You may know the chain: a hundred and sixty restaurants with a catalogue-like menu that, when I did a count, listed three hundred and eight dinner items including the forty-nine on the "Skinnylicious" menu , plus a hundred and twenty-four choices of beverage. The kids ordered mostly comfort food--pot stickers, mini crab cakes, teriyaki chicken, Hawaiian pizza, pasta carbonara. I got a beet salad with goat cheese, white-bean hummus and warm flatbread, and the miso salmon. The typical entree is under fifteen dollars. The decor is fancy, in an accessible, Disney-cruise-ship sort of way: faux Egyptian columns, earth-tone murals, vaulted ceilings. The waiters are efficient and friendly.
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Shopping I watched Mauricio Gaviria at the broiler station as the lunch crowd began coming in. Mauricio was twenty-nine years old and had worked there eight years.
He bounced in place waiting for the pace to pick up. He tapped the screen to open the order: medium-rare, no special requests. A ten-minute timer began. He tonged a fat hanger steak soaking in teriyaki sauce onto the broiler and started a nest of sliced onions cooking beside it.
While the meat was grilling, other orders arrived: a Kobe burger, a blue-cheese B. Tap, tap, tap. He got each of them grilling. I brought up the hibachi-steak recipe on the screen. Two things struck me. First, the instructions were precise about the ingredients and the objectives the steak slices were to be a quarter of an inch thick, the presentation just so , but not about how to get there.
Second, Mauricio never looked at the instructions anyway. He put the steak dish under warming lights, and tapped the screen to signal the servers for pickup. But before the dish was taken away, the kitchen manager stopped to look, and the system started to become clearer. He pulled a clean fork out and poked at the steak. Then he called to Mauricio and the two other cooks manning the grill station.
The mashed potatoes looked a bit like something a kid at the beach might have molded with a bucket. Mauricio fluffed up the potatoes with a fork. I watched the kitchen manager for a while. At every Cheesecake Factory restaurant, a kitchen manager is stationed at the counter where the food comes off the line, and he rates the food on a scale of one to ten.
A nine is near-perfect. An eight requires one or two corrections before going out to a guest. A seven needs three. A six is unacceptable and has to be redone. This inspection process seemed a tricky task. No one likes to be second-guessed. The kitchen manager prodded gently, being careful to praise as often as he corrected.
He was unhappy with how the fry cooks were slicing the avocado spring rolls. The managers had all risen through the ranks. This earned them a certain amount of respect. Still, the oversight is tight, and this seemed crucial to the success of the enterprise. The managers monitored the pace, too—scanning the screens for a station stacking up red flags, indicating orders past the target time, and deciding whether to give the cooks at the station a nudge or an extra pair of hands.
They watched for waste—wasted food, wasted time, wasted effort. The formula was Business Use the right amount of goods and labor to deliver what customers want and no more. Anything more is waste, and waste is lost profit. More difficult is the problem of wasted food. Although the company buys in bulk from regional suppliers, groceries are the biggest expense after labor, and the most unpredictable. Everything—the chicken, the beef, the lettuce, the eggs, and all the rest—has a shelf life.
If a restaurant stocks too little, it will have to tell customers that their favorite dish is not available, and they may never come back. Groceries, Gordon said, can kill a restaurant.
This seemed to me an absurd target. Yet this is precisely what the organization has learned to do. A computer program known as Net Chef showed Luz that for this one restaurant food costs accounted for As a doctor, I found such control alien—possibly from a hostile planet.
I asked Luz if he had ever thought about the contrast when he went to see a doctor. We were standing amid the bustle of the kitchen, and the look on his face shifted before he answered. His mother was seventy-eight. Getting her adequate medical care was, he said, a constant battle.
The doctors ordered a series of tests and scans, and kept her overnight. They never figured out what the problem was. Luz understood that sometimes explanations prove elusive. The emergency doctor told the family one plan, the admitting internist described another, and the consulting specialist a third.
Thousands of dollars had been spent on tests, but nobody ever told Luz the results. A nurse came at ten the next morning and said that his mother was being discharged. So they waited.
Then the next person they needed was at lunch. Luz pressed the call button to ask for help. No answer. He went out to the ward desk. The aide was on break, the secretary said. An aide was sent.
I respect what you do enormously. I had to do everything myself. It was unbelievable. But come on. No explanations. No chance to ask questions. The neurologist, after giving her a two-minute exam, suggested tests that had already been done and wrote a prescription that he admitted was of doubtful benefit. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic.
They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station—the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. Advertisement In March, my mother underwent a total knee replacement, like at least six hundred thousand Americans each year.
The surgeon warned, however, that the results would be temporary, and about five years ago the pain returned.
Big Med. The New Yorker. Gawande takes his inspiration from perhaps the least imaginable of places: The Cheesecake Factory. Can health care?
ATUL GAWANDE BIG MED PDF
Zulkitilar A practical, easy guide for…. Readers may copy and redistribute bi postings on other blogs, or otherwise for private, non-commercial or journalistic purposes, with attribution to Gartner. Go to navigation Go to content. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. The truth is that very little is standard about health care.