Hospitals Should Be More Like ... Cheesecake Factory

Medicine is plagued with inconsistency—different doctors have different preferred procedures; outcomes and costs are not predictable—and in an extensive New Yorker piece, Atul Gawande offers up a proposed solution: "Create Cheesecake Factories for health care." The doctor and author is serious—so serious that he spent time in a Cheesecake Factory kitchen to see how the chain restaurant serves up such diverse quality food so consistently. He asked a regional manager—who has had his own negative experiences dealing with health care for his mother—how he would implement Cheesecake Factory procedures in a medical setting. "This is pretty obvious. I’m sure you already do it," the manager said. "But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute." Nope, Gawande writes—hospitals, for the most part, don't already do that.

But that's starting to change, with an increase in large conglomerates comprising numerous hospitals and clinics, as well as the growing tendency of doctors to work for these conglomerates rather than remain self-employed. The idea of chain hospitals may scare some, but chains are successful for a reason, Gawande points out. "Size is the key," he writes. "It gives them buying power, lets them centralize common functions, and allows them to adopt and diffuse innovations faster than they could if they were a bunch of small, independent operations." Gawande takes a look at two people who are trying to increase consistency in health care: John Wright, who has cut both costs and recovery time by standardizing joint replacements, and Armin Ernst, who oversees ICU operations in 10 far-flung hospitals from an off-site control center. Such control centers could come to more hospitals—and though the idea of having a "kitchen manager" remotely overseeing your work is distasteful at first to many doctors, the end result will likely be better, cheaper, more efficient care. Click for Gawande's nearly 10,000-word article. (More doctors stories.)