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Fixin' Healthcare

Friday, April 21, 2006

The Lifestyle Chronicles - Oh, The Things You Will See

Two interesting examples of adaptation to change might be instructive for addressing problems that confront medical care today. One is the adaptation of automobile manufacturing to a shift in market conditions (Wall Street Journal, April 11, 2006) and the other is the development of container shipping.

For many years the automobile industry sold car models in large volume and assembly plants dedicated to one model operated at full capacity. However, when sales volume dropped expensive plants and equipment became idle because car models were not engineered for compatability of assembly. This has become a severe problem as market conditions for automobiles has changed resulting in rare mega-selling models.

The Japanese were first to develop flexible assembly plants to produce more than one car model. This required engineering the cars for compatibility of assemby and organization of the plant for rapid change-over from one model to another. The Japanese companies have reaped the rewards of this foresight. Now, Chrysler has moved in this direction and is gaining an edge on GM and Ford who have been slow to adapt.

The Box is a book by Marc Levinson that describes another example of adaptation. The history of cargo shipping is the slow and expensive moving of a wide variety of packages by the the muscle of stevedores and other heavy lifters. That changed with the standardized shipping container (the box) that could be moved from one means of transportation to another by machine or crane. Malcom McLean introduced the lifting of trailer bodies directly on ships at portside. An example is given of a 94% drop in costs shipping beer from Newark, N.J. to Miami.

For ten years McLean's innovation languished until the Vietnam War required rapid transport of huge amounts of material halfway around the world, and Japan's export boom of the mid-1960s. Ports that were willing to adapt prospered due to supercranes, reshaped docks, flexible labor contracts and connecting highways and railways. Newark, N.J. and Port Elizabeth would hasten the demise of antiquated and corrupt docks in Manhattan and Brooklyn. Boston and Phildelphia declined while Charleston, S.C., Savannah, GA and Los Angeles-Long Beach thrived.

These are examples of how market change, disruptive technology and innovative organization can produce success and cause failure. Medical care is involved in similar types of issues and searching for answers, e.g. application and dissemination of technology has been a constant struggle for medical care.

When change comes, some of it will be in the form of adjustments to the existing system, such as universal insurance coverage, different mechanisms for financing and application of information technology. But, the responses also will include actions and plans that redefine health care and change perspective as to its application.

These might be Humana using consumer oriented market research to develop programs that attract new business, a hospital in Portland, Oregon giving care to acutely ill patients at home or a risk-based health record vs a problem-based medical record.

Some are trying to create working models for community health care that emphasize health over sickness and create mechanisms for maintaining optimum health of populations. Finland is an example, Olmsted County in Minnesota has a model and Greenville County in S.C. has started to develop one. Steve Bellar has a model that addresses health and wellness for the individual.

There are other examples out there and more will come. Keep your eye on the development of innovative practices of public health that are oriented to primary and secondary prevention of illness and disease. I think communities all across America are moving in that direction.

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