Summary by Nicholas Sisto
Master of Accountancy Program
University of South Florida, Summer 2003
The purpose of this article is to illustrate how continuous learning professionals can utilize the just-in-time philosophy used in manufacturing. The authors explain the difficulties that continuous learning professionals such as doctors have in trying to keep up with the tremendous amount of knowledge that must be absorbed from various sources. A physician mentioned in this paper must know something about almost 10,000 different diseases and syndromes, 3,000 medications, 1,100 laboratory tests, and many of the 400,000 articles added each year to the biomedical literature.
In an effort to mitigate some of this information overload and reduce some of the medical errors, Partners HealthCare tried to incorporate the just-it-time methodology into the health care profession. In a staggering study by The Institute of Medicine, they estimated that more than a million injuries and as many as 98,000 deaths each year are attributable to medical errors.
Partners HealthCare knew that embedding knowledge into everyday work processing would be too time-consuming and expensive, therefore they concentrated their efforts on an essential work process. They selected the order entry process as errors in drug prescriptions and lab-test ordering had been well documented. Partners HealthCare developed a set of integrated information systems with a single database. The database is updated with information from a committee that specializes in a specific field of medicine. When the doctor orders a prescription or a lab test the system automatically checks the patient’s medical records for allergic reactions to any medications or prior lab test. If the system identifies a potential conflict it brings it to the doctor’s attention and makes recommendations. The doctor has the ability to override the system and use his professional judgment if he disagrees with the system's recommendation.
The results of the system appear to be promising, out of the 13,000 orders entered on an average day by physicians, 386 are changed as a result of the system's suggestion. In addition the integration of the hospital's event detection system resulted in a change in 72% of the 3,000 alerts per year. The system saved money by suggesting cheaper prescriptions, reducing hospital stays and adverse drug effects.
While this system appears to have great potential at Partners HealthCare it might present problems in other service industries. Developing the database from scratch and continually updating the information is very time consuming and expensive. In addition, professionals are very well trained and educated and might be resistant to using a suggestion from a computer as opposed to their own judgment. Even within the healthcare industry it will be very difficult to implement this methodology to more complex areas such as oncology. However, with all these drawbacks, the Partner HealthCare example supports the view that the just-in-time philosophy can be applied to the service sector.
Abernethy, M. A. and P. Brownell. 1999. The role of budgets in organizations facing strategic change: An exploratory study. Accounting, Organizations and Society 24(3): 189-204. (Summary).
Bast, J. L., R. C. Rue and S. A. Wesbury Jr. 1993. Why we spend too much on Health Care and what we can do about it. Heartland Institute. (Summary).
Cohen, F. 2011. Improving processes in your practice: Do the same thing with less, or more with the same thing with lean six sigma and lean principles in your toolbox. Medical Economics (June): 60-62,-67-69. (Note).
Kershaw, R. 2000. Using TOC to ‘cure’ healthcare problems. Management Accounting Quarterly (Spring): 22-28. (Summary).
Lyons, B., A. Gumbus and D. E. Bellhouse. 2003. Aligning capital investment decisions with the balanced scorecard. Journal of Cost Management (March/April): 34-38. (Summary).
MacArthur, J. B. and H. A. Stranahan. 1998. Cost driver analysis in hospitals: A simultaneous equations approach. Journal of Management Accounting Research (10): 279-312. (Summary).
Martin, J. R. Not dated. Lean concepts and terms. Management And Accounting Web. http://maaw.info/LeanConceptsandTermsSummary.htm
Martin, J. R. Not dated. Profit Beyond Measure graphics and notes. Management And Accounting Web. http://maaw.info/ArticleSummaries/ArtSumJohnsonBromsGraphicsNotes.htm
Martin, J. R. Not dated. What is lean accounting? Management And Accounting Web. http://maaw.info/LeanAccounting.htm
McDermott, R. E., K. D. Stocks and J. Ogden. 2000. Code Blue: A Tale of Romance, Murder, Mystery, Intrigue & Managed Care. Syracuse, UT: Traemus Books. (Note).
West, T. D. and D. A. West. 1997. Applying ABC to healthcare. Management Accounting (February): 22, 24-26, 28-30, 32-33. (Summary).