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Tuesday, September 25, 2012

In Response to the Big Med

Can health care be managed in a way that combines quality control, cost control, and innovation?  With the presidential elections around the corner and the advent of the ACA, the question has never been more acute than now. Public health-care reform is sought to reshape the system with the goal to reduce cost and provide quality care for the population. Along comes the difference in opinions on the ways how re-structuring of the health care should be accomplished to decrease soaring costs and at times mediocre or unreliable services. According to some, we should take a look at the restaurant business and adopt their deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality.
The idea to adopt a restaurant business model can raise an eyebrow or a mocking laugh in some, while it can seem appealing to others. Children of consumerisms, Americans expect quick, cheap, and reliable services. In a restaurant, every dish involves deviation from a set recipe and attention to detail for personal adjustments. We expect the restaurant chains, like Cheesecake Factory, manage to accomplish consistent quality results over and over again across the entire country. Similarly to the pager beeping that informs you about the table becoming available, we expect the emergency room staff to inform us about the time it is going to take to be seen by a physician, or the cardiac surgeon implanting the exact high-quality valve in the heart of our loved one as he did for some high-profile executive three surgeries ago.
I admit, I initially scoffed on the idea of adopt a restaurant business model to the health care, thinking, “Who is this person comparing intricacies of illnesses and individual health factors to the restaurant dishes?” Intrigued, I kept reading and found out that the author is a pretty much a colleague of mine who works in another hospital in the city and has not lost touch with reality. Sharing a personal experience in health care affirmed the thought that there is truth in what is said. Some patients chose a physician who has titles and titles after his name, but then they have to rely on doctors who may have insufficient information or economic incentives to pick the costliest treatment.
There are two sides to the coin. I think it is our duty as health care professionals to be informed about the best evidence regarding treatment options, and either to follow the best standards or to develop new standards. If the evidence shows that prescribing a blood-thinning medicine during the hospital stay prevents the formation of blood clots caused by decreased mobility, then it is only common sense to prescribe it to the qualified patients (note to deviate from a set recipe for contra-indications). Fewer blood clots leads ultimately to better patient recovery and lower hospital bill. Adhering to the best-researched evidence can after all allow the providers to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality.

The other side comes from the financial aspect of healthcare, ethical concerns, time that it takes to prove the effectiveness of certain interventions, and the nature of healthcare settings. Changes in healthcare seem to be harder to implement than in other customer-oriented areas. For example, I almost want to bet on the fact that it is easier to approve a new dish for a menu in a Cheesecake Factory at the Prudential than it is to implement the use of LUCAS chest compression system in a near-by BIDMC Emergency Room with well-trained, qualified personnel. Another example is treating a patient for pneumonia according to an algorithm that has been proven to be effective: one adhere to the best standard ever yet not to achieve the same result due to unforeseen factors like co-existing illnesses, constantly mutating microbes, religious beliefs against blood products, unnecessary tests the patient demands because “I read it on-line”, and what not. I am not saying that delivering quality care is an un-achievable goal in healthcare, I simply b

Read more: Atul Gawande: Big Med…Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?

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