I would like to thank David Noggles on his (letter to the editor) in the December 4 issue. I first heard about the CMC issues on the November 27 issue and the “red flags” started going up when I heard the three words: “just in time” when tied to “inventory.” I would also assume that since the CMC has adopted the Virginia Mason management style, that management is using similar measuring tools for such things as “performance or productivity” (more red flags).

When I worked over on the “wet side” for a large well known aerospace firm, we found that “just in time” may work in theory for a factory assembly line until a disruption happens in the supply of parts or components in the process. At that point, low or no inventory stops the whole system. We used to sarcastically say: “just in time to make scrap.” I would have the same fears for a hospital to apply such techniques on inventory to emergent situations or to the emergency room.

As to management following the Virginia Mason program, I have similar concerns. First, the CMC is a rural hospital, not a big city medical center. There are differences. Second, I feel that “measuring productivity” of the medical staff is a subjective matter that I feel uncomfortable with management using a “big city model” for a “rural setting.” Setting goals for patient beds or number of patients is disconcerting to me. What about those “emergent situations”? Once again, when I worked for the “large aerospace firm,” we did not feel comfortable with management evaluating our “performance or productivity” as manufacturing engineers and technicians using the latest Quality Improvement techniques.

I feel that it would behoove Scott Graham and Greg Behrens (two gentlemen I do not know) to “back off” on the “micromanagement” and work with the doctor/physicians’ assistant approach that has been previously developed. This inherently maintains a close doctor patient relationship and it is comforting to know that it was developed here locally.

John Overby