A culture of continuous improvement across Stanford Medicine requires the establishment of a set of basic assumptions, values, beliefs, and norms by which improvement efforts will be governed, easily applied, and understood to consistently implement a unified approach to improving performance on all dimensions. We must develop quality and effectiveness infrastructure within clinical areas to provide the ability to execute on area-specific improvement efforts. These will be led by performance improvement leaders educated on performance initiatives. To be successful, there will need to be coordinated engagement of both faculty and non-faculty administrative and clinical staff. Continuous improvement techniques must also be applied to non-clinical processes such as research and education.
The goal of the Stanford Medicine Center for Improvement is to become the best at getting better – Inspiring and accelerating the delivery of consistent, excellent care across Stanford Medicine measured by performance improvement in Safety, Quality, Patient Experience, and Cost Reduction (Collectively = Value) from today’s baseline and ultimately developing a reputation as a national leader, to which others look for inspiration and as an educational resource.
“It really is about being the best at getting better.
We measure our success by the value we provide to patients.
Our responsibility is to provide consistently compassionate, excellent and safe clinical care and a positive patient experience while minimizing costs. We recognize that the opportunity to serve patients is a privilege which must continuously be earned.
We focus our work on patient needs.
The question, “What is best for the patient?” is the driver for all of our actions and decisions. Whether we are serving the patient in front of us or individuals who will not be born for decades, our focus is on saving and improving lives and honoring patients’ values and preferences.
We value patient contact above all other activities.
The most important roles in our organization are those of the “frontline” physicians and staff – those who provide care or services directly to patients and their loved ones. We consider all other roles as being in support of the frontline roles.
We respect people.
Our organization is built on a foundation of respect. We respect and care for each patient with courtesy, compassion and genuine concern. We value each individual in our organization, regardless of role or seniority. We listen to each other, seek to understand each other, and treat each other with respect. We also respect the expertise of our partners outside of Stanford, challenge them to improve, and expect them to challenge us in turn.
We focus on individual growth and development.
We believe that continuous growth and development are fundamental to the human experience. We also believe that work gives meaning to people’s lives-especially the type of work we do. Therefore, we highly value personal growth and development and weave it into the daily work.
We improve ourselves and each other by improving our work.
The primary way we grow and develop is by striving to do our work well and continuously improving how well we do our work. Each individual is empowered to improve processes in order to increase value provided to patients, using accepted improvement methods.
We work together collaboratively.
Safe and effective care depends on teamwork and collaboration. We work constructively to establish shared aims and then to achieve those aims. We share information, teach and learn from each other, and constructively challenge each other’s ideas to make them better. We shun rivalries, silos, power struggles, and other destructive behaviors and attitudes.
We practice humility.
Improvement depends on discovering and improving our deficiencies. We strive to be good listeners. We actively seek feedback on our performance, quickly and freely admit to our mistakes, and work to improve accordingly. We avoid blame, but instead give each other the benefit of the doubt. We focus more on improving our own deficiencies and less on pointing out the deficiencies of others.
We measure and monitor.
We do not simply assume that our performance is consistently excellent. We measure and monitor our performance and use data to drive our decisions.
We go and see to understand the situation.
We respect the frontline staff by frequently going to the place the work is done to thoroughly understand what is actually happening. We learn by observing, asking questions, and revising our perceptions and opinions based on what we find.
We embrace standardization.
Achieving consistently excellent outcomes requires consistency in how we do our work. We continuously seek to establish consensus on the best way to do our work and then adhere to what we have agreed upon. We recognize that standard work represents best known practice at the current time and is constantly subject to change.
We practice the science of improvement.
Like scientific research, improvement works best when based on a systematic approach. Together we work to learn, develop, and practice a common improvement methodology, with core elements of establishing shared aims, iteratively testing and refining changes, and ensuring that improvements are sustained. We use the best available knowledge to guide our improvements. We also recognize that change is hard, so we strive to master the science of effectively leading and managing change.
The leaders’ primary role is to help the people they support be successful.
It is the responsibility of the frontline staff to do their best to do great work; it is the leaders’ responsibility to make it as easy as possible for the frontline staff to do great work. Leaders should provide the tools for their teams to be successful and help overcome barriers as they arise. Leaders are expected to be role models, teachers and coaches, frequently interacting with those whom they support.
We work together to achieve aligned goals.
We are a large, complex organization. To be able to achieve our shared goal of consistently excellent and safe clinical care and a positive patient experience while minimizing costs, we must continuously seek to be aligned. Leaders help define and focus the priorities of the organization, which guide the development of local goals, which in turn guide everyone’s daily activities and improvement efforts.
We are all engaged and accountable.
We do not outsource quality to the quality department. Everyone at every level actively contributes to our performance as an organization; we hold ourselves and each other accountable accordingly. When we fall short, we address it by candidly assessing the situation, setting expectations, developing a plan to improve, and following up on those plans. Leaders are responsible for leading this process, but we all actively participate in it. Leaders also safeguard the organizational culture, ensuring that our integrity, principles and values are upheld, which the leaders reinforce by example.
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 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.