Running Hospitals Like The Cheesecake Factory? 

by Suzanne Gordon

Boston Globe

September 11, 2012

http://www.bostonglobe.com/opinion/2012/09/11/podium-cheesecake/KSyjhIZLujtqfbH6wMCXLI/story.html

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.

Last 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
now pursuing litigation on behalf of current and former
servers at the chain in other parts of the country.
Their complaint alleges that 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."

Because of its continuing deficiencies in this area,
the Restaurant Opportunities Centers (ROC), a
nationwide restaurant workers group, gave the chain a
very low rating in its 2012 "Diners' Guide" to ethical
eating. The guide named the Cheesecake Factory as one
of the worst employers in the industry. At a restaurant
worker protest in Baltimore in May, ex-Cheesecake
Factory worker Raquel Rojas spoke for many when she
told a local reporter that a her former employer
"treated us like machines -- like we didn't have any
emotions or needs."

It is hard to consider the Cheesecake Factory's record
of process innovation while divorcing it from its
product. Dr. Gawande, who has written about the costs
of obesity-linked cardiac problems in some of his other
writings, does acknowledge that the food at the
Cheesecake Factory, " was sweeter, fatter and bigger
than it had to be." At the same time, he lauds the
chain for providing "goods and services of greater
variety, better quality, and lower cost than would
otherwise be available."

It is troubling to learn that a respected patient
safety advocate like Gawande -- someone who has long
written about enhancing patient safety and reducing
health care costs -- would assert that The Cheesecake
Factory produces a quality product. Just last year, The
Center for Science and the Public Interest gave the
chain one of its "Extreme Eating" awards for its
Farmhouse Cheeseburger, which weighs in at 1,530
calories, 36 grams of saturated fat and 3,210
milligrams of sodium. As Bonnie Liebman of the Center
put it, chains like the Cheesecake Factory seem intent
on "targeting the remaining one out of three Americans
who are still normal weight in order to boost their
risk of obesity, diabetes, heart attacks, and cancer."

In "The End of Overeating: Taking Control of the
Insatiable American Appetite," Dr. David Kessler,
former head of the Food and Drug Administration,
addresses the obesity crisis that is costing the US
over $147 million annually . He singles out The
Cheesecake Factory for manipulating the fat and sugar
content of its food to encourage over-consumption. Even
some business analysts in favor of standardization
health care argue that a restaurant chain that has
contributed so heavily to obesity can hardly be
considered our "best prospect for change."

As we search for ways to control health care costs
while still providing quality care, there are some high
reliability industries, like aviation, that do provide
promising models for change. The Cheesecake Factory --
with its history of violations of basic worker rights
and almost anti-lean cuisine -- just isn't one of them.

---

Suzanne Gordon is a health care journalist and
coeditor of "First Do Less Harm: Confronting the
Inconvenient Problems of Patient Safety.''

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