Would McSickcare Be So Bad?

is coming to a clinic near you and many are wary of the McDonaldization of Sick Care. They claim that the four basic principles of operations management driving the underlying business model of McDonalds—efficiency, calculability, predictability and control—“often leads to adverse consequences and… the doctor-patient relationship will be threatened." I disagree and think the opportunities to improve Sick Care are in those and other domains, recognizing how they can be applied to patients.

"McDonaldization’s first dimension is efficiency, or the effort to find the optimal means to any end." Effective and efficient operations in medical services are increasingly important, given the mismatch between an almost infinite demand for services and the limited supply. Waste, abuse, friction, and non-value added intervention continues to cripple an already overwhelmed system. Demand management is key and many patients wish they could wait as little as they have to for an Egg McMuffin as they do to see a dermatologist in Boston.

"Calculability, or an emphasis on quantity rather than quality, has spread throughout medicine." The goal is to replicate the production of high-quality, high-value products with minimal errors. Sick Care is plagued with variations in quality and value and, as expected, doctors push back and frequently ignore best practice guidelines or standards. Only recently has the problem of how to measure and improve diagnostic errors received attention.

"Predictability is the assurance that products and services will be the same regardless of time or place." In fact, the logical outcome of progressive reduction of variabilities in medical outcomes will be an increasing commoditization of care, which arguably would improve outcomes. Customers go to McDonalds because they know they will get the same product in Miami as they will in Mombasa.

"The final dimension of McDonaldization is control of humans by nonhuman technology, which is increasingly applied to both physicians and patients." Most car accidents are due to human error. Most airline fatalities are due to human error. Most diagnostic errors and surgical mishaps are due to human error. Using technology to support or even replace humans is not just under the hood of new Volvos, but is coming rapidly to an EMR near you, and should help to remove the "human factor" from decision- making and procedures.

Yes, indeed, treating patients is different from making hamburgers. However, many companies are creating innovative ways to deliver not just mass-customized products, but services as well, using advanced data analytics and artificial intelligence technologies to give us exactly what we want in the most efficient way, as many times as we want it, delivering a consistent product we trust. McSickcare as a goal is not so bad and new care models are here. The hospital food sure would taste better.

Image by Mike Mozart, cropped and used with Creative Commons License.