Is it time to reimagine the US Healthcare Quality System?

July 27th 2021

It is twenty years since the IOM reports on “To Err is Human” and “Crossing the Quality Chasm” catalyzed a transformation in our healthcare delivery system focused on clinical quality and patient safety. Virtually every healthcare delivery system has created an elaborate multi-million dollar infrastructure to comply with regulatory requirements for data collection and reporting. A cottage industry of “rankings” has accompanied the regulatory requirements, increasingly accompanied by public shame or financial penalties for suboptimal performance. Unquestionably, there have been improvements particularly in hospital acquired conditions. But the complexity and interpretation of many of the measures alludes most frontline team members as the world of quality is increasingly owned by payers and regulators rather than providers and patients. In sum, the tyranny of quality measurement has become a stick rather than the carrot. It is time to re-center the US Healthcare Quality system around measures that matter to patients and providers.

We will discuss:
What is the structure of the current quality system?
How should the quality system be re-imagined?
How does a Lean management system facilitate a new approach to healthcare quality?

Richard P. Shannon

Richard P. Shannon, MD serves as the Chief Quality Officer for Duke Health. He is responsible for the overall direction, leadership and operational management of the quality and safety programs of Duke Health, and provides leadership in strengthening a quality culture where everyone is engaged and respected.

Prior to joining Duke Health, he served as executive vice president for health affairs at the University of Virginia, where he worked with faculty and staff to transform the UVA Health System into the premier health care provider in Virginia. Dr. Shannon has also served as the Frank Wister Thomas Professor and Chair of the Department of Medicine at the University of Pennsylvania Perelman School of Medicine, and as Chair of the Department of Medicine at Allegheny General Hospital in Pittsburgh. He has received numerous teaching awards from Harvard Medical School, Drexel University College of Medicine, and the University of Pennsylvania School of Medicine.

Dr. Shannon received his BA from Princeton University and his MD from the University of Connecticut School of Medicine. He completed his training in internal medicine at Beth Israel Hospital, his cardiovascular training at Massachusetts General Hospital, and was the Francis Weld Peabody Fellow and Associate Professor of Medicine at Harvard Medical School before becoming the Claude R. Joyner Professor of Medicine at Drexel University College of Medicine.

Dr. Shannon’s pioneering work in patient safety is chronicled in the chapter “First, Do No Harm” in Charles Kenney’s The Best Practice – How the New Quality Movement is Transforming Medicine. His innovative work also has been featured in the The Wall Street Journal and The New York Times, on CNN and CNBC news segments and on ABC’s “20/20”, and was a centerpiece for the PBS report entitled “Remaking American Medicine.”

Dr. Shannon is an elected member of honorary organizations, including the American Society for Clinical Investigation, and served as a senior fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. He currently is a teaching fellow for the Institute of Healthcare Improvement. Dr. Shannon serves as a Director of the National Institutes of Health, Clinical Center Research Hospital Board; and a member of the Boards of Directors of the Kaiser Foundation Hospitals and Kaiser Foundation Health Plan, Inc., where he chairs the Quality Health Improvement Committee.

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.