by Jen Jenkins
When this fascinating article by surgeon and public-health researcher Atul Gawande made an appearance in the New Yorker, it posed a very interesting question: Does healthcare need a makeover similar to what casual-dining, big-chain restaurants have done? Gawande juxtaposes the medical and restaurant industries, using the Cheesecake Factory as an example. Although, for obvious reasons, the two industries are incredibly different, they both still seek a similar goal of delivering “a range of services to millions of people at a reasonable cost and with a consistent level of quality.”
The format of medicine delivery in America is changing. Instead of community-based hospitals, there are now large conglomerates formed between hospitals and clinics; physicians who were once self-employed or working in small private-practice settings are now predominantly joining said conglomerates. In Gawande’s comparison to the big-chain restaurant industry, health systems have turned into chains and physicians have become employees. Hospitals and medical groups used to pose mainly as landlords. Now, due to health-care reforms, they have taken a radical interest in how physicians conduct their business. Why? Clinical performance is becoming linked to financial rewards and can mean the difference between hospitals keeping or losing tens of millions of dollars. Unfortunately, this shift has not necessarily meant an improvement in the way healthcare is delivered on a mass scale.
“Good medicine cannot be reduced to a recipe”
In the article, Dr. Gawande does a spectacular job of bringing a typical Cheesecake Factory kitchen to life. You feel as if you are there as he describes the different roles, the precision, and the necessary steps to bring a food order from the menu, to plate, to table. Also fascinating is the forecasting models he describes. In order to have an almost psychic-worthy accuracy for purchasing groceries to avoid spoilage and food waste, chain restaurants have developed forecasting models using computer analytics. “Chain production requires control, and they’d figured out how to achieve it on a mass scale.” The medical industry, although it has taken on a similar format, has had a difficult time finding a way to obtain similar control and have it trickle down.
Dr. John Wright is among those attempting to inspire change. Following something very similar to this “Cheesecake Factory model” as Dr. Gawande calls it, Dr. Wright began researching what the best people in the industry are doing and how, then he standardized it. Now he is attempting to get the rest of the industry to follow suit. Unlike the Cheesecake Factory, there are certainly many more components that must be woven in and, when exercised, it is much more difficult to persuade clinicians to follow a standardized plan, whereas restaurant employees do it without question. To articulate this process, Dr. Gawande shares a story of his mother’s knee replacement and working with Dr. Wright’s team, who did exactly as what is described above; something called “systematic care.” The results were outstanding in the case of Dr. Gawande’s mother, all due to having someone (Dr. Wright) responsible for the total experience of care, including the costs and the results.
There will always be those who are skeptical of change, yet slow transformation seems almost unavoidable. Dr. Gawande believes that reinventing medical care could produce hundreds of innovations; most significantly, a way to put someone in charge of overseeing the healthcare process from start to finish and ensuring that it is “coherent, coordinated, and affordable.” The Cheesecake Factory model is a very interesting one and, according to Gawande, possibly the best prospect for change in medicine.