Yup, you read that right. After recovering from my knee-jerk foodie reaction (what??? trade Oakland/Berkeley/SF local fare for the Cheesecake Factory?? no way!!!), I read on and have been thinking about challenges and opportunities for innovation, change and improvement in healthcare ever since, including two thoughts:
- You can't get good care without some thoughtful coordination across team(s) of care providers.
- Great description of an experience with uncoordinated care on page 4.
- Astute (and challenging) prescription for improvement from a Cheesecake Factory manager: "...study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute."
- Why don't we put more resources into this in provider/system workflows?
- Standardization has numerous cost and quality of care outcome benefits. But how you implement standardization matters immensely.
- Remote ICU oversight stations as a second set of eyes
- Poorly received if just catching errors; sought out and respected if praising what was done well by the teams the oversee
If you haven't seen it yet, it's worth the read. Would love to hear what folks think about standardization, care coordination, and team-building to improve care.
1 comment:
What an interesting article - Atul Gawande has a way of putting abstract ideas into context by comparing a chain restaurant to a medical system. Admittedly, I have been to a Cheesecake Factory before and I too, wondered how they were able to control for quality. The menu reads more like a book and spanned at least three continents, from Italian to Asian fusion to American food. In any smaller restaurant, all those food options and variability would undoubtedly lead to inconsistency, a hallmark of unsuccessful restaurants.
However, they use data analytics to measure food waste, quality assessment to ensure the final product is cooked appropriately and arrives in a timely fashion, and offer opportunities to involve and train staff in meaningful ways. Can medicine be run as objectively, using standardization, technology and coordination to reduce waste and deliver better health outcomes? Is this something that can only be achieved in large medical “chains,” which are better apt at allocating resources and controlling costs?
One thing that interests me is how the physician workforce is changing – fewer and fewer physicians are in private practice and many have transitioned to larger health care systems as a means to deliver care. Increased costs in private practice start-ups, fallen reimbursement rates and a desire for more work-life balance have all factored into this transition. Big Medicine is absolutely on its way, whether we like it or not. The question then becomes, can this health care system support a fundamental change in the delivery of care through standardization? One example given in the article, knee replacement surgery, may be a medical service that lends itself better to standardization – the odds of a successful operation are generally fairly high. However, the odds of successful diabetes management may not improve with standardization, as a patient may still become sick regardless of the physician following clinical practice guidelines.
One other thing to consider regarding the Big Medicine model. Have you ever had a dining experience that left you saying “that was the most amazing food I ever ate”? If yes, now compare that delectable food creation to your miso salmon experience from the Cheesecake Factory. Doesn’t even compare, correct? The same thought can be applied to medicine. Standardization may lead to everyone receiving the same care, with less degree of variation. However, it precludes people from receiving extraordinary care and even, perhaps, a cure.
Essentially, we will be moving away from an individualistic care model, to a population-based one. I’m not saying this is a bad thing, simply that it is something that should be considered as Big Medicine appears upon the horizon.
Thanks for sharing, Michele.
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