5.13.2009

Does Standard Work in Healthcare Require Legal Protection?

Several key healthcare industry groups have pledged to join in President Obama’s efforts to curb rising costs, though there are few details yet as to how that will be achieved.

One of the approaches everyone is talking about is evidence-based guidelines. This means establishing what would be, in effect, best practices in medicine. (In lean terms, they might also be called standard work.) They would be designed to eliminate, or at least reduce, wide variations that currently occur in the numbers and types of tests doctors order in specific situations – many of which are believed to be unnecessary.

However, The Wall Street Journal Health Blog quotes Jim Rohack, president-elect of the AMA – one of the groups making the pledge – as saying doctors want something in return: protection from being sued.


If we as the profession come up with evidence-based ways to provide care, and as a result of that can reduce unnecessary tests or unnecessary procedures, then the physician and the patient should feel comfortable that if the physician has followed the guideline, the physician is not later going to be sued.


Presumably, many unnecessary tests are ordered today because doctors fear being sued if they don’t order every possible test.

The essence of continuous improvement is that best practices are constantly evolving, and those involved in a work situation – whether it is manufacturing or medical treatment – should be able to constantly look for better ways to operate, and to eliminate waste.

If a medical test almost never reveals anything of value, it might be considered waste, and eliminated.

But perhaps the test does reveal something of value one percent of the time. If the test is not performed in that one-percent situation, and something bad happens, should the patient have the right to sue the doctor for not performing the test?

I’m inclined to support the doctors’ push for legal protection, but it’s a tough question. What do you think?

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