Over the years I have taken my family to a variety of manufacturing plants to learn about how things are made. They have enjoyed these trips, especially ones to food processing plants where you get free samples.
The most memorable of all the sites has been the Harley-Davidson Motorcycle assembly plant in Lancaster, Pennsylvania, where you can get close to the assembly line and watch how the cycles are assembled. As we watched the cycle frames come down the line, I noticed a large bar code page hanging on each one. It specified the individual preferences of the person ordering the bike. Did they want it in purple, red, or blue? High handlebars or low? Fenders or no fenders?
All these options are part of what is known as mass customization. The starting point for mass customization is learning what the customer wants, needs, or expects and then customizing the product or service accordingly. Other terms for mass customization include collaborative customization, co-creation, made-to-order, or built-to-order.
While mass customization traces its origins to manufacturing and retail, it can easily and appropriately be applied to non-manufacturing industries like health care and education. Mass customization places the customer (patient) at the center of the process and provides a methodology to enhance strategic advantage and add economic value.
All this sounds good, but what we produce in health care is not like making motorcycles or other manufactured products. True, the inputs to the health care process are not as consistent as those involved with making motorcycles. Patient characteristics and conditions vary. We also do not have control over the inputs that the patient brings to the situation. But we can still apply mass customization to selected aspects of patient care.
Mass-Customizing to Increase Quality of Life
Patients undergoing hip or knee replacement surgeries typically move efficiently through a process not unlike an assembly line. Take, for example, the case of a 63-year-old male suffering from osteoarthritis of the right hip. The patient has a lifelong history of running and playing other sports. He is in pain and starting to walk with a limp. His problem is not life-threatening, but it is a quality-of-life issue.
The surgeon the patient selects starts the mass customization process with a simple question: “How can I help to make your life better?” Bingo! The patient thinks, “This guy is interested in what matters to me.”
Next, the patient attends a cleverly named pre-surgery program for hip replacement patients and their post-surgery caregivers called “Joint Adventures.” The 63-year-old patient was the youngest of over 20 patients in the room. After a general orientation to the hip replacement process, patients and caregivers met with a surgical support team to hear about their customized treatment and recovery plan.
After the team described what they would do during hospitalization and post-discharge, they asked the patient to comment on their plan and adjusted various aspects of the plan to meet his needs. They explained that, due to his overall good physical condition, he would most likely be in the hospital only 1.5 days, then go home with follow-up care by a visiting nurse and a physical therapist. The team explained that they would adjust the recovery plan based on how quickly the patient was able to complete the home-based physical therapy program.
Putting Patients at the Center
For a 63-year-old female with a lifelong history of playing field hockey, the mass customization process started when her surgeon asked, “How can I help you do what you want to do?”
The patient began exploring her surgical options after a knee reconstructed over 30 years earlier because of a torn ACL began to fail. She walked with a limp and her quality of life began to suffer. She eventually found a sports medicine orthopedics group that specialized in reconstructive knee surgery.
After learning what mattered to the patient and assessing her health status and level of physical activity, the surgeon determined that she would be a candidate for outpatient knee replacement surgery. The procedure would take approximately 90 minutes with a four- to five-hour recovery period. The surgeon would then discharge the patient home for follow-up care.
A month before surgery, the patient had an MRI to customize the prosthetic implant to minimize bone loss when they fitted it to her bone structures. This was a clear demonstration of customizing the process to meet the patient’s needs. Within two months of surgery, the patient began attending her regular exercise classes. She no longer limps or experiences pain in her left knee.
They may call it by another name, but many health care providers already engage in mass customization if they to listen to those they serve and adjust clinical practices, when appropriate, to meet patients’ needs and expectations. My wife and I — the patients described above — can speak from experience about the benefits of such an approach.
Bob Lloyd, PhD, is a Vice President at the Institute for Health Care Improvement.
You may also be interested in:
IHI’s Improvement Coach Professional Development Program
Quality Is Everyone’s Responsibility