I know. I know. Fast food is not healthy, but the business story of the modern hamburger franchise is a perfect parable for where we are in healthcare. Both are service industries. The Founder is the story of McDonald’s and how it got started. If you are a healthcare leader, worker, patient, or community leader it is a must see with the medical parable in mind.
The hamburger sales model that preceded McDonald’s was the individually owned drive-in restaurant. If you were traveling, every drive-in was different, but there were certain things that were very predictable. You could expect that service would be painfully slow, the order would have mistakes, the parking lot would be dirty, and the servers would be distracted. Variation in the product was the rule. As you traveled, the drive-in menu was highly variable, but even if you bought a hamburger, the variation in the product between drive-ins was huge. Even within the same restaurant, it was substantial. If Harvey was preparing the burgers, they were one way. If Alice was making them, they were quite different. . The end product was unpredictable, but you could count on this--Slow, distracted service in an environment that was not consumer-friendly. American medicine is still stuck in the drive-in stage of service and that is a problem—especially in the management of chronic diseases.
The McDonald brothers reengineered the system entirely. They understood the problems and they corrected them. They limited the menu to just a few consistent items. They totally redesigned the kitchen to support the 20 steps required to deliver a hamburger, fries, and a drink in 30 seconds instead of 30 minutes. The product was perfectly consistent whether Harvey or Alice were cooking. Everything was systematized. The fries were cooked at the same temperature for the same amount of time. The customer could count on the product, and she could get it in 30 seconds. It all happened in a clean, family friendly atmosphere. Consumers loved the McDonald’s hamburger meal and there was always a line to get food. But that was one restaurant. They had tried to expand, but they had failed. Then Ray Kroc appeared. He standardized everything about the operation and scaled it, so that no matter where you were in the country, you could pull into a McDonald’s, and you knew exactly what to expect in the service and the product.
Chronic condition management is a service industry. Optimal medical therapy is the product. There are systems and steps that must be used every time to produce that product and they are worked out for cardiovascular and related conditions like diabetes. In type 2 diabetes, there are three targets for blood pressure, glucose, and cholesterol and eight steps to achieve those goals. That system will produce OMT for 80-90 percent of patients much more consistently. A system can serve them, and provider expertise can handle the exception.
The medical equivalent of the McDonald’s kitchen for cardiovascular and related conditions is the primary care special operations team. The team addresses a limited menu of related conditions. The cardiometabolic team would treat the National Academy of Medicine priority conditions congestive heart failure, atherosclerotic vascular disease, diabetes, chronic kidney disease, heart attack, stroke, and hypertension. The targets and steps are very similar for each of these. By using highly systematized ptotocols and processes, they can produce a much more consistent optimal medical therapy product with more convenience and a much better patient experience. We can leave the drive-in stage of medical care now.
The McDonald brothers founded McDonald’s in 1940 and Kroc bought them out twenty years later. Our current medical model is decades old too. It is the most dysfunctional, anachronistic service industry in the country. It is in the drive-in stage of development, but the day is not far off when you can receive care with an experience and product that is completely predictable wherever you are. It will prolong healthy life and reduce costs. I don’t know when it is coming, but it is inevitable. In the food business an outdated operation means a longer wait and disappointment. In medicine, it means death, disability, and ruinous expense. Won’t you join us in reengineering our system sooner. wbestermann@congruityhealth.com
Very good article! Exactly what we need to fix our broken system.