Adapting Cheesecake Factory Success to Healthcare

The Cheesecake Factory serves millions of customers each month, happily preparing food from a menu with 308 different meal choices at 160 restaurants nationwide.  In the New Yorker magazine's beach reading edition for the weeks of August 13th and 20th, Dr. Atul Gawande outlines how The Cheesecake Factory has duplicated successful systems in all of their locations and how healthcare simply does not at all create successful systems right now.  This has been the popular emailed article for those of us in senior care this week.

Hospital discharge planning has long been an area that I have found to be nothing short of a circus.  As the owner of a senior home care agency, I would always coach clients on how to best be discharged from a hospital.  My tips included planting yourself at the nurse's station to find out exactly who must sign all of the paperwork at the beginning of the day the person is to be released from the hospital.  If a wheelchair wil be required, you should also immediately find out who will be in charge of this so you can begin movement on this aspect which could hold you up for hours if a wheelchair is not available after the paperwork has been signed.  For those of us who operate businesses, the disorganization and lack of communication in hospitals is astonishing.  However, they get paid regardless of how well they perform, and usually by a third-party insurance company.  Soon hospitals will have a reason to care about quality as Medicare will pay them less if they have excess readmissions.

The magazine article presents the idea that if a restaurant can serve more than 300 different menu items at 160 locations nationwide, and make sure each meal is prepared the same way then a hospital should also be able to create systems that could be replicated again and again.  Items such as managing a patient's discharge truly should be managed professionally and simply - but right now they are not.  My own mother was hospitalized a year ago and was to be discharged on a Saturday and we would have been there the entire day if I had not hunted down the doctor myself after waiting for 4 hours.  I then pleaded with him to come to approve my Mother for discharge and sign the paperwork because we had purchased groceries that were sitting in the car.  Scheduling a caregiver to be in the home at a certain time is always a huge challenge on the day a senior is going to be discharged from the hospital simply because you cannot get a firm discharge time.  It doesn't need to be this way and would be a rather easy item to fix.  The Cheesecake Factory manager also shares his story of waiting all day for discharge from a hospital for his Mother who has Alzheimer's disease, simply because a nurse was on break or a nurse was at lunch and nobody was navigating the process.  Hospitals, unlike restaurants, are not making sure the customer has a postive experience and simply do not care if the patient will refer others and want to return again and again.  

This is all about to change.  And Dr. Gawande profiles how his own mother had knee replacement surgery by a doctor who has vastly improved the process at Brigham and Women's Hospital in Massachusetts.  Dr. John Wright hails from New Zealand and applied research findings to the task of how to best do a knee replacement.  Those who sell everything from hamburgers to toothpaste have been doing this for decades but the medical system has not.  One study showed that it takes more than 15 years for a new medical discovery to become implemented for all Americans.

Medicine is beginning to become more modern because reimbursements via Medicare are going to change and hospitals will be at the front of this - they will receive lower payments if there are "rehospitalizations" too soon.

It is important to also remember that many American seniors have never had health insurance prior to going onto Medicare or Medicaid (for low-income seniors) at age 65.  Read the New Yorker article titled Big Medicine to learn more about how easy it really is to build better healthcare systems and to learn about which hospitals are paving the way for better accountability in anticipation of the new reimbursements requirements through Obama Care which will begin to chip away at the more than $60 billion in fraud that has been taking place - much of this was "legal" fraud from reimbursements that made it easy to keep getting paid without accountability for care needs.