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INTRODUCTION

Key Points

  • Medicine is a labor-intensive industry that lags behind other nonfarm industries in productivity.

  • Automation using intelligent software and robotics is an obvious solution but one which faces regulatory and labor force resistance.

  • The automation of the airline cockpit has many instructive parallels for the medical industry.

Medicine is a labor-intensive industry with a relatively low investment in computers and technology. When compared to other industries, the rate of labor productivity growth in the hospital sector lags well behind the nonfarm sector. As medical costs continue to escalate, pressures for cost-efficiencies and increased productivity will continue to grow (Fig. 19-1).

Figure 19-1

Medical costs as a percentage of gross domestic product are escalating at an unsustainable pace.

There are a number of ways in which medical care is bound to practice models (i.e., specific nursing ratios for ICU patients) that could be streamlined, but will be difficult to change. For example, it is easy to imagine ways in which care in an ICU or operating room could be made more efficient and less labor-intensive using intelligent computer algorithms and/or robotics. In much the same way that airline cockpits have become automated using intelligent software and fly-by-wire technology, some of the activities of ICU and operating room nurses and physicians could be performed by machines. Automation of the cockpit permitted a reduction in crew size.

The crew manning commercial long-haul aircraft in the 1950s consisted of five to six people, including two pilots (plus a relief pilot), a flight engineer, navigator, and radio operator. The latter role was folded into that of the pilots fairly quickly, and the role of the navigator was eliminated in the 1970s with the advent of new navigation technology. The flight engineer remained part of the crew until the mid-1980s, when the 747 became available, with computers that performed many of the tasks previously done by the engineer. The battle over the elimination of the “third man” (the engineer) is instructive. Pilots unions fought automation fiercely, and it wasn’t until a presidential commission endorsed the conversion to two man cockpits that the change became possible (Table 19-1).

Table 19-1Cockpit personnel for transoceanic flight

The evolution of the automated cockpit is instructive. The engineers who designed the automated cockpit were initially concerned that pilots would have too little work in the new cockpits. It quickly became apparent, however, that automation created new work relating to interaction between the pilots and the computers. ...

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