How much walking do you have to do every day?

I am an industrial quality professional, and I am currently involved in a panel on health care reform. (I previously was part of Governor Rendell's health care reform panel, where he brought in doctors, business professionals, and so on to comment on health care reform efforts in Pennsylvania.)

I have written several trade journal articles on the need to implement quality management systems (like ISO 9001:2000) in health care systems. A recent one in Patient Safety and Quality Healthcare says that hospitals should fix the root causes of mistakes--four out of five of which are the responsibility of the system in which health care workers must work, as opposed to negligence or carelessness--instead of disciplining nurses. The latter approach discourages nurses from reporting mistakes or even near-misses, which means the underlying problems never get corrected and the same mistakes can happen again.

In a Japanese-run hospital, a nurse would immediately report that she had, for example, almost given somebody the wrong medication. The system in which she worked would be changed to make such an error impossible in the future. Not only would she not be disciplined, she might even be praised or rewarded for bringing the potential problem to management's attention. Japanese workers do this all the time. Shigeo Shingo said that any job that requires "worker vigilence" (e.g. "being careful") to prevent mistakes is not properly designed.

30 to 60 cents of every health care dollar is wasted on activities that do not create any benefit for patients. This includes things that hurt patients, like hospital-acquired infections. If this cost of poor quality could be reduced or eliminated, patients would have better outcomes and lower costs, while nurses and physicians could be paid more. The government's current health care "reform" plans do not even begin to address the costs of poor quality and inefficiencies in health care.

Ford would indeed have done this so fewer nurses could care for more patients--but without reducing quality by reducing the time that the nurses could spend with the patients. Suppose, for example, that proper care for a group of patients requires 30 minutes per patient per shift. A nurse who must walk for 2 hours out of every shift can care for 12 patients. If the nurse must walk only 30 minutes, he or she can care for 15 patients--and be paid 25 percent more. If the walking time can be put to productive use, however, this does not really apply.

Ford never objected to paying good money for a good job, but he did not consider it fair to his customers or workers to hire, for example, ten people to do the work of five (because the job design wasted half of the worker's time). On the surface, this looks like jobs for five more people, but the bottom line is that five workers' pay must then be divided among ten people.