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Changing healthcare as we do it: with evidence and cheesecake?

Dr Atul Gawande, Associate Professor at Harvard School of Medicine and practicing General and Endocrine Surgeon at the Brigham and Women’s Hospital in Boston, has gained a fair bit of attention in North America with his lectures, articles, and bestselling publications, such as Complications, Better, and Checklist Manifesto, which all deal with the need to renew our thinking regarding patient safety and quality control. Recently, he took this theme one step further in an article titled “Big Med,” published in The New Yorker in the August 13, 2012 issue [1]. He took a novel approach by looking behind the scenes of several large high-quality restaurant chains and retailers in North America to identify their secrets to success. Without oversimplifying his message too much, he found mainly two factors to be of cardinal importance: adaptive standardization and effective quality control. At a certain high-end restaurant chain, freshly made first-rate cheesecake served consistently at every location despite an ever-changing menu laid the foundation for its sustained and ongoing success. In his article, Dr Gawande then translated the principles behind the success of this particular restaurant chain to healthcare. He demonstrated how these same underlying principles of quality control and adaptive standardization were incrementally being applied by several large, recently formed hospital chains in the United States. To exemplify this, he described a visit to a centralized ICU monitoring unit, which through video and complete data control was trying to assure best possible and standardized treatment for all ICU patients throughout the hospitals of a large, new healthcare system. This was no different from the restaurant chain, which used centralized high-end video monitoring and mentoring of its kitchen staff to assure best possible cheesecakes to be produced throughout its more than 150 restaurants. No room for improvisation, no need for improvisation—the product is as good as it can get and the customers are obviously happy.