The New Yorker recently published an article about hospital chains and their potential for improving medicine. The question the author, Dr. Atul Gawande, poses is an interesting one: Will scale and uniformity decrease patient fees and improve care?
It seems an obvious question. At one point in the article, Gawande follows a Cheesecake Factory regional manager, who recently had a negative hospital experience with his mother. When Gawande asks him how healthcare can improve, the manager replies, “I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”
Makes sense, right?
There are people working to help the issue, working to “study, standardize, and execute,” in the language of the Gawande's Cheesecake Factory manager. The progressive tactics range from setting standards to a remote unit electronically supervising I.C.U. staff in multiple hospitals. Gawande reports, “The tele-I.C.U. team provided the staff with extra eyes and ears when needed. If a crashing patient diverts the staff’s attention, the members of the remote team can keep an eye on the other patients. They can handle computer paperwork if a nurse falls behind; they can look up needed clinical information. The hospital staff have an OnStar-like button in every room that they can push to summon the tele-I.C.U. team.”
Spoiler Alert: Not every hospital staff member appreciates the supervision. To them, bureaucracy looks the same on a screen as it does on paper.
Picture a pendulum. In healthcare, the pendulum is historically pointed to private and bureaucratic operation, and hospital chains are working to swing it toward a mindset of standards and manufacturing.
I fear the Big-Brother nature of a new system centered on standardization, and a full, gut-check pendulum swing in that direction. I hope the boards guiding these hospital chains focus on the patient first and the factory second. There’s something so cold about uniformity—prepackaged food arriving in huge plastic bags—and it’s important to recognize the potential for losing sight of the point.
Pendulums swing, but when they come to rest, they point to the middle. The middle is seeing the issues through the eyes of patients—every child, mother, father, grandparent, and friend—looking for care. The key is serving them quality care at affordable rates, and relating to them as people.
When I go out to eat, I appreciate knowing I can get exactly what I want. But I like the option of ordering something homemade too.
What do you think? Has this been an issue in your career? Do you work in a place that’s progressive and making change? Post your comments below.
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