The Cheesecake Factory isn’t health care’s answer
By Suzanne Gordon
| September 11, 2012
A Cheesecake Factory at the North Shore Mall in Peabody.
In their drive to cut costs and produce better patient outcomes, American health care policy makers and administrators are embracing a variety of work re-organization schemes borrowed from other industries. Some boast of their “Toyota lean” approach to health care delivery. Others have looked to Disney World for new ideas. The newest business model being touted is the chain restaurant The Cheesecake Factory.
Earlier this month, Boston’s own Atul Gawande, a well-known surgeon and writer about health care, surprised many readers of The New Yorker by praising The Cheesecake Factory for demonstrating how the US health care system could provide more standardized, high-quality patient care.
According to Gawande, the “delicious” fare served by over 180,000 employees in its more than 2000 restaurants represents just the kind of reliable, innovative product that would better fit the budgets of cost-conscious health care providers — and meet the needs of their “customers” — in the competitive new world of US medicine.
He admits, in passing, that “the front-line worker” at the Cheesecake Factory and similar chains “now generates unprecedented value but receives little of the wealth he is creating.” But because firms like these “have learned to increase the capabilities and efficiency of the human beings who work for them,” the Cheesecake Factory model of food preparation and service “represents our best prospect for change” in health care, he argues. Although standardization is long overdue in health care, it is questionable if this particular model of standardization addresses the needs and complexities of health care.
Because of its continuing deficiencies in this area, the Restaurant Opportunities Centers (ROC), a nationwide restaurant workers group, gave the chain a very low rating in its 2012 “Diners’ Guide” to ethical eating. The guide named the Cheesecake Factory as one of the worst employers in the industry. At a restaurant worker protest in Baltimore in May, ex-Cheesecake Factory worker Raquel Rojas spoke for many when she told a local reporter that a her former employer “treated us like machines — like we didn’t have any emotions or needs.”
It is hard to consider the Cheesecake Factory’s record of process innovation while divorcing it from its product. Dr. Gawande, who has written about the costs of obesity-linked cardiac problems in some of his other writings, does acknowledge that the food at the Cheesecake Factory, ” was sweeter, fatter and bigger than it had to be.” At the same time, he lauds the chain for providing “goods and services of greater variety, better quality, and lower cost than would otherwise be available.”
It is troubling to learn that a respected patient safety advocate like Gawande — someone who has long written about enhancing patient safety and reducing health care costs — would assert that The Cheesecake Factory produces a quality product. Just last year, The Center for Science and the Public Interest gave the chain one of its “Extreme Eating” awards for its Farmhouse Cheeseburger, which weighs in at 1,530 calories, 36 grams of saturated fat and 3,210 milligrams of sodium. As Bonnie Liebman of the Center put it, chains like the Cheesecake Factory seem intent on “targeting the remaining one out of three Americans who are still normal weight in order to boost their risk of obesity, diabetes, heart attacks, and cancer.”
In “The End of Overeating: Taking Control of the Insatiable American Appetite,” Dr. David Kessler, former head of the Food and Drug Administration, addresses the obesity crisis that is costing the US over $147 million annually . He singles out The Cheesecake Factory for manipulating the fat and sugar content of its food to encourage over-consumption. Even some business analysts in favor of standardization health care argue that a restaurant chain that has contributed so heavily to obesity can hardly be considered our “best prospect for change.”
As we search for ways to control health care costs while still providing quality care, there are some high reliability industries, like aviation, that do provide promising models for change. The Cheesecake Factory — with its history of violations of basic worker rights and almost anti-lean cuisine — just isn’t one of them.
. Suzanne Gordon is a health care journalist and coeditor of “First Do Less Harm: Confronting the Inconvenient Problems of Patient Safety.’’
Let Them Eat Cheesecake
By Suzanne Gordon
The other day, at the suggestion of Boston surgeon and New Yorker writer Atul Gawande, my husband and I made a lunchtime visit to The Cheesecake Factory. In his latest New Yorker article, “Big Med,’ Dr. Gawande touted the national chain restaurant as a model of the kind of standardization and quality that have been so lacking in healthcare. The Cheesecake Factory, he argues, delivers “delicious’ meals that represent just the kind of affordable, reliable product that would better fit the budgets of cost-conscious health care providers–and meet the needs of their “customers”–in the competitive new world of medicine. The chain’s highly profitable and efficient “model represents our best prospect for change” in health care, he argues.
This Rx from a well-respected and generally insightful physician who has become a leading health policy observer surprised me. Read more >>
Anyone interested in patient safety should read today’s story in the New York Times on the young boy who died unnecessarily because of undiagnosed sepsis. This, of course, should never have happened and once again confirms the need to team training throughout healthcare. People interested in preventing these kinds of cases should of course read the work of many patient safety advocates trying to prevent these kinds of incidents. Lucian Leape, Michael Leonard, etc. They should also immediately read Michael Woods’ book Healing Words; The Power of Apology in Medicine.
I just published a review of Alison Whittaker’s new play Vital Signs in Beyond Chron. You can check it out. Here is a longer version.
Nurse Alison Whittaker’s Vital Signs:
A Reality Check on Life and Work At the Bedside
By Suzanne Gordon
As the lights dim in a small theater in the Mission district of San Francisco, a trim 57-year-old RN takes center stage and begins her woman-one show, Vital Signs: The Pulse of an American Nurse. She paces the room and delivers the following lapel-grabbing soliloquy:
“If I asked you to smile and stick your tongue out, you would. If I asked you to follow my finger, you would. If I told you to take off your pants and show me your genitalia, you wouldn’t argue with me. You’d take off your pants and show me your genitalia. Believe it or not, if I told you to bend over and spread your buttocks and show me your anus, you’d willingly bend over, spread your buttocks and show me your anus.
“I could stick a suppository in you or give you an enema. If neither a suppository nor an enema worked for you, I’d glove up, lube up my finger, gently slide it up your anus and dis-impact you. I’d do what it takes. I’d get it out. I could put a tube up your penis, all the way to your bladder; you’d thank me. I do these things these extremely intimate things to strangers, People I’ve just met, people like you. It’s my job. I’m a nurse.” Read more >>
Over the past two weeks, I have heard two talks that illustrated how leadership can embody what I call Team Intelligence — the ability of people to think, learn, plan, and work together. These talks were also examples of what Edwin Hutchins calls “distributed cognition.”
The talks were given by very different people. One was Captain Chesley “Sully” Sullenberger, who has become world renowned for safely landing US Airways Flight 1549 in the Hudson river in 2009 after it was fatally hit by a flock of Canada geese. The other is a young sociologist Adam Reich, who’s just published a book in the Culture and Politics of Health Care Work series at Cornell University Press that I co-edit with Sioban Nelson. Sullenberger was talking at a bookstore in Marin County about his new book on leadership entitled Making A Difference: Stories of Vision and Courage from America’s Leaders. Reich was also talking about his new book, one that I had the privilege to edit, entitled With God on Our Side: The Struggle for Workers’ Rights in a Catholic Hospital. What could these two men possibly have in common? Read more >>