I came across an interesting article the other day, "Standardized care vs. Personalization: Can They Coexist?" The first sentence of the article is somewhat prophetic, "Mention the word 'standardization' to a group of healthcare professionals, and you may start a debate." We hear a lot about standardization in healthcare today, and it's not always a very popular concept for physicians in particular. Mention the word "standardization" on the hospital wards to a group of physicians and you may get the response, "That's cookbook medicine!" I'm not sure what "cookbook medicine" refers to (actually, I do), but I suspect that it's not meant to be a positive affirmation of standardization.
Standardization is actually a really good method of improving the delivery of healthcare. There are multiple examples of how standardization can simplify care, decrease expenses, and improve outcomes. For example, in my own specialty (pediatric critical care medicine), children with new-onset diabetes mellitus often present with a serious complication of their illness, called diabetic ketoacidosis. Our hospital - really, every hospital that I have ever worked in - has had a standardized protocol for managing children with diabetic ketoacidosis for many years. Why? These protocols simplify care, in terms of making sure that everyone - physicians, nurses, and even the patients and their families - are on the same page on how these patients will be managed and what to expect next. These protocols shorten the length of stay in the PICU and prevent unexpected and untoward complications.
Outside of my specialty, there are standardized protocols for treating patients with cancer that have been around for years. These protocols have facilitated progress in understanding on how best to treat patients with certain types of cancer. If everyone with a certain type of cancer is being treated the same way, physicians from multiple different centers can collect data and determine if the protocols have the desired effect. Treat everyone differently from center to center and it becomes difficult to compare outcomes (no single center would likely have enough patients to measure the impact of treatment).
I am amazed at how long standardization has truly been around. It's actually not a new concept at all. For example, there was a fire in the city of Baltimore in 1904 ("Great Baltimore Fire"). The city of Baltimore burned for over 2 days, and over 1,200 firefighters were required to bring the fire under control. Fire departments from Baltimore, Washington, D.C., and even Philadelphia and New York City came to help put out the fire. Why did it take two days to control the fire with so many different fire departments and so many firefighters working together? As it turns out, there were no standards back in those days, so all the different water hoses didn't fit to the local fire hydrants.
Did you know that more than 200 billion screws are used every year in the United States alone? Imagine, if you will, if all of the screws that were manufactured by different companies were different. The earliest screws were handmade, and no two screws were the same. Can you imagine if you had to replace a screw today and couldn't find one to match? That was actually the case until around 1920, when the National Screw Thread Commission provided recommendations to standardize how screws were manufactured (see "History of Standardization of Screw Threads").
Finally, consider why you stop at a red traffic light? Was there ever a time when "red" meant "go" and "green" meant "stop"? It turns out the answer to this question is "yes"! Traffic lights in the city of New York weren't standardized until the 1920's (see "A History of New York Traffic Lights"). At one time, the different colors in traffic lights meant different things depending upon where you lived. Imagine someone from Boston coming to New York and trying to drive when "Red means stop" in Boston and "Red means go" in New York!
It turns out that standardization can be a very good thing. Standardization makes us more efficient, and standardization is actually safer in almost every case. We are somewhat behind the times in healthcare. I know there will inevitably be someone out there that will point out that "Patients aren't fire hydrants" or "Patient care is not like traffic safety." I would argue otherwise. Standardization is not only a good idea, it can coexist with personalization of care. More on that later.
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