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.
In the labor intensive world of health care delivery, as physician and patient safety advocate Lucian Leape, of the Harvard School of Public Health has pointed out, quality patient care (and thus customer satisfaction) depends on whether health care employers treat their staff respectfully. While the Cheesecake Factory may have developed a highly efficient and thus profitable business model, it seems to be one based on punitive labor practices. In California, Cheesecake Factory workers won a $4.5 million settlement with the chain for its widespread wage and hour law violations. It appears that the chain has not learned its lesson: A law firm in Tennesee is pursuing litigation on behalf of current and former servers at the chain. The complaint alleges that all across the country Cheesecake Factory servers have worked hours for which they have not been compensated or for which they have been paid “at rates less than one-and-one-half times their normal hourly rates, and/or for which they were paid below the minimum wage.”
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