Technology Creates Moving Targets
The Henry Ford Museum/Greenfield Village in Dearborn, Michigan is one of my favorite museums in the world. It features some of the coolest historical technology anywhere: many car-related exhibits (of course), a huge locomotive collection, great aviation displays, an extensive farm machinery collection, etc. Among its treasures are the very first car (actually a “quadricycle”) Henry Ford built, the first Ford Mustang to roll off the assembly line, Thomas Edison’s laboratory relocated from New Jersey, and the Wright Brothers’ bicycle shop moved from Dayton, Ohio.
I was telling my son that they also have the rocking chair that Lincoln was in when he was assassinated, Kennedy’s limousine from Dallas when he was killed, and the Reagan presidential car from his attempted assassination. He question was, “What, is that just a museum of things people were shot in?”
The museum has a fascinating exhibit of typical American kitchens through the centuries. One is from the late 1700s, one from the mid-1800s, one from the late-1800s, and one from the 1930s. It shows technology’s impact on appliances, cooking processes, and amenities.
(Keep reading below the photos.)
My wife and I visited the museum years ago, and an earlier version of the kitchen display included a kitchen (which they have since removed) from about 1910 when electricity first started powering appliances like electric refrigerators and electric stoves. No longer did housewives have to cook over wood-burning stoves or deal with clumsy ice blocks and drip pans. These breakthroughs saved hours each week.
There was an intriguing sign from the 1910s kitchen that threw a wrinkle in the time savings generated by technology. Now, the sign said, instead being expected to bake one pie a week, the housewife was expected to bake three since the task was so much easier. So tech upped the ante, and housewives’ work day remained as long as ever since the expected output increased.
And therein lies the rub! How often have hospitals been sold on a technology buy based on saving time? Or improving efficiency? Or increasing quality? Although these improvements undoubtedly hold in the immediate term, over time, expectations expand to ingest any performance improvement.
So it’s a moving target. Time is saved, but rather than being able to reduce staffing, the vacuum is often filled by other worthwhile activities. Efficiency increases and care is improved, but time is not saved. Similarly, technology supports quality improvement efforts, but as other hospitals also improve their quality positions, my quality ranking may remain the same relative to others’. So although absolute quality improves, my “pecking order” in the quality hierarchy may not change.
Don’t get me wrong! I’m 100% behind technology advancements, but the idea that in the long term they can cut costs through saving time or that they will improve my quality rankings is probably optimistic. Tech will certainly improve many aspects of healthcare, but the march toward greater efficiency and higher relative performance never ends. In a sense, you have to run like crazy to stay in place.