“Yellow shoes! We need more yellow shoes!”

“The trick is to organize by organ system.”

“What about doing all the weird ones first?”

“Make it like an assembly line: you know, like in the ER.”

Take 100 third-year medical students, 160 Mr. Potato Head toys, a half dozen stopwatches—and mix well. What might sound like a recipe for chaos is actually an amazing test of teamwork, problem-solving skills and “lean manufacturing strategies as applied to medical care,” said Eric Dickson, MD, professor of emergency medicine and senior medical director for the UMass Memorial Medical Group. “When you think about what makes for good manufacturing practice—eliminating mistakes, using time and materials efficiently, and above all, taking every opportunity to improve a process—you’re also describing what can make for good medical care.”

Why third year students—and why Mr. Potato Head? “The patient safety interclerkship gives medical students who are being introduced to their intensive clinical experience the ‘permission’ to focus on issues of quality care, quality improvement and the primacy of the patient outcome,” said Eric J. Alper, MD, associate professor of medicine and co-director, with Susan Zweizig, MD, associate professor of obstetrics & gynecology and radiation oncology, of the Medical Error and Patient Safety Interclerkship. “Exercises like this are good illustrations of how teamwork, critical thinking and decision-making and process improvement should be parts of practicing good care.”

The exercise, stripped to its bones, is simple: Teams of 10 students must assemble 16 different Potato Head toys to match—exactly—16 photographs of the finished doll, aiming for a total time in the range of 6 minutes. Anything over 8 minutes—more than 30 seconds per “patient”—means a sad end. Teams have two “implantation specialists” who deliver selected parts to the two “reimplantation surgeons,” who actually assemble the toys; the other team members sort and organize the various and sundry eyes, ears, hats, feet, noses and accessories to try to keep the surgeons “fed” with the right parts. (Like snowflakes, no two Potato Heads are exactly the same.)

“The key is ‘added value,’” explained Dr. Dickson. “Any time that the assemblers spend on anything other than actually attaching a part is wasted time, so you’re trying to arrange a team that eliminates wasted time and resources from the system.”

The analogy to medicine couldn’t be clearer, according to Dickson. “Be clear about the problem to solve; make sure that all on the team contribute; make a decision and then be clear about the decision and the expectations. Do that, and the result will be high added value, and low waste.”

The relation to patient safety is apparent as the teams start to face off against each other and the clock: since making an error—a doll with the wrong ear or nose—means a time penalty, most of the student teams immediately focus on quality control, through multiple students checking and rechecking the assembled toys against the photograph, and returning anything that isn’t a perfect match.

Interestingly, some teams opted for a rapid and comprehensive sorting stage, while others passed out the photographs across the team to try and get 10 sets of hands gathering 10 sets of parts; “time to first doll completed” turns out to be a highly accurate predictor of team success, as the teams that focus on immediately assembling dolls pull away from the teams with painstaking, but time consuming, sorting methods.

The top teams ended up near 6 minutes, the theoretical ideal. All the students, however, will have this exercise on their minds when they next see a patient, recognizing the subtle individuality that makes each one different from all the others—and especially worthy of that extra moment of care.