Stanford Medicine Center for Improvement

The goal of the Stanford Medicine Center for Improvement is to help us become the best at getting better. Please join us as we create a community of improvers – inclusive of everyone in the Stanford Medicine community in all disciplines and at all levels. Together, we will inspire and accelerate the delivery of consistent, excellent care across Stanford Medicine, inspiring and sharing our learnings with others everywhere.

Upcoming Events

SMCI Lecture Series

Date: March 28th         

Time: 12pm PDT

Title: 10,000 Ways That Don’t Work. Resilience in a Healthcare Journey.

Speaker: John E. Billi, MD

Highlights of the Best of the Best in Improvement Publications

Thank you again to the judging team, our supportive volunteers, and all the SMCI members who submitted their publications! I appreciate all your contributions to this year’s awards.

The 48 publications submitted this year clearly demonstrate that SMCI affiliates and fellows are committed to be the best at getting better! The 4 winning manuscripts tackle challenging problems with creativity to improve care locally as well as make substantial contributions to the literature.

To pique your interest, here are the highlights I gleaned from these 4 great publications:

Best Publication focused on the Adult Population: Manali I. Patel, et al. Effect of a Community Health Worker Intervention on Acute Care Use, Advance Care Planning, and Patient-Reported Outcomes Among Adults With Advanced Stages of Cancer: A Randomized Clinical Trial. [Link]

Authors: Manali I. Patel, MD, MPH, MS; Kristopher Kapphahn, MS; Marilyn Dewland, RN; Veronica Aguilar, BA; Blanca Sanchez, BA; Etsegenet Sisay, BA; Ariana Murillo, BA; Kim Smith, MBA; David J. Park, MD

  • This study evaluated the effect of a community health worker (CHW)-led advance care planning (ACP) and symptom screening on utilization of acute, supportive, and end-of-life care; ACP documentation; patient- reported outcomes; and survival compared to usual care for patients with newly diagnosed advanced-stage or recurrent solid and hematologic cancers.

  • Compared to patients receiving usual care, patients in the CHW intervention used less acute care during the 6 months post-enrollment and had more documentation (i.e., goals of care, advance directives, and Physician orders of Life Sustaining Treatment), utilization of palliative and hospice care, and improved mental and emotional health status.

  • This study suggests that CHW-led ACP conversations and symptom screening have many benefits for patients with advanced cancer and closes a gap left by previous interventions that did not include both ACP conversations or screening.

Best Publication focused on a Pediatric Population: Marie E. Wang, et al. Improving Efficiency on a Pediatric Hospital Medicine Service With Schedule-Based Family-Centered Rounds. [Link]

Authors: Marie Wang, MD, MPH; Amit Singh, MD, R. Marissa Hutauruk, RN; Jenina Chang, RN, MSN, Shanna Perales, MPA, Joseph Kim, MD

  • Using a quality improvement process, an implementation team integrated the evidence-based practice of family-centered, multi-disciplinary scheduled rounds with established start/end times format, defined team member roles, and created an EHR-linked scheduling tool.

  • The multi-disciplinary implementation team used the Model for Improvement to identify key barriers and build consensus by surveying attending physicians, residents, and nurses; the intervention was designed to address the identified key barriers.

  • The intervention has improved timeliness and nurse involvement in rounds and has been sustained for over 3 years with ongoing improvements being made to family notifications and education.

Best Publication focused on an Healthcare Workers: Karleen F. Giannitrapani, et al. Promising Strategies to Support COVID-19 Vaccination of Healthcare Personnel: Qualitative Insights from the VHA National Implementation. [Link]

Authors: Karleen F. Giannitrapani, PhD, MPH, MA; Cati Brown-Johnson, PhD; Natalie B. Connell; Elizabeth M. Yano, PhD, MSPH; Sara J. Singer, PhD, MBA; Susan N. Giannitrapani, MSN, APRN, CCRN; Wendy Thanassi, MD, MA; Karl A. Lorenz, MD, MSHS

  • Key informant interviews were conducted with employee occupational health providers to identify barriers and facilitators to the Veterans Health Administration (VHA) COVID-19 vaccination program for healthcare workers.

  • Results are summarizable and could inform implementation of other healthcare services; identified themes included leveraging interdisciplinary teams, aligning processes and resources, prioritizing trustworthy communication, facilitating shared learnings, and strategically preparing for the “tsunami” of early adopters and the “slow trickle” of later adopters.

  • To increase buy-in, healthcare providers need adequate time for conversations that address individual concerns, feature shared decision making, respect beliefs and identities, and recognize both parties’ shared identity as healthcare providers.

Best Publication Authored by a Trainee: Caroline Park (Fellow, Stanford Geriatrics), et al. Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury. [Link]

Authors: Caroline Park, MD, PhD; Ankur Bharija, MD; Matthew Mesias, MD; Ann Mitchell, RN, MSN, CNS, PHN; Purnima Krishna, MSN, MBA, RN; Nannette Storr-Street, RN, MS, AG-CNS-BC; Alyssa Brown, MS, OTR/L; Marina Martin, MD, MPH; Amy C. Lu, MD, MPH; Kristan L. Staudenmayer, MD, MPH

  • The Stanford Geriatric Trauma Care Pathway, a novel clinical pathway based on best practices, was implemented by an extensive multidisciplinary team, including trauma, geriatric medicine, emergency department, critical care, nursing, physical and occupational therapy, speech and language pathology, case management, social work, pharmacy, nutrition, transitional care, quality, and the patient family advisory council.

  • This retrospective case-control study evaluated the pathway’s impact on delirium and hospital length of stay and extensive process measures identified by leadership; process measures included adequate pain control within 24 hours, time to first mobilization, and completion of and time to first goals of care discussion.

  • Improvement was seen in the process metrics related to goals of care conversations demonstrating implementation success, but the evaluation also identified specific and actionable next steps to support further improvements.

Congratulations to these 4 amazing teams! And we look forward to seeing everyone’s submissions for FY 2023 in the fall!

Four Core Principles

  • We create value for patients
  • People are our most valuable resource
  • We strive to be the best at getting better
  • Our leaders foster an environment for improvement
Learn More About the Center

Our Aims

  • Support Stanford Medicine in becoming the “best at getting better”

    • Assist efforts to improve key performance indicators in value (quality, safety, experience, and cost) at Stanford Children’s Health, Stanford School of Medicine, Stanford Health Care, Stanford Health Care – Valley Care, University HealthCare Alliance and Packard Children’s Health Alliance

    • Develop the next generation of leaders in improving health

    • Generate and share new knowledge related to improvement in health delivery across Stanford and beyond

  • Enhance Stanford Medicine’s reputation for excellence in improving the health and well-being of ourselves and of the people we serve through collaborative, team-based work

  • Ensure our continued leadership in the knowledge economy, by investing in internal knowledge generation and sharing throughout Stanford Medicine

 

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Affiliation Criteria

Karen Frush, MD, is the former Chief Quality Officer at Stanford Health Care. She is a Clinical Professor of Emergency Medicine and Pediatrics. She also serves as a member of the Stanford Medicine Center for Improvement Advisory Committee.

Dr. Frush has been an MCHB funded researcher and helped lead an effort funded by the CMS Innovation Center to improve patient safety and quality across 70 small community and rural hospitals through the LifePoint Hospital Engagement Network. LifePoint was recognized with the John M Eisenberg Patient Safety and Quality Award in 2017 for this work. Dr. Frush has published peer review manuscripts in the areas of pediatric emergency care, patient safety and quality, teamwork, safety culture, interprofessional care, and quality improvement, and she has authored multiple books on these subjects, including Improving Patient Safety through Teamwork and Team Training, with Eduardo Salasin 2012. She is a Team STEPPS Master Trainer and served on the Department of Defense, Team STEPPS Technical Expert Panel (2008-2010). She is an alumnus of the AHA-NPSF Patient Safety Leadership Fellowship program, served on the American Academy of Pediatrics Steering Committee for Quality Improvement in Pediatrics(2006-2011), and has been named one of 50 experts leading the field of patient safety by Becker’s for the past five years. She served on the Board of Advisors and the Board of Directors for the National Patient Safety Foundation and currently serves as Chair of the Institute for Healthcare Improvement (IHI)Certification Board for Professionals in Patient Safety.

Former Leadership positions include Chief Patient Safety Officer of the Duke University Health System (2004-2018); member of the Board of Trustees, North Carolina Center for Hospital Quality and Patient Safety (2005-2012), and Vice President for Quality, LifePoint Health and Duke-LifePoint Healthcare (2011-2018). Dr. Frush received a BSN from the University of Pittsburgh School of Nursing and then attended the Duke University School of Medicine where she earned her MD.

Alice R. Georgitso, MPH, joins the SMCI Advisory Committee as our first Patient Partner. Alice has served as a Patient Partner with the Stanford Health Care (SHC) Patient & Family Partner Program for over 4 years and was appointed Chairperson of the Adult Congenital Heart Program Patient & Family Advisory Council in January 2020. She assisted in developing the Stanford Adult Congenital Heart Program’s Peer-to-Peer Program and serves as a Mentor to ACHD patients pre-and-post-organ transplantation. Alice has presented Stanford Health Care’s C-I-CARE framework for structuring best practice communications and developing relationship-based care approaches with patients and colleagues to 500+ Stanford Medicine Directors, Managers and Clinical Staff.

Alice is a Patient Relations Manager at Stanford Health Care. Within her role, she provides a channel for problem resolution to promote the highest quality of care and service excellence. Alice has also worked as an Unrelated Donor Search Coordinator with the Blood & Marrow Transplant at Stanford Health Care to coordinate allogeneic hematopoietic stem cell transplants through collaborative planning and partnership with the National Marrow Donor Program and SHC clinicians. Prior to her work with SHC, she was the Community Service Foundation Director at San Mateo County Medical Association where she partnered with local stakeholders and clinicians to expand county-wide community health programs to diverse populations. She has also delivered invaluable community health services through her work with the American Heart Association.

Alice earned her Bachelor of Arts in Sociology and Biology at Saint Bonaventure University in Olean, NY and her Master of Public Health from SUNY Buffalo in Buffalo, NY. Alice is a member of The Beryl Institute and Adult Congenital Heart Association professional associations, Donor Network West partner advocating for organ, eye, tissue, and blood donation, and remains an active volunteer with SHC. Alice continues to promote patient-and-family-centered care in both hospital and community settings to support precision health and improve the healthcare experience for patients, families, and clinicians.

John Shook learned about lean management while working for Toyota for 11 years in Japan and the U.S., helping it transfer production, engineering, and management systems from Japan to NUMMI and other operations around the world. While at Toyota's headquarters, he became the company's first American kacho (manager) in Japan. In the U.S., Shook joined Toyota’s North American engineering, research and development center in Ann Arbor, Michigan as general manager of administration and planning. His last position with Toyota was as senior American manager with the Toyota Supplier Support Center in Lexington, Kentucky, assisting North American companies adopt the Toyota Production System. Shook co-authored Learning to See, the book that introduced the world to value-stream mapping. He also co-authored Kaizen Express, a bi-lingual manual of the essential concepts and tools of the Toyota Production System. With Managing to Learn, Shook revealed the deeper workings of the A3 management process that is at the heart of Toyota’s management and leadership.
Shook is an industrial anthropologist with a master’s degree from the University of Hawaii, a bachelor’s degree from the University of Tennessee, and is a graduate of the Japan-America Institute of Management Science. At the University of Michigan, he was director of the Japan Technological Management Program and faculty member of the Department of Industrial and Operations Engineering.
Shook is the author of numerous articles, including "How to Change a Culture: Lessons from NUMMI"; Sloan Management Review, January 2010, which won Sloan’s Richard Beckhard Memorial Prize for outstanding article in the field of organizational development.

The Stanford Medicine Center for Improvement benefits from the diversity of its members and the richness of the experiences that they bring. Although the program continues to evolve from when it first launched in October 2019, we continue to reach out to improvers across Stanford Medicine in the School of Medicine, Stanford Health Care, Stanford Children’s Health, Stanford ValleyCare, UHA and PCHA. We welcome everyone from every discipline and recognize that we are stronger together as we value the contributions of every member of our teams.

Dr. Paul Maggio is the Chief Quality Officer of Stanford Health Care. Prior to being appointed the SHC CQO, he was Vice Chair of Surgery for Clinical Affairs, Associate Chief Medical Officer of Operational Effectiveness, and Associate Director of the Adult Intensive Care Unit. He trained in General Surgery at Brown University and obtained advanced training in Adult Surgical Critical Care and Trauma at the University of Michigan. He holds a Masters of Business Administration from the University of Michigan and is triple board certified in General Surgery, Critical Care, and Medical Informatics. In addition to being a clinician and surgeon, Dr. Maggio participates in the National Committee on Healthcare Engineering for the American College of Surgeons, and his research interests are focused on the delivery of high-value care.

Dr. Maggio received the SHC Board of Hospital Director’s Denise O’Leary Award for Clinical Excellence in 2013

Micah Duchesne joined Stanford Medicine in 2020 as a Principal Consultant project managing the deployment and operations of the Hospital Incident Command System (HICS) for COVID-19. He is now the Administrative Director of Performance Improvement at Stanford Health Care where he leads annual operations planning, improvement consulting, and capability development. Micah is also a Fellow at the Stanford Medicine Center for Improvement.

Before joining Stanford, Micah was an independent consultant for his company Silicon Valley Strategy Group, which partnered with Novartis and the Perelman School of Medicine at the University of Pennsylvania to commercialize cellular therapies. He led a team of clinicians from Europe, Japan, and Australia in designing a global logistics model and quality management system for Kymriah, the world's first approved CAR-T therapy, and helped create an international advisory board aimed at improving global capacity.

Prior to independent consulting, Micah was the Director of Performance Improvement at Kaiser's Santa Clara Medical Center, and he previously held improvement roles of increasing complexity within other health systems. Micah has both a Bachelor of Science in Accounting and Master of Health Services Administration from Mississippi College. He also holds certifications as a Lean Six Sigma Master Black Belt and Project Management Professional.

As a professional, Micah enjoys organizing complex stakeholder ecosystems, clarifying ambiguous goals, aligning visions, and driving high-stakes change. As a human, Micah just enjoys breaking a sweat. While he's not at work, he's at his very own gym in San Jose, CrossFit Moxie. You can find him there coaching olympic weightlifting or working out with his wife. He has a daughter in elementary school and two gym dogs.