The New Yorker recently published an article by a Harvard surgeon in which he contended that the Cheesecake Factory restaurant chain provides a model for the future of healthcare. The author touted the efficiency and innovation of the restaurant chain as a way to improve quality and reduce costs. Unfortunately, despite the tenuous analogy between quality dining and quality healthcare, there is an unrelenting trend towards corporatization of healthcare, often with poor results.
The article reminded me of news, learned years ago, that the Cleveland Clinic was adopting principles developed by Toyota to improve efficiency in auto manufacturing. Despite its success and global expansion, Consumer Reports gave the Cleveland Clinic a “less-than-outstanding” safety score of 39 out out of 100 in its most recent ratings. Thus, bigger and more efficient doesn’t always mean better when it comes to healthcare.
There are a number of factors that must be considered before trying to fit healthcare into a corporate mold. First, while every Toyota or cobb salad should be made the same way every time, every patient is different. Patients usually require customized care to account for distinctive risk factors, medical profiles and clinical presentations. When “advancements” like electronic medical records or remote tele-monitoring limit caregivers’ choices, the ability to respond to a specific patient’s specific needs can be lost.
Corporations may be able to reduce labor costs by resorting to mechanization, but hospitals reduce labor costs by understaffing or replacing skilled personnel with less skilled personnel. Thus, many hospitals accept unsafe nurse-to-patient ratios as a way to improve the bottom line. However, there is no substitute for vigilant assessment by skilled bedside nurses.
While restaurant chains and car manufacturers thrive on profits, a profit motive can lead to unwise healthcare practices. For example, one hospital chain in Ohio closed its uprofitable maternity ward in a medium-sized city while at the same time ramping up its moneymaking interventional cardiology services. So, that community lost an essential service because it was not sufficiently profitable. Meanwhile lucrative cardiology procedures, like stenting and ablation, are frequently overprescribed to unsuspecting patients.
Another problem is that healthcare should never be the subject of clever marketing campaigns. Yet, that is exactly what we are seeing with hospitals touting their brick-and-mortar attractiveness, their corporate rankings and investment in minimally-invasive or robotic technology. Meanwhile, patient satisfaction scores remain unacceptably low, medical malpractice rates are out of control, and caregivers’ conflicts of interests in dealings with device manufacturers and pharmaceutical companies are proliferate. As the Harvard surgeon noted, “
In the process of becoming more like Big Business, big hospital chains have acquired undue political influence, just like their corporate counterparts. Rather than serving the public good and taking their fiduciary obligations to patients seriously, they lobby to protect their own self-interest in expansion and monopolization, tort reform and reduced oversight and transparency, all to the detriment of patients. Hospitals and their associations continue to lobby for the right to hide medical errors. Moreover, because the truth about quality of care has been hidden from public view, a hospital may, as the Harvard surgeon wrote, “have a great reputation, but it’s hard to know about (its) actual quality of care.” This is not acceptable.
While a one-size-fits-all mentality may work in the restaurant and auto industries, it is not adequate in healthcare. As the Harvard surgeon observed, in a restaurant, “everything we ordered was sweeter, fattier, and bigger than it had to be.” However, excess, like other profit-driven constants, can be deadly in the healthcare setting.
