Four Health Care Lessons from The Cheesecake Factory

Aug 7, 2012

Atul Gawande, a doctor in Boston and a writer for The New Yorker, wrote the best piece on health care I’ve read all year. Besides telling a good story, he goes into what I dub, “The Cheesecake Factory Way.” The restaurant chain combines good process, quality control, teaching, and scale to produce meals from a menu of 308 dinner items for over 80 million people yearly at its 160 restaurants.

This may not be what pops into your head when you think of “innovation,” but designing and institutionalizing an effective system makes for a pleasant, consistent eating experience. How The Cheesecake Factory approaches food could be the future of American health care. Here are some lessons we can learn from The Cheesecake Factory on improving health care.

1. Process

Each Cheesecake Factory is essentially a made-from-scratch meal factory where process is critical. Refrigerators and prep stations in the back of the kitchen supply the manufacturing “floor”—the grills and griddles--with ingredients. Computers and touch screens above the grills show the cooks what has been ordered, the recipe, what the final dish should look like, and cooking times.

Because wasted food comes directly off the restaurant's bottom line, minimizing it is a key company metric. The Cheesecake Factory’s Chief Operating Officer, David Gordon, told Gawande that the company’s goal is to throw “away no more than 2.5 percent of the groceries they bought, without running out.” They rely on inventory software to know exactly how much, say, chicken breast was purchased that week, how much has already been cooked, and how much has been wasted. The restaurants also use software to forecast customer demand to make sure there's enough food on hand.

Contrast this to health care. While there have been moves to digitize personal medical data, and billions of dollars have gone into the latest equipment to diagnose and treat patients, few hospitals or clinics have a process that is anything like your average Cheesecake Factory. Few health care centers do well at keeping track of inventory to prevent waste or monitor results to know what treatments work best.

2. Quality Control

Each Cheesecake Factory has a kitchen manager in charge who examines a finished dish before a waiter takes it to the dining room. He grades the dish, makes any needed fixes, encourages kitchen staff, and orders cooks to start over if the dish is unacceptable. The kitchen manager is responsible for quality control.

Gawande found that having a medical version of a kitchen manager to coordinate all the moving parts of patient care could be beneficial. He offers an example of an orthopedic surgeon in Boston standardizing procedures for knee replacements that have resulted in patients leaving the hospital sooner and on the path to recovery faster. He also shows some interesting results of hospitals using centralized teleconferencing to consult with multiple hospitals and ensure they’re following best practices.

3. Teaching

The Cheesecake Factory puts out a new menu every six months with the rollout taking only seven weeks. In medicine, new research can take years to spread throughout the community.

To prepare for the new menu, restaurant and kitchen managers go to California to learn how to prepare new dishes and also how to teach other staff how to prepare new dishes. In contrast, doctors “hardly ever think about how to implement what we’ve learned. We learn what we want to, when we want to,” according to Gawande.

4. Scale

Gawande writes that The Cheesecake Factory’s size allows the company to implement the lessons above. It “gives them buying power, lets them centralize common functions, and allows them to adopt and diffuse innovations faster than they could if they were a bunch of small, independent operations.”

On this point, we’re seeing hospitals and clinics going along the same path as chain restaurants. Medical groups like the Cleveland Clinic and Steward Health Care System have formed their own chains to let them buy at scale and share best practices, according to Gawande.

We know the American medical system faces tremendous challenges. Gawande writes:

Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital.

At first glance, making fettuccini alfredo or a hamburger seems quite different than fixing broken bones or treating cancers. However, a customer-focused company like The Cheesecake Factory consistently satisfies customers all over the country. It doesn't matter if the restaurant is in Austin, Texas; Milwaukee, Wisconsin; or Arlington, Virginia. You expect the same experience, and The Cheesecake Factory delivers. Their lessons can be used to improve patient care, control costs, and make care more affordable. In short: Improve the patient's experience.

Who knew you could learn that much from a slice of a decadent dessert?

Gawande talked to NPR about his article:

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