PPO Serve was created to help clinicians work in a rewarding environment where providing consistently great care is routine.

It’s an uncomfortable truth that there’s a wide variation in the quality provided by the health care sector. While clinicians believe they are providing the best level of care possible, health economists and large funders see real differences and patients experience it differently.  Care provision varies significantly between individual clinicians, whole systems and geographic regions. In fact, there is more variation in healthcare outcomes than in most other industries. Most industries routinely apply standard operating procedures and measure quality standards, so that, as a consumer, you expect and reliably get high quality food from restaurant chains and franchises. Similarly, we happily pay ‘top dollar’ for a top car brands because of the reputation for quality it carries….

Atul Gawande, in his 2012 article BIG MED poses that question and answers it – we need to learn from other industries.

Gawande proposes that our sector could learn a great deal from restaurant chains that routinely provide complex, high quality products at prices affordable for the mass market. Also, value as the basis for competition between branded healthcare systems is in the best interests of consumers and patients.  

The ‘Cheesecake Factory’ is a very successful national US restaurant chain that provides food and service of a type and quality usually associated with ‘up market’ restaurants. They have a huge and complex menu and are able to provide this at prices affordable to the mass market. He contrast this with the healthcare sector with our high costs, mediocre service and unreliable quality….

Gawande identifies key factors in the success in consistently providing these quality services.

  • Scale is critical, the single or small practice (mom and pop restaurant) vs. large organised teams in a sophisticated chain; and branded systems that compete on
    Big Med
    their reputation for quality and reliability. In our hospital systems, in the absence of meaningful measures, public speculation about questionable practice do occasionally harm hospitals but typically patients can judge quality only by appearances. In the US, large chains are increasingly competing on for patients and being paid by insurers based on their clinical production.
  • Process re-engineering is crucial. The Cheesecake Factory is a process reengineered restaurant chain, with an approach remarkably similar to that taken by the most progressive and successful integrated healthcare systems. Tasks are carefully designed and assigned, electronic systems provide support, record performance measures and enable the monitoring of quality. Also, while standardisation is key (95%), customisation is fine (5%) and individual professional autonomy determines how results are achieved.
  • Reduce waste. A dynamic capacity planning model matches the demand for products and the supply of staff and consumables (food or drugs…) so waste is reduced to under 2.5%. Planning includes a forecasting element, predicting high utilisation by season, weather or large events.

The article explores the application of these principles in the setting of the ICU – our most complex clinical system and where patients typically experience highly variable outcomes.

The intervention described is of an ‘off site’ technology support centre that provides a package of back up services to many ICUs, including monitoring and compliance. Interventions are based on aspirational standards of care, with related reference lists and alerts.       

The conclusion acknowledges that change is hard to navigate and is a deliberate process needing time and careful support.

PPO Serve exists to help you navigate this change.  We can help you create the teams, the brand, the planning model and the processes. 


Read Big Med and then engage with us.