Can medicine learn from the restaurant industry?

“We can bristle at the idea of chains and mass production, with their homogeneity, predictability, and constant genuflection to the value-for-money god. Then you spend a bad night in a “quaint” “one of a kind” bed-and-breakfast that turns out to have a manic, halitoxic innkeeper who can’t keep the hot water running, and it’s right back to the Hyatt.

Medicine, though, had held out against the trend. Physicians were always predominantly self-employed, working alone or in small private-practice groups. American hospitals tended to be community-based. But that’s changing.”

Atul Gawande at the New Yorker talks about Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?. His foil is the Cheesecake Factory.

“The place is huge, but it’s invariably packed, and you can see why. The typical entrée is under fifteen dollars. The décor is fancy, in an accessible, Disney-cruise-ship sort of way: faux Egyptian columns, earth-tone murals, vaulted ceilings. The waiters are efficient and friendly. They wear all white (crisp white oxford shirt, pants, apron, sneakers) and try to make you feel as if it were a special night out. As for the food—can I say this without losing forever my chance of getting a reservation at Per Se?—it was delicious.”

“I’d come from the hospital that day. In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how.”

The examples are from the companies that are often subject to hate, companies like Wal Mart that have developed techniques and know-how that allow them to provide more for less. The Cheesecake Factory is one of these companies and Gwande goes behind the scenes to see how they do it. He posits that there is a lot of room for learning from these companies in the medicine business. He also describes an example of how this learning is there. The question is about how to make such learning the norm rather than the exception.

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