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Box 1 Surgical time and motion
Remember seeing those elegantly lined up surgical instruments at the start of an operation with the surgical nurse ready to hand the right instrument at the right moment to the surgeon.
Where did that idea and practice come from?
The advent of scientific management in operating rooms at the beginning of the 20th century was a part of the long history of applications of management methods and principles in healthcare. Early pioneers in this field were Frank and Lillian Gilbreth. The Gilbreths’ primary focus was on work performance and worker satisfaction. They conducted pioneering research in the fields of time and motion study. This covered the livelong search for “The One Best Way” in organising and executing work flows and processes.12
Scientific management was a development of the 1880s and 1890s and is most closely associated with Frederick W. Taylor (1856–1915) whose Time Study method defined the field.34 His favourite example of this approach was observing the work of 75 men at the Bethlehem Steel Company who moved pig iron by shovel all day. After a careful analysis of this hard repetitive work, Taylor’s engineers decided that great improvements in productivity could be achieved. One worker was carefully selected and asked to change the way he worked by following the engineer’s directions exactly. “We want no back talk… When he tells you to walk, you walk, when he tells you to sit down, you sit down.” As a result, this worker raised his productivity from 12.5 to 47 tons of pig iron moved per day. The worker, who was paid piece rate, thereby increased his pay from $1.15 to $1.85 per day.5 Taylor's approach also included the redesign of the equipment, such as the size and shape of the shovels in use. In another project …
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