trying to mislead you. Simon and Garfunkel were right when they sang, “A man hears what
he wants to hear and disregards the rest.” Many practitioners and their advisers routinely ignore
evidence about management practices that clashes with their beliefs and ideologies, and their own
observations are contaminated by what they expect to see. This is especially dangerous because
some theories can become self-fulfilling—that is, we sometimes perpetuate our pet theories with
our own actions.
The side effects outweigh the cure. Sometimes, evidence points clearly to a cure, but the effects of
the cure are too narrowly considered. (Many school systems that have tried to end the practice have
quickly discovered the fly in the ointment: Holding students back leaves schools crowded with older
students, and costs skyrocket as more teachers and other resources are needed because the average
student spends more years in school. The flunked kids also consistently come out worse in the end, with
lower test scores and higher drop-out rates. There are also reports that bullying increases: Those flunked
kids, bigger than their classmates, are mad about being held back, and the teachers have trouble
maintaining control in the larger classes.)
Stories are more persuasive, anyway. It’s hard to remain devoted to the task of building bulletproof,
evidence-based cases for action when it’s clear that good storytelling often carries the day. And
indeed, we reject the notion that only quantitative data should qualify as evidence. As Einstein put it,
“Not everything that can be counted counts, and not everything that counts can be counted.” When used
correctly, stories and cases are powerful tools for building management knowledge. Good stories have
their place in an evidence-based world, in suggesting hypotheses, augmenting other (often quantitative)
research, and rallying people who will be affected by a change.
, What passes for wisdom – potential hinder
If a doctor or a manager makes a decision that is not based on the current best evidence of what may
work, then what is to blame? It may be tempting to think the worst. Stupidity. Laziness. Downright
deceit. But the real answer is more benign (goedaardigheid). Seasoned practitioners sometimes
neglect to seek out new evidence because they trust their own clinical experience more than they
trust research. Most of them would admit problems with the small sample size that characterizes
personal observation, but nonetheless, information acquired firsthand often feels richer and closer
to real knowledge than do words and data in a journal article.
Another alternative to using evidence is making decisions that capitalize on the practitioner’s own
strengths. This is particularly a problem with specialists, who default to the treatments with which
they have the most experience and skill. Surgeons are notorious for it. Similarly, if your business
needs to drum up leads, your event planner is likely to recommend an event, and your direct
marketers will probably suggest a mailing. The old saying “To a hammer, everything looks like a nail”
often explains what gets done.
Hype and marketing, of course, also play a role in what information reaches the busy practitioner.
Doctors face an endless supply of vendors, who muddy the waters by exaggerating the benefits and
downplaying the risks of using their drugs and other products. Meanwhile, some truly efficacious
solutions have no particularly interested advocates behind them.
Numerous other decisions are driven by dogma and belief. When people are overly influenced by
ideology, they often fail to question whether a practice will work—it fits so well with what they
“know” about what makes people and organizations tick. In business, the use and defense of stock
options as a compensation strategy seems to be just such a case of cherished belief trumping
evidence, to the detriment of organizations.
Ideology is also to blame for the persistence of the first-mover-advantage myth. Research by
Wharton’s Lisa Bolton demonstrates that most people—whether experienced in business or naive
about it—believe that the first company to enter an industry or market will have a big advantage
over competitors. Yet empirical evidence is actually quite mixed as to whether such an advantage
exists, and many “success stories” purported to support the first-mover advantage turn out to be
false. (Amazon.com, for instance, was not the first company to start selling books online.) In Western
culture, people believe that the early bird gets the worm, yet this is a half-truth. As futurist Paul Saffo
puts it, the whole truth is that the second (or third or fourth) mouse often gets the cheese.
Unfortunately, beliefs in the power of being first and fastest in everything we do are so ingrained
that giving people contradictory evidence does not cause them to abandon their faith in the first-
mover advantage. Beliefs rooted in ideology or in cultural values are quite “sticky,” resist
disconfirmation, and persist in affecting judgments and choice, regardless of whether they are true.
Finally, there is the problem of uncritical emulation and its business equivalent: casual
benchmarking. Both doctors and managers look to perceived high performers in their field and try to
mimic those top dogs’ moves. We aren’t damning benchmarking in general—it can be a powerful and
cost-efficient tool. Yet it is important to remember that if you only copy what other people or
companies do, the best you can be is a perfect imitation. So the most you can hope to have are
practices as good as, but no better than, those of top performers—and by the time you mimic them,
they’ve moved on. This isn’t necessarily a bad thing, as you can save time and money by learning
from the experience of others inside and outside your industry. And if you consistently implement
best practices better than your rivals, you will beat the competition.
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