August 13, 2012
In this week’s New Yorker, Atul Gawande plays out one scenario for the future of medicine in the United States. He projects the rise of large health care chains that manage health care outcomes in a much more coordinated and standardized way. To drive the point home, he contrasts how hospitals work today to how a major successful restaurant chain, Cheesecake Factory, operates today. He knows the contrast will make us uncomfortable, but he drives home how the Cheesecake Factory approach yields higher quality and more consistent results at moderate prices.
I found myself thinking how much health care today resembles higher education today: prestige trumping quality, and no sustained focus on whether students are actually learning.
Gawande recounts the story of his mother (herself a doctor) seeking a knee replacement. She turns to her son, a doctor at a high-prestige hospital, for help.
Gawande writes, “But even a doctor doesn’t have much to go on when it comes to making a choice. A place may have a great reputation, but it’s hard to know about actual quality of care. Unlike some countries, the United States doesn’t have a monitoring system that tracks joint-replacement statistics. Even within an institution, I found, surgeons take strikingly different approaches. They use different makes of artificial joints, different kinds of anesthesia, different regimens for post-surgical pain control and physical therapy.
“In the absence of information, I went with my own hospital, the Brigham and Women’s Hospital. Our big-name orthopedic surgeons treat Olympians and professional athletes. Nine of them do knee replacements. Of most interest to me, however, was a surgeon who was not one of the famous names. He has no national recognition. But he has led what is now a decade-long experiment in standardizing joint-replacement surgery.”
Gawande goes on to focus on John Wright, a no-prestige champion of standardization based in assessment of quality. Wright can demonstrate with a decade of data that more of his patients thrive in less time, with less pain at lower cost: pretty impressive.
To me, Gawande’s description of his prestigious hospital resembles most institutions of higher education, especially the more prestigious ones: professors taking strikingly different approaches, no quality assessment monitoring system, students led to choose among institutions and professors on the basis of word-of-mouth prestige.
“A place may have a great reputation, but it’s hard to know about actual quality of care.” Or quality of learning. Ouch, but too true. Sure standardization gives most of us the willies. But we cannot defend everyone doing his/her own thing when we don’t study and steer by results.
Health care and higher education will go awkwardly together into the future.