Wednesday, August 15, 2012

Better healthcare through Cheesecake Factory?

Restaurant chains are often viewed as social pollutants, a sort of capitalistic abomination that quashes artistry and uniqueness for the financial benefits of uniformity and mass-production.  Contrast that with the viewpoint put forth in the current issue of The New Yorker, of all places, which suggests that an operation like The Cheesecake Factory could hold the solution to one of the country’s dire problems.

If Cheesecake Factory can bring high-quality cuisine to the masses at an affordable cost, why couldn’t its methods be employed for the same end in healthcare?
So asks Dr. Atul Gawande. In a book-length article, he brings readers into the kitchen of a Cheesecake to show them how standardization, technology and a strict adherence to best practices are delivering a once-elitist dining experience to the mainstream. In short, it's realized the ideal of democratic healthcare.

It's not as if the rigid processes have left no room for a cook’s skill and insight, a point Gawande stresses. There's still creativity on the plate. Indeed, the controls serve as cost and satisfaction guarantees, arguably enhancing the customer's satisfaction. In one scene that other chains should memorize, a kitchen manager reviews a beef dish with the line, complimenting the cooks for nailing the proper grill time and leaving impressive grill marks, but pointing out the mashed potatoes weren’t presented in an artful way.

Gawande shows that you wouldn’t find a similar unity of approach and delivery in medicine. Ask three clinicians how to handle a situation and you’re likely to get three widely varying responses, even from doctors within the same department of the same hospital.

Data might show that a particular protocol is the most effective, but doctors often resist its adoption out of sheer ego. Changes in routine are similarly resisted, as are high-tech observation methods that enable a peer to flag a departure from practices that research has proven to be best.

The article is a celebration, a long overdue one, of something the industry’s many critics fail to observe. Yes, some artistry and chef discretion may be lost in the standardization and processing that chains prefer. But the counterbalance is often high-caliber fare at a price within reach of most consumers. People can access foods and preparations that would otherwise fall beyond their spending limits.

As Gawande cogently argues, hasn’t Cheesecake done what healthcare reformers are struggling to figure out?

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