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For years, “cookbook medicine” has been the favorite cliché of docs who resist attempts to standardize how care is delivered. But what about restaurant medicine? According to one physician, hospital systems could learn a few lessons in patient management from the Cheesecake Factory.
The physician in question, Atul Gawande, spells the whole thing out at length in this week’s New Yorker, and the ideas he presents are challenging and possibly controversial, but they’re not silly.
He was particularly interested in the restaurant chain’s use of kitchen managers, who inspect and rate all the food that’s been prepared before it goes out to customers. They also monitor the pace at which food is prepared and check to make sure the cooks aren’t wasting goods or labor. Since the managers came up through the ranks, the kitchen staff are less likely to resent their oversight.
Gawande thinks a similar approach could benefit hospitals and patients by improving the standard of care and reducing costs. Indeed, something like it is already in place at Steward Health Care System in Massachusetts. Steward has set up an ICU command center in which clinicians at a central location can remotely monitor the care being delivered at ICUs in several different hospitals and make sure standards are being followed.
According to the article, the remote ICU concept is in place at about 250 hospitals nationwide, and has “produced significant improvements in outcomes and costs — and, some discovered, a means of driving better practices even in hospitals that had specialists on hand.”
If the concept sounds a little Orwellian to you, you’re not alone. Some clinicians resent having someone else looking over their shoulder electronically — to the point where a few “have been known to place a gown over the camera, or even rip the camera out of the wall,” according to the article.
Still, as Gawande points out, the health care industry has been notoriously bad at encouraging the adoption of even rock-solid evidence-based practices. Never mind clinical guidelines on the use of beta-blockers — many if not most hospitals are still trying to figure out how to get people to wash their hands.
So although I admit the concept of electronic supervision of clinical care makes me uneasy, maybe hospitals do need more “kitchen managers.” If it can raise the quality of care and reduce costs for the sickest and most expensive-to-treat patients, then a little Big Brother might not be such a bad thing.