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Atul Gawande's 80% Healthcare Solution

Joe Cantlupe, for HealthLeaders Media, September 20, 2012

Looking at the article through a "data" microscope, Merlino says that its proposals to link healthcare to "reliability, precision, and operational efficiency" is certainly needed and being developed in healthcare. "That's about 80% right," he says.

But about 20% of the Cheesecake story is off the mark, Merlino says, 
because there is an element in healthcare that involves experience among staff, involvement and passion, "that differentiates this kind of custom approach" from a restaurant chain, and can't be duplicated.

"When you get into complicated disease management, I may be biased because I'm a surgeon, but nobody behaves like everybody else, that's where skill and experience play a role," he adds.

"They can't come up in an assembly-line mindset. There may be up the road some diagnostic treatment computer that functions like some Star Wars machine. There's no question, 50 or 60 years from now, it will come to that. Now, there is still a requirement of the skill level and very important experience for a delivery of customized care that doesn't just roll off the assembly line."

At Cleveland Clinic, there are at least a dozen high-volume surgeons, "who are grounded by this tremendous process," Merlino adds. "But you can't put anybody in that role and you still have the skill mix and skill experience to make it a customized approach in healthcare to take care of the very sickest of patients. There's that highly skilled piece to manage patients, with experience that you can't get off the assembly line to do cookie cutter medicine."

Merlino caught himself, "yeah, cookie cutter."


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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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.