Further to an earlier post (Can Hospital Chains Improve the Medical Industry? : The New Yorker), the counter argument to Atul Gawande’s arguments that big medicine and learning from the service industry can improve healthcare. I think he is right on noting that improvements are more complex than the Gawande’s article suggests. Quote:
As I noted in an earlier article, Gawande’s initial hypothesis that checklists were a panacea for medical errors steadily gave way to the realization that it wasn’t the checklist itself that caused the gains. Simply adding a piece of paper wasn’t the answer. The checklist was an artifact that could, in the right setting, enable enhanced collaboration among a team. What made the difference in performance were things like the fact that the low-status nurse knows what is needed for perfect performance and is able and willing to point out to the high-status surgeon that a critical step has been missed; and the fact that the surgeon pays attention to what he or she has been told. The checklist may have prompted the interaction, but what makes the difference is the interaction. Without the interaction, the checklist by itself achieves little. Artifacts like checklists can be helpful, but what matters ultimately is the quality of management being practiced.
So the checklist wasn’t the answer to the problems of US health care. Nor is the Cheesecake Factory model of hierarchical bureaucracy the answer either. Instead of looking for “the answer”, we need to pursue a deeper understanding of how different kinds of organizations are managed in the 21st Century. The age of hierarchical bureaucracy is coming to an end. Now is not the time to impose it on the US health system.