Thursday, September 28, 2006

Reasoning by (Mis)Analogy Redux: General Motors and Health Care "To Specs"

The Detroit News published an article profiling one Sam Shalaby, who works at General Motors.

Sam Shalaby is a car guy. He used to run a Delphi components plant in Dayton, and his language is still sprinkled with manufacturing terms....
What is the relevance to Health Care Renewal? Sam is now director of community health initiatives for General Motors. Some of his thoughts:

If we ran an auto plant like they run hospitals, we'd be out of business. The medical system is so obsolete, no one understands how to make it work.

We build cars to specs. Hospitals should treat patients to specs.
The article shows that Shalaby's thinking is reflected at even higher levels of General Motors management. It quoted GM CEO Rick Wagoner,

If you want to buy a car, you can go on the Internet, and you can check out the Consumer Reports rating, the J.D. Power rating, the relative stopping distance, the relative resale value, you know all these things.

It amazes me that you could be going into a surgery tomorrow and genuinely want to know about the place you're going, how many times they've done this surgery, how successful they've been, and more than likely, you won't be able to find that information. This is Business 101.

There is considerably more in the article, and some of its criticisms of doctors, hospitals, and the health care system are right on.

But the notion that treating patients in a hospital and making cars on an assembly are closely analogous just amazes me. It is true, as Shalaby says, that automobile makers build cars "to specs." After all, they designed the cars themselves, based on the laws of physics, and engineering principles.

But human beings are not built, much less built "to specs." In fact, our understanding of human biology, physiology, etc is obviously incomplete. Human beings are orders of magnitude more complex than automobiles. Hence our understanding of how to fix their physical problems is also incomplete. Human beings show up in doctors offices or to hospitals with unique sets of circumstances, characteristics, and problems. So the statement, found in the article, "treatment for identical medical conditions varies widely," is close to nonsensical, since different people with sore throats, pneumonia, depression, or whatever may have problems given the same overall name, but are hardly identical.

We have blogged before about how business people with limited understanding of health care seem happy to charge in with simplistic solutions to complex health care problems based on unsupportable analogies. (See post here about a previous leader of Intel who thought hospitals were like computer chip factories, and here about a New York Times op-ed comparing hospitals to companies like Toyota.)

Why they feel so confident in doing so is beyond me. I may be a "car guy," and have an engineering degree, but I would not feel competent to jump in and assume a leadership role in automobile design at GM.

Maybe the car guys now in charge of health care should consider a quote attributed to H L Mencken:
For every complex problem, there is a solution that is simple, neat, and wrong.


Anonymous said...

We all know how well Delphi and GM are doing financially. During my graduate program in business I was disappointed to see the instructors, as well as the class, bottom line a problem. Show me the numbers and I will give you an answer.

I come from a craft background, construction. You learn very quickly that numbers are an important guide. Something's work faster, some slower, and everyone has good and bad days. When I read these manufacturing solutions to problems involving, to a great extent, personal performance I cannot help but think: They were the not the right answers then, and they are not the right answers now.

Steve Lucas

Dan Ross said...

To identify a solution, shouldn't the managers be looked at? The entire system was revamped in the early 1980s by the surviving managed care industry. Do these companies make more profits as Americans become sicker?