(2012-08-13) Gawande Hospitals Vs Cheesecake Factory

Atul Gawande wonders whether HospitalChains (HealthCare) can learn from RestaurantChains-s (Cheesecake Factory).

*The ideas start out in élite, upscale restaurants in major cities. You could think of them as research restaurants, akin to research hospitals. Some of their enthusiasms—miso salmon, Chianti-braised short ribs, flourless chocolate espresso cake—spread to other high-end restaurants. Then the casual-dining chains reëngineer them for affordable delivery to millions. Does health care need something like this?

In medicine, good ideas still take an appallingly long time to trickle down. Recently, the American Academy of Neurology and the American Headache Society released new guidelines for migraine-headache-treatment. They recommended treating severe migraine sufferers—who have more than six attacks a month—with preventive medications and listed several drugs that markedly reduce the occurrence of attacks. The authors noted, however, that previous guidelines going back more than a decade had recommended such remedies, and doctors were still not providing them to more than two-thirds of patients. One study examined how long it took several major discoveries, such as the finding that the use of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.*

He associates the push for change with big consolidations (M And A) of hospitals. But is that scale really necessary? It seems like even within a single hospital this should be possible. Is it because only the big chains have distant-enough Management to force change on clinicians? That goes against my usual attitude about Culture, but may be consistent with the "tools of cooperation" matrix from Disrupting Class.