The New York Times had an article that surprised me: Current Job: Award Winning Chef. Education: IHOP.The article, by food writer Priya Krishna, profiled how many high-end chefs credit their training in — gasp! — chain restaurants, such as IHOP, as being invaluable for their success.
Ms. Krishna mentions several well-known chefs “who prize the lessons
they learned — many as teenagers — in the scaled-up, streamlined world of chain
restaurants.” In addition to IHOP, chefs mentioned experiences at
chains such as Applebee’s, California Pizza Kitchen, Chipotle, Hillstone,
Houston’s, Howard Johnson’s, Olive Garden, Panda Express, Pappas, Red Lobster,
Waffle House, and Wendy’s.
Some of the lessons learned are
instructive. “It was pretty much that the customer is always
right,” one chef mentioned. Another said she learned “how to be
quick, have a good memory, and know the timing of everything.” A
third spoke to the focus that was drilled into all employees: “Hot food
hot. Cold food cold. Money to the bank. Clean restrooms,”
In a well-publicized and well-written article in the New Yorker, Atul Gawande (one of my doctor writing heroes) talks about his visit to the popular restaurant, The Cheesecake Factory, and how that visit got him thinking about the sad state of health care.
The chain serves more than eighty million people per year. I pictured semi-frozen bags of beet salad shipped from Mexico, buckets of precooked pasta and production-line hummus, fish from a box. And yet nothing smacked of mass production. My beets were crisp and fresh, the hummus creamy, the salmon like butter in my mouth. No doubt everything we ordered was sweeter, fattier, and bigger than it had to be. But the Cheesecake Factory knows its customers. The whole table was happy (with the possible exception of Ethan, aged sixteen, who picked the onions out of his Hawaiian pizza).
I wondered how they pulled it off. I asked one of the Cheesecake Factory line cooks how much of the food was premade. He told me that everything’s pretty much made from scratch—except the cheesecake, which actually is from a cheesecake factory, in Calabasas, California.
I’d come from the hospital that day. In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital.