How the Cheesecake Factory is like Healthcare and CS Education

Stephen Dubner of the Freakonomics Podcast did an interview with Atul Gawande, author of the Checklist Manifesto. Atul is a proponent of a methodical process — from a behavioral economist perspective, not from an optimization perspective. People make mistakes, and if we’re methodical (like the use of checklists), we’re less likely to make those mistakes. If we can turn our process into a “recipe,” then we will make fewer mistakes and have more reliable results. Here’s a segment of the interview where he argues for that process in healthcare.

DUBNER: Okay, what’s the difference between a typical healthcare system and say, a restaurant chain like the Cheesecake Factory?

GAWANDE: You’re referring to the article I wrote about the Cheesecake Factory…Basically what I was talking about was the idea that, here’s this restaurant chain. And yes, it’s highly caloric, but the Cheesecake Factorys here have as much business as a medium-sized hospital — $100 million in business a year. And they would cook to order every meal people had. And in order to make that happen, they have to run a whole process that they have real cooks, but then they have managers.

I was talking to one of the managers there about how he would make healthcare work. And his answer was, “Here’s what I would do, but of course you guys do this. I would look to see what the best people are doing. I would find a way to turn that into a recipe, make sure everybody else is doing it, and then see how far we improve and try learning again from that.” He said, “You do that, right?” And we don’t. We don’t do that.

Here’s where Gawande’s approach ties to education. Later in the interview:

DUBNER: And do you ever in the middle of, let’s say, a surgery think about, “Oh, here’s what I will be writing about this day?”

GAWANDE: You know, I don’t really; I’m in the flow. One of the things that I love about surgery is: it is, I have to confess, the least stressful thing I do, because at this point I’ve done thousands of the operations I do. Ninety-seven to 98 percent go pretty much as expected, and the 2 percent that don’t, I know the 10 different ways that are most common that they’ll go wrong and I have approaches to it. So it’s kind of freeing in a certain way.

I think about teaching like this. I have been teaching computing since 1980. I actively seek out new teaching methods. Teaching CS is fun for me — because I know lots of ways to do it, I have choices which keeps it interesting. I have mentioned the fascinating work on measuring teacher PCK (Pedagogical Content Knowledge) by checking how accurately teachers can predict how students will get exam questions wrong. I know lots of ways students can get computer science wrong. I still get surprises, but because I’m familiar with how students can get things wrong, I have a starting place for supporting students in constructing stronger conceptions.

We can teach this. The model of expertise that Gawande describes is achievable for CS teachers. We can teach new CS teachers methods that they can choose from. We can teach them common student mental models of programming, how to diagnose weaker understandings, and ways to help them improve their mental models. We can make a checklist of what a CS teacher needs to know and be able to do.