Monthly Archives: August 2012

Of Big Food and Big Med

Writing in The New Yorker, Atul Gawande has an interesting article comparing management practices in a modern corporate restaurant chain, The Cheesecake Factory, to management in health care.  Gawande makes a number of interesting points about ways in which corporate management techniques have been applied to bring what was once an extremely diverse cottage industry of small restaurants of highly variable quality into a more reliable and efficient mode operation.  By comparison, much of health care remains in the cottage industry phase with few effective mechanisms in place to monitor and improve the overall efficiency and quality of the process.  The consequence for patients is often a confusing and poorly coordinated experience.

The Cheesecake Factory is clearly successful at delivering an experience that customers want, but the long term consequence for health do not appear to be a major part of the decision making.  On the positive side, TCF posts the nutrition data for their menu in an easily accessible format on line.  The bad news is that a decade after the film Supersize Me documented the adverse effects of excess caloric content of restaurant menus, the median caloric content of a meal at TCF is 2,000 calories (split an appetizer 340, main dish 1290, accompaniment 200 and beverage 160).  A single meal at TCF approaches the recommended daily caloric intake for a moderately active male (~2400) and exceeds the recommended daily caloric intake for women (~1800).  If you add a small salad (390 calories) and desert (930 calories), the median caloric content for a single meal at TCF goes up to 3,310 calories, well into the obesity inducing range for both men and women.

Making the analogy in health care, we might anticipate that modern corporate management would bring efficient scheduling, prompt service, pleasant waiting rooms, crisply dressed, cheerful attendants and more efficient billing.  The challenge will be insuring that the health of the patient factors prominently in the equation.