Monday, August 13, 2012

Standardization in Health Care: Atul Gawande and The Cheesecake Factory

In this week's New Yorker, Atul Gawande writes about the rise of health care chains and the standardization of medical care.
Gawande frames his article by asking a question.  To paraphrase: why can't doctors and hospitals deliver quality care as efficiently as middle-brow restaurant chains (such as The Cheesecake Factory, which he uses as his example) deliver good food?

He argues that the only way we can ever control the rising cost of health care is to accept a level of standardization.

He also says that this process is happening (and accelerating):
Medicine held out against the [chain model]. 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. Hospitals and clinics have been forming into large conglomerates. And physicians have been flocking to join them.
This phenomenon arrived in Charlottesville last year when Sentara purchased Martha Jefferson Hospital.

549. Is Sentara a not-for-profit?  Gawande says that the majority of the hospital chains are not-for-profit -- although Steward Health Care System, on which he focuses, is for-profit (it was started when Cerberus (!) purchased six Catholic hospitals in the Boston area).


One of the most interesting parts of the article is the desription of tele-I.C.U.'s, in which doctors and nurses in remote "command centers" monitor patient care in multiple hospitals. The command center doctors give feedback (and sometimes directives) to the on-site clinicians. 

Gawande analogizes the off-site doctors, who ensure quality control (and standardized practices) to the kitchen managers who circulate through The Cheesecake Factory's kitchens to monitor the chefs who are actually preparing the food.  Gawande says that there is tension and pushback from many of the doctors being monitored this way, but he also says that some of them are buying-in. Fascinating.


The article made me think about standardization in the legal services realm. There are some legal tasks/documents/approaches that would benefit from greater standardization, but it's hard to imagine most attorneys responding positively to proscribed methods and third party monitoring.

550. In what ways are legal services more "standardizable" than medical services, and in what ways are they less so?

The views of the Blue Ridge from the new Martha Jefferson Hospital are beautiful (and calming).

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