> In-N-Out instead of McDonalds,
What is this comparison trying to illustrate?
What is this comparison trying to illustrate?
Responding to the request below for a specific example. Hand washing, you wash your hands when medically appropriate to prevent facility acquired infections. If you don't you are progressively warned ultimately leading to termination and/or loss of license. If instituted nationally this alone would save at least 5,000 lives a year. Good luck getting it instituted at most facilities.
A different example, diesel fuel and generator maintenance is a meaningful part of medical facility physical plant. A shocking number of facilities place procurement responsibility and oversight of this in the hands of a doctor who also has medical responsibilities. The results are as financially and operationally disasterous as you would expect. Data centers have similar requirements. Who do you think pays more and operates better?
Formularies are a sort of default medication lookup table. Most organizations have one that was created decades ago by people who aren't with the organization anymore. Review and revise them with someone who understands both the medical/pharmacological aspects of the drugs involved as well as their costs. Win for doctors, win for patients, win for insurers, almost no one does this. They have some clueless administrator carry forward last years formulary with minor changes or alternatively have a medical professional with absolutely no idea what costs are involved do it.
Sad thing is most staff in hospital doesnt wash hands. Reality is it would cost so much time. Handwashing is like a minute and staff has to go in an out of rooms where hand washing is needed so many times an hour it would slow everything down. And then trying to fire staff about this is not real because this would kick out half of it and it isnt replaceble. The problem is more why has staff to get in and out of stations so frequently. And multiresitence bacteria.
Regarding gloves, gloves don't solve disease transmission from dirty hands. You need both hand washing and gloves.
Sounds like the workflow is poorly designed then. Use gloves instead of hand washing.
E.g. what are your recommendations? pay staff more? i.e. increase doctor pay?
I also completely disagree that In n Out is “dramatically better” and I’d be very surprised if that was the resounding opinion across Americans. It is fine, but again, it serves a different purpose, so making such broad apples-to-apples comparisons seems a little short sighted.
“Competence in operations” is a nice sound bite but without some real examples related to restaurant management I’m just not convinced. I ensure you that it has indeed come up in a McDonald’s boardroom that raising their wages would result in more competitive hiring, that is not a novel observation. I did three years at McDonald’s and another several at other restaurants; admittedly it doesn’t sound like this comment was made from a place of experience, more a place of convenient idealism.
They also have software that was developed entirely in house that is unbelievably optimized. Weird, but usable. They are a company that fully understands the problem space they operate in. Hospitals should be doing everything they can to run like them but no one likes to hear that.
I don’t understand the people who rave about it. There’s very little difference other than the fact that they have a “secret” menu with their own coded language.
I’ve been to both good and bad McDonalds. Burgers and fries from well-run ones can taste very good. In-n-Out has better consistency, and it’s on par with the quality of well-run McDonalds. It’s probably due to the fact that In-n-out has fewer items? I don’t know.
That's a bit overstated, the majority of Americans haven't been to an In-and-Out, ever, because they are a mostly-California chain. They're only available in a very small handful of states.
In-and-Out can probably run so efficiently because their menu is extremely tiny.
The key is they have an absolute ton of employees in the restaurant (a busy McDonald’s might have four or five, In-n-out can have double or triple that. I’ve seen other fast food with two employees, never an In-n-Out) and they work exceptionally hard on specific tasks.
They also only deploy in areas where they’ve determined they’ll be able to keep the store busy enough.
What they don’t understand (until explained) is that what we get in a European countries are just a small selection of big franchises (McDonald’s, Burger King, Starbucks etc) and maybe a handful of other ones. In America there are dozens and dozens of restaurant franchises where you can eat for weeks each time in a different fast food restaurant in the same city without going to the same place twice. This is what always amazes me as a European, that huge amount of choice of everything you can have there.
These people acting like "everone knows it" essentially have the same world view that the entire world that matters is Southern California.
Diesel fuel and generator maintenance: how do you hire for that? Does that position require experience? In what? Where do you post that job ad to get qualified candidates? If you hire wrong, it seems like the results could be worse than foisting the task on a doctor, no?
Revising formularies: how many doctors at a hospital have the right expertise for that? Who cares for their patients while the formulary work is happening? Can you hire someone temporary to come do it so it doesn’t disrupt operations, and how expensive is that person and how good is the result?
I’m a software person, not a doctor, but I _can_ see how these choices would be made if the alternative seemed riskier to someone inexperienced at hiring for hospitals.
Yes, that's the discipline called "operations". Crucially it's a separate set of skills from anything one might learn in medical school.
This is typically part of the job of a facilities manager, someone who is in charge of maintaining the physical structure and amenities of a building or complex of buildings. You hire for it the same way you hire for everything else; you find someone in the category that you want, who has apparent success doing something similar to what you're doing.