Monday, May 4, 2009


The backyard of my parents’ winter home in Arizona sports an orange tree.

That’s quite a novelty for grandchildren visiting from Saskatchewan.

Grandpa likes a glass of fresh-squeezed orange juice for breakfast and asked if his 2 young grandsons would make it for him. The next morning, the boys rushed outside, filled a bag with oranges, and brought them back to the kitchen. There, they had worked out an assembly-line system to get Grandpa his juice. The older one sliced each orange in half and the younger one squeezed. And squeezed. And squeezed.

But a 3-year-old only squeezes a dribble of juice out of each orange before moving on to the next half. It wasn’t long before they had to pick more oranges. And then run to the neighbor’s yard to pick those oranges. And still, Grandpa’s glass wasn’t full of juice.

Then, the boys’ older sister woke up, came into the kitchen and saw what her brothers were up to.

“Why don’t you use Grandma’s juicer?” she asked.


And Grandpa got his juice.

Those little boys were committed to providing a service for someone they cared about, and dedicated all their energy to that end. When their first efforts weren’t successful, they responded in the only way they knew how: They did more. Picked more, cut more, squeezed more.

While they were sincere in their efforts, they didn’t know about the technique that would let them get more juice for those efforts.

Is there a juicer for health care?

Last month, I attended the annual meeting of the Saskatchewan Association of Health Organizations (SAHO), and there was plenty of talk about squeezing more oranges.

A College of Medicine representative spoke about the plan to increase enrollment significantly over the next few years. Lobbying for increased physician numbers is a popular national policy, promoted by (among other interest groups) the Canadian Medical Association.

A Health Ministry representative talked about the imminent loss of a pair of physicians from a small town, and the need to replace them promptly.

All this talk of bolstering physician numbers reminded me of my sons’ experience with Grandpa’s orange juice. In health care, we’ve been trying to tackle supply problems by increased the number of providers – by doing more work. Certain under-serviced geographic areas or under-represented physician groups would benefit from having more providers, but all of them would benefit from improving the productivity of their providers. Are we training more physicians with the same habits that are responsible for current wait times? Are medical students’ mentors trained in – or even aware of - techniques such as Clinical Practice Redesign?

While we invest in training new physicians about these techniques, we should also teach existing physicians how to squeeze more juice out of each orange. Otherwise, the policy we choose is: Quality improvement through retirement.

1 comment:

  1. Originally posted by Dorothy 05/05/09 1:30 PM

    Your comparison of the juice-making ordeal to the health system is very thought-provoking. There is more to be learned from this analogy. An interesting point is that it took someone from outside the juice-making system to realize that there was an alternative and your juice-makers were open to trying the suggestion. An entirely automated juicing system would likely be very efficient but not as satisfying or responsive to the recipient of the service. A balance needs to be struck. As well, the juice-makers were not (I don't think) spending a significant portion of their time needing to report to a number of others with slightly different reporting expectations to justify their existence or the need for juice. As always, reading your blog is a very valuable use of my time.