Suddenly the surgeon was the patient, and Kenagy was horrified by what he saw.
Cardiologists have done the same thing to vascular surgeons like Kenagy and their once-godlike colleagues, cardiothoracic surgeons.
Kenagy says medicine needs the same type of modularity that drove down costs in the computer industry.
Medicine needed to be disrupted, Kenagy realized, to deliver the simultaneous goals of higher quality and lower price.
On further investigation, Kenagy found there are 748 ways a drug order can work its way from doctor to pharmacy to patient at UPMCPresbyterian.
Over the coming months Kenagy will try various ways to eliminate less important tasks that distract the nurses on 10B from their primary job of patient care.
Looking over her shoulder and scribbling in a notebook is John Kenagy, a vascular surgeon by training who is now a visiting scholar at Harvard Business School.
But Kenagy has some powerful supporters backing his experiment.
Convinced the problem was rooted in poor management, Kenagy, now fully recovered, became an administrator at a Catholic health care system outside of Seattle that tried to integrate doctors and hospitals into one seamless process.
Up on 10B of UPMC Presbyterian, Kenagy is trying to disrupt long-established patterns of inefficiency by adapting the Toyota production system a manufacturing process that emphasizes low inventory, a high degree of flexibility and zero defects to medicine.
"Nurses spend a third of their time in patient care and two-thirds of their time hunting, documenting and clarifying, " says Kenagy, who has studied hospitals in Massachusetts and Pittsburgh as part of an experiment to bring industrial-style management principles to health care.
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