What hospitals can learn from restaurant chains
Here is a good article in the New Yorker from Prof Atul Gawande, a professor of surgery at Harvard Medical School, on how hospitals and doctors can learn from restaurant chains. Medicine seems to be depressingly far behind on some basic issues.
I say “seems to be” because it is extremely hard to judge how far operations and stays in hospitals are really being standardised. To what extent are patients being put on controlled pathways? To what extent is data collection on best practice really driving treatment on a day-by-day basis?
The problem is that everywhere, apart from in Germany and the Alzira franchises in Spain, doctors remain the customers – the people who generate most of the business – rather than salaried employees. This means that hospitals have to deploy a lot of tact and diplomacy.
Helios and other operators are changing that, principally through information transparency – show a surgeon that his operations underperform, and eventually he will give up the “my patients are different” tack and start paying attention.
The Cleveland and Mayo clinics in the USA are also pioneering here, but it is extraordinary to read Gawande’s statement in the article that “this year, my employer’s new contracts with Medicare, BlueCross BlueShield, and others link financial reward to clinical performance. The more the hospital exceeds its cost-reduction and quality-improvement targets, the more money it can keep. If it misses the targets, it will lose tens of millions of dollars. This is a radical shift. Until now, hospitals and medical groups have mainly had a landlord-tenant relationship with doctors. They offered us space and facilities, but what we tenants did behind closed doors was our business. Now it’s their business, too.”
It is extraordinary that, until 2012, this was not the case.
But perhaps I shouldn’t be surprised. I recently chatted to a junior doctor in a large London NHS teaching hospital who says that, if he criticised the work carried out by one of the consultants, he could damage his career. “It is very heirachical and yet everyone knows that some surgeons have far more patients who routinely end up on critical acute care lists than others. No one does anything about it. We just joke that his patients are ‘special’.”
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
