Mark Graban, a good friend of this blog, commented on the NYTimes report about the steps that Intermountain Health is taking to lower costs while improving patient outcomes. Mark's entire post is well-worth reading, even if you're nothing more than a consumer of health care. What most struck me, however, was this bit near the end:

A final idea is that using standardized methods as much as possible is a way of freeing the mind up to think about the truly important things (which Toyota preaches, by the way, for assembly workers):

[James] adds that he is simply trying to focus that resource [physician's thinking abilities] on the problems where it is most needed: those for which data does not have an answer.

I've heard Toyota people say you want to eliminate the hundreds of LITTLE repetitive decisions so that the person involved can focus on the FEW major decisions with a fresh mind that's not fatigued from constant decision making.

This is something I've talked about frequently. I believe that to-do lists don't work because they force you to constantly choose among the options on your list, a process that is itself both time-consuming and fatiguing. (Do I answer email now or later? Do I start Sarah’s performance review, review the latest budget numbers, or change the toner in the copier?) When you're constantly spending time and energy making choices, when you never have the option of running on autopilot, you impair your ability to think creatively. You get so mired in making small decisions that you can’t free your mind to attack the big stuff. As the psychologist William James wrote,

The more of the details of our daily life we can hand over to the effortless custody of automation, the more our higher powers of mind will be set free for their proper work. There is no more miserable person than one in whom nothing is habitual but indecision…. Whether you're in health care, advertising, or production engineering, there's real value in automating tasks through standardized work (or even, as Jon Miller points out, work standards). Give it a try.

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