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Atul Gawande's 80% Healthcare Solution

Joe Cantlupe, for HealthLeaders Media, September 20, 2012

The other day, our 20-year-old son Max, afflicted with a painful throat abscess and its aftermath, was a patient in a suburban Maryland hospital. He smiled for the first time in days when he started feeling hungry and called the cafeteria from his bed, asking about available menu options.

Max was surprised at the range of possibilities, even though his diet was limited to soft food. "Desserts, too? And cookies, and cake?" he asked, stunned. Yes, no problem.

Our son didn't go for the desserts after all. Still, when he finished eating his meatloaf, and macaroni and cheese, he said, "Really good. Yummy."

Only a month earlier, we all were in Florida, where we dined one evening at the Cheesecake Factory in Coconut Grove outside of Miami. I remember Max exclaiming, "Really great, I'm stuffed."

Surely, there is no comparison between the high-quality Cheesecake Factory food and the better-than-average fare of the hospital, he remarked later. Then again, controlling infections and repairing throats is not the Cheesecake Factory's line of work. Nor is scrumptious food a specific hospital specialty.

But over the past month, there's been a lot of "food for thought" debate about how the highly regarded restaurant chain attained excellence, and whether hospitals can be mentioned in the same breath—not for the food, but for their overall line of work.

That debate was prompted by physician Atul Gawande's piece in the New Yorker on the lessons that can be learned from the Cheesecake Factory about consistent care at a reasonable cost.

Criticizing healthcare delivery, Gawande wrote, "unlike the Cheesecake Factory, we haven't figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreal." Gawande, MD, is a surgeon at Boston's Brigham and Women's Hospital and professor of surgery at Harvard Medical School.

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2 comments on "Atul Gawande's 80% Healthcare Solution"


sdaniels (9/21/2012 at 9:01 AM)
Only when the hospital can rid itself of its archaic dual governance structure and adopt a top down quality culture, can it truly hope to emulate the quality and consistently of the Cheesecake Factory. With Boards and execs who are loathe to confront the "accommodating culture" that pervades most of the healthcare industry, there is little hope of successfully confronting the fragmentation and problems so artfully described in Brownlee's "Overtreated" and Markary's recent "Unaccountable."

Adrian Byrne (9/21/2012 at 8:43 AM)
Joe has correctly noted, Atul's commentary on the Cheescake Factory solution is 80% correct. In the words of my friend Dr. Ed Henegar we must plan for the normal and manage the exceptions. No amount of systems or standardization will cure all. Anyone in hospitals who has worked with Sodexho or other outsourcing companies will know the product and service is only as good as the on site manager. Meanwhile, there is still a lot Healthcare can learn from other industries.