The Cheesecake Factory By Atul Gawande Analysis

Article Summary: Big Med
Park University

Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?

Article Summary In his August 2013 article, Dr. Atul Gawande discusses how large conglomerates in health care could increase quality, control cost, and maximize innovation if they would only consider methods employed by a prominent and successful restaurant chain – The Cheesecake Factory. Gawande argues The Cheesecake Factory is able to consistently provide high-quality food and service at reasonable prices because they identify best practices, standardize them, train employees in the standards, and monitor. After observing and discussing the methods employed by the restaurant, the author discusses two health care examples in which similar methods have resulted in improvements in care quality and reduction in costs. The first example was a Boston area hospital’s orthopedic team responsible for total knee replacement. Dr. John Wright, a staff orthopedist, had been working for over a decade to standardize an efficient, high quality, reduced cost, knee replacement program. He believed 95% of cases could be standardized, with only 5% requiring unique deviations –
the reverse of how the hospital had been doing business. Despite some resistance from other physicians, the hospital has established standards regarding implant costs, anesthesia, and post-op protocols. In the second example, a Boston area healthcare organization (HCO) wanted to improve the quality of care and staff development in their Intensive Care Units (ICU).
They found the answer in the establishment of a remote monitoring and consultation center. The center was staffed with physicians and nurses who could monitor patients and advise staff at multiple locations. Hospital staffs were initially not pleased with the “oversight”. They felt like others were looking over their shoulder. It only took a couple of successful consultations and catches by the center to convince the staff they were not there to evaluate their performance, but rather to assist them in providing the highest quality of care to their
patients.
Reaction to Article The article was well constructed and offered a logical discussion of how successes of standardization and training in a major restaurant chain could be applied to healthcare organizations. I was a little surprised by the author’s strong support for such bold efforts to standardize and manage healthcare teams and practices – he is a surgeon after all. The author and the other physicians interviewed all share the realization that they must become a team member if they want to continue to earn and, more importantly, continue to improve the quality and accessibility of care. Dr. Gawande noted, “According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed—an extraordinary turnabout from a decade ago, when a majority were independent. They’ve decided to become employees, and health systems have become chains” (Gawande, p. 3).
Article Analysis: Correlation to Course The article’s discussion applies to the course in several facets. First, it highlights the importance of quality in a product – food and healthcare. A successful HCO will always keep the pursuit of quality care as its number one priority. Second, the author makes a sound correlation of managing a kitchen to the healthcare environment. Ensuring you have trained staff providing quality food is not unlike having a trained, engaged staff delivering superior care. Lastly, the two HCO examples of standardization and improvement re-enforce our discussions regarding protocols, service lines, and process improvement.

References
Gawande, A. (2012). Big med. The New Yorker, 20, 53-63.