Dr. Atul Guwande’s latest piece in the New Yorker, entitled Big Med, introduces the idea that healthcare could learn a great deal from the lessons of the restaurant chain industry.


If you’re asking yourself, just how does perfecting mass production of miso salmon relate to the art of diagnosing and treating a person’s diabetes, heart condition or fainting spell, well, in the words of the Boston regional manager of the Cheesecake Factory, healthcare should “ study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”

Is this about cookbook medicine (pun intended)? Turns out, yes, in the sense that often there are identifiable ingredients (or steps) that do lead to better outcomes. And it requires people to come to consensus on those ingredients, how much to use and when to use them, and even more importantly how to teach the recipe to others, so it becomes what everyone always does, and with the same great result.

Dr. Guwande’s article provides examples of several organizations that have taken this regional manager’s advice to heart, by developing cost effective, quality producing standards of care, based on the best available evidence from research studies as well as their own experience, and then figuring out how to spread, and more importantly, continually support their teams in carrying out those standards.

I encourage you to read the article, discuss it with your colleagues, and think about how can we identify and standardize the recipes for the best practices of care, and then spread them across San Francisco primary care.