Over the holidays I was in Egypt, where my wife, Wendy, will spend some of January assisting in the Johns Hopkins dig at the Temple of the Goddess Mut at Karnak. Before the dig began, we had a chance to view various antiquities dating back to 3,000 B.C. Amid the splendor of the pyramids at Giza, our tour guide mentioned that the Great Pyramid, constructed about 4,500 years ago, remained the tallest man-made structure (at 481 feet) ever constructed until the Eiffel Tower surpassed it in 1889. However, the most striking statistic, assuming our guide had his numbers correct, had to do with the pyramid's incredible accuracy: If you measure the length of the structure's four diagonals (each more than 700 feet long), you find that each measurement is within 4 inches in length of the other. Once again, I was struck by the link between quality and variation.
As I toured the pyramids, temples, tombs, and looked at various artifacts of ancient Egypt, I began noticing that the perceived quality of an object was usually a function of low variability: It was a matter of how straight the lines were on the sides of temples, pyramids, obelisks; how regular the hieroglyphs were; and so forth. When you view a statue, for example, your eye is sensitive to subtle variations in the character of the lines defining the object. The less variation your eye detects, the more you will perceive the object as something of high quality. The walls of the Great Pyramid show finer joints than any other masonry constructed in ancient Egypt. To this day, some important aspects of how the ancient Egyptians achieved such exacting standards are still not completely understood.
In the hospital, we have difficulty coordinating the efforts of a few dozen people in order to provide high quality (and, of course, low variability). Imagine the organizational skills needed to manage 20,000 workers putting together the pyramids to extremely tight tolerances-it makes our task at Hopkins seem somehow trivial by comparison.
But there is an important difference between pyramid building and delivering care in a modern hospital. For the pyramids, there was one person in charge of the overall operation, and each of the 20,000 construction workers ultimately reported to that one man, or his designee. All work was coordinated in order to optimize the quality of construction. In the hospital, on the other hand, we have many disparate functional units, each with its own pharaoh, and oftentimes multiple physician specialists, each overseeing one aspect of the patient. No one person is empowered to be the ultimate patient advocate, making sure that all services and processes are optimally managed for the highest quality medical care. Maybe we should take a lesson from the ancient Egyptians.
In the hospital, we have difficulty coordinating the efforts of a few dozen people in order to provide high quality (and, of course, low variability). Imagine the organizational skills needed to manage 20,000 workers putting together the pyramids to extremely tight tolerances-it makes our task at Hopkins seem somehow trivial by comparison.
But there is an important difference between pyramid building and delivering care in a modern hospital. For the pyramids, there was one person in charge of the overall operation, and each of the 20,000 construction workers ultimately reported to that one man, or his designee. All work was coordinated in order to optimize the quality of construction. In the hospital, on the other hand, we have many disparate functional units, each with its own pharaoh, and oftentimes multiple physician specialists, each overseeing one aspect of the patient. No one person is empowered to be the ultimate patient advocate, making sure that all services and processes are optimally managed for the highest quality medical care. Maybe we should take a lesson from the ancient Egyptians.
