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Whooo Says…

October 2012

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Dear Whooo,

I’ve been hearing comments advocating that the practice of health care would be much better if it were managed like the Cheesecake Factory. This is an interesting comparison, but I’m not quite sure what it means. I’m interested to know more about the healthcare environment even though this probably doesn’t apply to librarians. Can you explain this to me?

Cheesecake Fan

Dear Fan,

Thanks so much for writing. I’m pleased that you are interested in following issues in medicine and health care. As we all know, health care in America is faced with huge challenges and is undergoing serious transformations. The suggestion that health care adopt the practices of the Cheesecake Factory is directed at improving quality of care and working toward controlling cost.

Both Atul Gawande and Peter Pronovost, champions for quality of care, have spoken about this suggestion. In his Annals of Health Care column in the New Yorker,1 Gawande describes an evening with his family at the Cheesecake Factory and his reflections on the quality of that experience leading to recommendations for healthcare. The basis of the comparison is that both entities are trying to deliver multiple services to large numbers of people at a reasonable cost with consistent quality.

The Cheesecake Factory is a chain of restaurants with standardized restaurant and kitchen design, and precise instructions about ingredients and objectives. There is a large body of “tacit knowledge” or that knowledge that resides with the individual and has not been formalized into instructions. Also, each Cheesecake Factory restaurant has a kitchen manager that rates each serving as it comes off the line. No food is served that does not pass the kitchen manager; the kitchen manager acts as a coach rather than a policeman in order to respect and improve the skills of the cooks. This restaurant company also has an elaborate “guest forecasting” system that predicts the number of guests to be served, the most ordered items on the menu and the amount of groceries needed to purchase. It even makes adjustments for weather conditions. Scheduling and execution of quality service follows in a carefully prescribed fashion.

Traditionally, health care has resided within individual physician practices and independent hospitals. The emerging model is for large chains of health systems operating with many staff physicians. “According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed—an extraordinary turnabout from a decade ago, when a majority were independent.”1 Also changing is the reimbursement system. Previously, physicians were paid for services performed; the new model is to link financial reward to clinical performance. Though healthcare chains have not yet developed the coordination and teamwork necessary to operate as efficiently as the Cheesecake Factory, the new model is moving toward this goal. Work is being done to explore the idea of “kitchen manager” in the surgical arena, building consensus among physicians about best practices, standardizing procedures and prostheses to deliver high outcomes as well as improved cost. I think the crucial element here is the consensus building and enforcement of quality standards while controlling costs.

Now, Fan, you have mentioned that you don’t see how this issue pertains to librarians. Let’s step back and take a look at the healthcare system and the role of the librarian in that system. We all know that healthcare is a huge and complex system requiring a significant flow of knowledge and information to operate smoothly. We also know that librarianship is detailed and requires a variety of skills and knowledge.

  • How and where do the two intersect?
  • Is it seamless?
  • Is there a possibility of error, misunderstanding, or miscommunication?
  • Are the librarian’s skills excellent, up to date, and appropriately engaged for the needs of the hospital?
  • Does the librarian have a peer review process to ensure her skills are excellent?
  • Do the members of the healthcare team know about and use the services of the librarian?
  • Is there a review process for the library that will identify and hopefully eliminate the potential for error?

These are a few of the questions that the librarian should ask when evaluating the contribution of the library to healthcare. Answers to these questions are not easy. It will take all of us as individuals in our own environments and as a profession to work on these questions. We need to assess our environment to make sure our services are appropriate for our users. We need to continuously evaluate our practice, identify and implement needed changes. Our users and our patients depend upon us; we cannot afford to be complacent.

I hope this has piqued your interest, Fan. The healthcare environment is in the midst of huge changes and the librarian must change to meet the needs of that system. There are many articles and books being written on this and related topics. If you are interested in some recommended reading, contact Barb Jones at or 573-884-5042.




1 Gawande, Atul. Big Med. Annals of Health Care. The New Yorker. August13,2008.

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