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The Conflicts Between Customized and Standardized Care
Currently, the are two views on the organization of patient care: one emphasizes the customization of the services to the needs of individual patients while other advocates the standardization of practices based on research. A general consensus on the topic is that these approaches need to complement each other, but several conflicts exist between the two which complicate the integration. First, the standardization implies well-defined and regulated practices.
This excludes the human factor, which is known to be one of the chief concerns of the healthcare. However, it also compromises the flexibility which is necessary in certain cases. This conflict was partially addressed by introducing the regionalized care (Nguyen, Kahn, & Angus, 2010). However, this has led to a related conflict, which attempts to determine the boundaries of customization. Once the possibility emerges to introduce the customized practices on a certain level, the inevitable question is: which level should it be? Another conflict associated with these views is grounded in the patients perception of the service. The personalized care improves the patients involvement in the treatment, which coincides with the current understanding of the successful healthcare process (Geisler & Heller, 2012).
Besides, it appeals to the patients concept of a family doctor, a specialist who can account for all the individual needs. This, in turn, improves patient satisfaction. At the same time, it applies only to a fraction of health providers, while introducing unnecessary waste of time and resources and a possibility of a faulty judgment. Finally, the standardized procedures are more effective in terms of cost and administrative effort. Customization introduces the unpredictable number of variables and complicates planning.
The Applicability of Demings Concept of Waste to Health Care Entities
Edward Demings principles of quality improvement have initially been created for use in the business sector. However, they are flexible and universal enough to be utilized in a number of other areas, including healthcare. Of particular interest is the concept of waste. This concept is specifically mentioned in the fifth principle, Improve constantly and forever the system of production and service. (Orsini, 2012) While improvement is a broad and somewhat vague term, Deming offers one possible way to do it: through waste reduction.
Waste, in this case, mostly characterizes ineffective human resource management. According to Deming, the system which is intrinsically flawed will inevitably hamper the ability of people involved to develop their potential. This notion notably coincides with the established practice of just culture, which is aimed, among other things, at finding the weak points of the system by analyzing mistakes made by the personnel (Kaplan & Fastman, 2003).
According to the Demings concept of waste, the shortcomings of the system is considered an inhibitor which will render the effort of employees, their skill, training, and education useless (Orsini, 2012). As the constant improvement in healthcare is usually achieved by adding new entities to patch the already existing problems, it is almost a certainty that some of these additions will be of questionable value. Demings concept suggests making the reduction a part of the process, which will remove unnecessary complexity and allow for an improvement through personal achievement.
Besides the implementation in the administrative sector, the waste concept can be applied on a more material level. For instance, poorly organized work environment, e.g. improperly placed inventory, can slow down or disrupt the efficiency of the medical procedures, and can be categorized as waste. Thus, the concept of waste can be utilized in healthcare as a guiding principle for improvement through simplification and fighting redundancy.
References
Geisler, E., & Heller, O. (2012). Managing Technology in Healthcare (Vol. 1). Boston, MA: Springer Science & Business Media.
Kaplan, H. S., & Fastman, B. R. (2003). Organization of event reporting data for sense making and system improvement. Quality and Safety in Health Care, 12(suppl 2), ii68-ii72.
Nguyen, Y. L., Kahn, J. M., & Angus, D. C. (2010). Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach. American Journal of Respiratory and Critical Care Medicine, 181(11), 1164-1169.
Orsini, J. The Essential Deming: Leadership Principles from the Father of Quality. New York, NY: McGraw Hill Professional.
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