When a manufacturer builds a mass-produced product, nothing is left to chance. Every major component (for example with a car: the bodyshell, the engine) and every nut and bolt is ordered to be at the factory, just In time, such that a continuous flow of finished vehicles leaves the production line, quality checked and ready for delivery. To do this they use a computerised production control system which manages the ordering, transport, receipt, storage (minimal, hopefully to reduce the cost of work in progress), supply to the production line and then the availability of both manpower and machinery with which to assemble the vehicles.
Such systems have also been adapted to manage repair and overhaul lines for high-value equipment such as that used in defence, aerospace and on the railways. In this, the control system will know about the fixed inspection, test and scheduled replacement items, but not about those items requiring repair or replacement on inspection or test – however, historical records reveal a trend – for example, that 33% of brake pads will require replacement on a 250 hour inspection. Sufficient replacement parts are therefore ordered from suppliers on that basis, and labour recruited to handle it.
As the results of each inspection and test are recorded, the system automatically adjusts the master schedule, not just for that one vehicle, but across the whole factory. And, all the time, statistics are output to reveal any weaknesses in the whole system – surpluses or shortages of manpower or materiel, and effectiveness of outcomes.
Turning to hospitals, we see a remarkable similarity. There is no production line, but there certainly are multiple lines of examination (inspection), test and operation (repair). While appointment systems are used for scheduled outpatients and elective operations, there is the accident and emergency workload to deal with, as well as unexpected and urgent outcomes of outpatient tests, examinations and operations to deal with. It is this unscheduled workload that has bedevilled the efficient operation of hospitals, the standard answer so far being to throw more resources at the problem. However, when times are tough, those resources are taken away, and whole system begins to creak.
In the past, any suggestion that one could apply production control techniques to hospitals would have been met with horror, “You’re heartless, wanting to treat patients like cars on a production line.” But, frankly, the cars are treated better than patients often are. They do not have to wait around for anything, there is always the right number of workers and parts to look after them, and when they leave the factory, they are 100% functioning. And these days, with personalised ordering of bespoke vehicles combining a myriad of options, each car even “knows” where it is going next, whereas hospitals suffer from “bed blocking” while they find aftercare facilities for otherwise dischargeable patients.
All that is changing now – there is a trial project called “Improving Patient Flow” which has aims that remarkably could be satisfied with a decent repair management system. This has been trialled in at least two hospital trusts, and results are encouraging. This offers the hope of better, more efficient and effective outcomes without throwing more resources at hospitals and could offer a way out of the dilemma we face in providing an effective health care service in times of increasing demand.
We would urge the UKIP Health Policy Group to study this trial.