"How many lawyers does it take to…?" asks a local billboard. Frivolous lawsuits inflate malpractice premiums, squeeze physicians who cannot pass the added costs to their patients, and force many of them to leave the state. There are, however, two sides to this story, and most malpractice suits are probably justified. 30 to 50 percent of medical costs are due to errors, inefficiencies, and poor quality. Medical mistakes of all kinds kill up to 120,000 people annually. (References appear in the health care section of my new book, "Henry Ford's Lean Vision." The Henry and Clara Ford Hospital actually used Ford's industrial management methods to improve both quality and efficiency of care. I can supply these references to interested doctors, nurses, and attorneys.)

It is a basic quality management principle that the system in which the doctor works can promote mistakes. A hospital's deficient quality management system can knife the world's best doctor in the back. As an example, handwritten prescriptions kill up to 25,000 people a year. Workplaces that conform to the ISO 9000 standard for quality management systems do not allow any kind of handwritten work instructions, period. Modern technology can allow doctors to enter prescriptions into a computer that can double-check them for unusual dosages or interactions, and issue unambiguous instructions to the pharmacy.

Hospitals often complain that they don't have enough nurses. The statement, "We're shorthanded," is almost prima facie evidence of managerial deficiencies, and it should not be an acceptable defense in a malpractice suit. It is management's job to recruit and retain (through adequate pay and desirable working conditions) qualified personnel such as registered nurses. It should be noted that laws govern the amount of time that commercial pilots and truck drivers can work without rest, because a tired pilot or truck driver is more likely to have an accident. Putting nurses on six-day, 12 hour-a-day shifts (as has been reported) is very questionable managerial judgment.

Ford and his contemporaries like Frank Gilbreth and Frederick Winslow Taylor stressed the fact that cheap lighting, cheap materials, cheap workers, and cheap equipment are often very costly in the long run. Fluorescent lighting in hospitals (and other workplaces) seems to reduce lighting costs. Fluorescent light is not, however, really the white light with which the human eye is designed to work. (Look at it through a prism or take an unfiltered photograph under it with daylight film, and you'll see what I mean.)  If it fatigues workers and makes them less efficient, or increases the chances for mistakes, it's a false economy.

Dry air in hospitals may make patients (and staff) more susceptible to respiratory infections. ISO 9000 also addresses temperature and humidity controls. The Henry and Clara Ford Hospital, which was built more than 80 years ago, had such controls; does yours?

Error-proofing is commonly used in industry to prevent, for example, parts from getting the wrong processes. Some hospitals use color-coding and bar coding to make it impossible for patients to get the wrong medications or surgical procedures. This is another example of applying industrial quality methods to health care.