Operating principles
A car production line and a hip surgeon's operating table may seem odd environments to compare, but research carried out by Kamalini Ramdas, Professor of Management Science and Operations at London Business School, shows they're not as dissimilar as they seem. In fact she's been helping orthopaedic surgeons learn from her research into how companies manage product quality and the effects of standardisation on quality
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Over a number of years my research examined standardisation in assembled products like automobiles. Next I began exploring the impact of standardisation in services. And then I had an accident skiing. This led to knee surgery and over a month in bed. That was when I had the realisation that perhaps there might be some implications for standardisation in the area of medical devices.
Intrigued, I talked to my surgeon and persuaded him to let me observe a knee replacement operation. This gave me a better understanding of how the process works. Then I spoke to a large number of people - other surgeons, faculty in the bio-engineering department of the University of Virginia, doctor friends, and others. I singled out device choice as a good place to begin to understand standardisation in this entirely different sphere.
Clearly, a surgeon is more extensively qualified than a car assembly line worker. But, whether you are a surgeon or a car assembly worker, the basic principle is much the same: when you do more and more of the same type of procedure, you get better at it. Similarly, if you think about how car components need to be designed differently for cars that have different characteristics, the devices that are used in hip surgery, for example, need to be well tailored to the patient they're used on, and people come in a huge spectrum of different shapes and sizes.
I am doing this work with Dr Khaled Saleh, an orthopaedic surgeon and professor at the University of Virginia and with an economics professor, Dr Steven Stern, also at the University of Virginia. In the surgical setting we were at first interested in examining how the experience that surgeons have with specific components affected the outcome of the surgery, for example, whether or not the surgery would result in a revision, taking into account whether the device was a good fit for the individual patient it was used on.
The outcome we were looking at was whether or not a revision occurred. The rate of revisions is actually quite low, making it hard to look into this question with accuracy. As a result, we decided to focus on the amount of time it took to do the surgical procedure. In hip replacement surgery the amount of time that the surgery takes is actually a very important variable. If you think about infections that occur during surgery, the chances of an infection are directly proportional to how long it takes to do the surgery.
One thing that we hope will come out of our study is an understanding of what kind of experience actually matters. You want to go to a surgeon who has a lot of experience but the specific type of experience the surgeon has with particular devices may also matter. In hip replacement, for instance, surgeons use cemented and uncemented devices for the procedure. And it may matter where their experience is.
In the United States there have been discussions in the Senate discussing standardising the components used in surgery. Understandably, the device manufacturers have been up in arms about this because they're worried about how standardisation might affect their product lines. Our research may contribute to this debate.
The reality is that research on the standardisation of components is applicable to almost any assembled product company where you're making a product that comes with assembly components. In addition it is also applicable to services where you are trying to serve different customers or market segments and there are certain parts of the service or certain tasks that can be standardised.
Kamalini Ramdas (kramdas@london.edu) is a Professor of Management Science and Operations at London Business School