'Not cremated exactly, but barbecued would be okay.'The critical question is how soon that sort of quality and cost control will be available to patients everywhere across the country. We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change. Some will see danger in this. Many will see hope. And that’s probably the way it should be.

Atul Gawande “Big Med”

There is an article from the New Yorker that made the rounds a couple of years ago about the coming revolution in medical care. The author, Atul Gawande, uses the Cheesecake Factory restaurants as an example of a business that delivers a high quality product in every location in a predictable fashion. He then identifies several examples in medicine where these sorts of things are beginning to happen, one around orthopedic procedures and one involving care of the intensive care patient. The orthopedic procedure is much more personalized, in part because Gawande’s mother is the “case” with her knee replacement being the example. As a wise health care consumer, he identifies the surgeon with the best outcomes for his mother’s  particular need. What he finds is that standardization, team-based care, and attention to consistency trump individual skills in healthcare. The article was not without its critics. Mostly, not about how dare Dr Gawande criticize the-best-healthcare-system-in-the-world but more about how taking bad systems and superimposing incremental change was a recipe for disaster. Might make for a delicious sandwich brought out quickly but not great hip replacements and diabetes care. Instead, it was suggested, medicine as an organization should look at “new methods of managing [that] have been developed that build on self-organizing teams working in an iterative fashion and closely linked to what customers might want.” Less putting a delicious sandwich on the table, more giving people the equivalent of an  “Angry Birds” app when they need it. People do love Angry Birds… In the last 2 years we at South Alabama have been struggling how we are going to practice and teach in our Academic Health Center. We need to train the next generation of physicians. The next generation of family doctors will need to be able to move quickly from caring for people who have a minor complaint to working with non-physicians doing the same to helping folks manage their own chronic illness to helping those whose illness has progressed manage their symptoms. We have decided, as a system, to get good by focusing on the following:

  • Create and sustain culture of constant improvement throughout care delivery cycle
  • Create and sustain highly accessible primary care medical homes
  • Coordination of services between primary and specialty care
  • Coordination of services across hospital, ambulatory, and rehabilitative settings
  • Reward interdisciplinary team-care approaches as defined by coordination, communication, and shared responsibility
  • Create and sustain infrastructure to provide real-time data to inform care decisions
  • Partner with sister institutions and community agencies who share common patients/clients to facilitate care across continuum

South Alabama is about to begin redesigning our care delivery and, presumably, educational offerings to meet these goals. I suspect we will need more and better recipes. I also think some Angry Birds might help as well.