The August 13 issue of The New Yorker had an article by Atul Gawande (one of my favorite writers) about how hospital chains are increasing quality and lowering costs by taking the individuality out of the practice of medicine. In it, he compares the way hospitals treat patients to the way Cheesecake Factory treats customers. It’s a great article, and the lessons in it apply to more than just the medical industry.
I particularly liked this description of the value proposition of chain restaurants:
It’s easy to mock places like the Cheesecake Factory—restaurants that have brought chain production to complicated sit-down meals. But the “casual dining sector,” as it is known, plays a central role in the ecosystem of eating, providing three-course, fork-and-knife restaurant meals that most people across the country couldn’t previously find or afford. The ideas start out in élite, upscale restaurants in major cities. You could think of them as research restaurants, akin to research hospitals. Some of their enthusiasms—miso salmon, Chianti-braised short ribs, flourless chocolate espresso cake—spread to other high-end restaurants. Then the casual-dining chains reëngineer them for affordable delivery to millions.
There’s an important point to be made, which is that the idea of manufacturing is to produce things at a predictable cost and at a predictable quality level. In some case, that means flimsy T-shirts that you can buy for two bucks, in others it’s a Mercedes Benz car that costs many tens of thousands of dollars. In most cases, the best handmade items incorporate no small amount of individual brilliance and have many advantages over manufactured alternatives. At the same time, there are lots of handmade items that are just terrible. If you haven’t invested the time or effort to choose between them, the predictability of the manufactured option is often a safer bet.
I think about this a lot when it comes to restaurants like Chipotle. Is Chipotle as good as the better California-style burrito restaurants? Of course not. But most towns don’t even have a non-chain burrito place, and even in those that do, there are plenty that aren’t as good as Chipotle. Your best bet is to do research ahead of time and find a truly outstanding dining experience. But barring that, trusting in the luck of the draw can often turn out to be a poorer choice than going with a known quantity like Chipotle.
Gawande’s argument is that the discipline imposed by chains may make even more sense in the medical field than it does in restaurants. Certainly it’s the case that for the person who wants to find excellent food to eat, the resources to help out are nearly limitless. Not so for the person seeking excellent medical care. Having the option to choose a hospital with predictable, high quality results would represent an upgrade for nearly every patient.