Gawande makes an interesting argument suggesting that the U.S. health care system can improve the quality, efficiency, and cost of care by adopting The Cheesecake Factory’s standardized and quality control approach to food delivery and management. According to this approach, Gawande suggests that a standardized health care conglomerate will foster consistent care that reduces medical mistakes and wasteful use of resources, as well as increase the use of best practices across the organization. However, the idea of standardization of care may be commonly rejected by doctors. Unlike food management, the practice of medicine often requires customization. For example, medicine must be prescribed based upon a patient’s medical history, such as allergies, pre-existing and at-risk conditions, and existing drug regime. In addition, standardization often describes a consistent way of repeatedly doing something. Because of this glass ceiling effect, doctors may be inclined to reject standardization as it degrades their self-worth and autonomy. Undoubtedly, there will be cases that require doctors to provide customized care, but the assembly line approach to medicine as connoted by Gawande lacks fluidity and may not resonate with leaders in the field, especially by doctors who are the backbone of the U.S. health care delivery system.
Clinical quality standards should be developed through a bottom-up approach, in collaboration with the Federal Government, health care professionals and public health and social care practitioners, accrediting societies, medical societies and boards, insurers, and service users. However, it’s important to recognize that the vexing problems of quality care and cost-effectiveness in the U.S. health care system are unlikely to get resolved without the leadership from the Federal Government. Ideally, leadership would naturally surface from within the industry to lead the development of quality care standards, but the fragmented health care...
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