The New Yorker has a great article by Atul Gawande ("Can Hospital Chains Improve the Medical Industry?") that looks at whether standardization of processes is possible and worthwhile in hospitals. The answer is yes. For example, knee replacement surgery was standardized by a group at Brigham and Women's Hospital in Boston:
A few years ago, [Dr. John Wright] gathered a group of people from every specialty involved--surgery, anesthesia, nursing, physical therapy--to formulate a single default way of doing knee replacements. They examined every detail, arguing their way through their past experiences and whatever evidence they could find. . . . they studied what the best people were doing, figured out how to standardize it, and then tried to get everyone to follow suit.Wright is quotes as saying "Customization should be five per cent, not ninety-five per cent, of what we do."
What is especially fascinating about the article is that the author (himself a physician) went looking at the restaurant industry for insight as to how thousands of meals at casual dining chains come out both affordable and tasty:
It's easy to mock places like the Cheesecake Factory--restaurants that have brought chain production to complicated sit-down meals. But the "casual dining sector," as it is known, plays a central role in the ecosystem of eating, providing three-course, fork-and-knife restaurant meals that most people across the country couldn't previously find or afford. The ideas start out in élite, upscale restaurants in major cities. You could think of them as research restaurants, akin to research hospitals. Some of their enthusiasms--miso salmon, Chianti-braised short ribs, flourless chocolate espresso cake--spread to other high-end restaurants. Then the casual-dining chains reengineer them for affordable delivery to millions.
But least you think that this is strict mindless assembly line type of work, Gawande gives us this description of watching grill chef Mauricio Gaviria at work in one Cheesecake Factory restaurant. Each work station has a computer monitor that displays both the order and the recipe for that order:
I brought up the hibachi-steak recipe on the screen. There were instructions to season the steak, sauté the onions, grill some mushrooms, slice the meat, place it on the bed of onions, pile the mushrooms on top, garnish with parsley and sesame seeds, heap a stack of asparagus tempura next to it, shape a tower of mashed potatoes alongside, drop a pat of wasabi butter on top, and serve.Two things struck me. First, the instructions were precise about the ingredients and the objectives (the steak slices were to be a quarter of an inch thick, the presentation just so), but not about how to get there. The cook has to decide how much to salt and baste, how to sequence the onions and mushrooms and meat so they're done at the same time, how to swivel from grill to countertop and back, sprinkling a pinch of salt here, flipping a burger there, sending word to the fry cook for the asparagus tempura, all the while keeping an eye on the steak. In producing complicated food, there might be recipes, but there was also a substantial amount of what's called "tacit knowledge"--knowledge that has not been reduced to instructions.
Second, Mauricio never looked at the instructions anyway. By the time I'd finished reading the steak recipe, he was done with the dish and had plated half a dozen others. "Do you use this recipe screen?" I asked.
"No. I have the recipes right here," he said, pointing to his baseball-capped head.
That is a great description of work in a great number of areas that combine standardization with worker tacit knowledge. But the system doesn't completely rely on tacit knowledge. The Cheesecake factory has a kitchen manager who makes sure that every order is right before it goes out to the customer - thus insuring the standard is maintained. Thus, tacit knowledge works in conjunction with the standardization, not against it.
A good example that many other industries have and should follow.
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