June 2nd 2021 Lecture

Target Based Care: An Intervention to Reduce Variation in Postoperative Length of Stay

Inconsistencies in the inputs of healthcare delivery such as variability in which and when therapies are introduced, titrated, or tapered importantly contribute to differences in outputs such as quality, patient experience, and cost. In this lecture, we will discuss a clinical effectiveness intervention aimed at reducing practice variability developed at Stanford called Target Based Care that promotes a shared mental model between providers and patients by establishing transparent clinical targets within the hospitalization. For a given patient undergoing surgery, the local electronic health record is used to derive a personalized comparative cohort resembling the patient undergoing surgery. From this electronic “control population” a median experience for each clinical milestone is obtained, from which we develop achievable targets in clinical care. These clinical targets are displayed at the point of care transparent to all the stakeholders in the patient’s care, including families throughout the patient’s hospital stay. We have found Target Based Care to be associated with reduced outcome variability and improved length of stay with preserved safety. The program is now live in over 40 surgeries across Stanford Children’s Health. Its generalizability is being evaluated as part of a multicenter learning collaborative with 18 participating pediatric cardiology programs across the country

Claudia Algaze

Claudia Algaze, MD, MS is an Assistant Professor in Pediatrics (Cardiology) and Medical Director of Clinical Effectiveness at Stanford Children’s Health at Stanford University. Her purpose is to transform our healthcare delivery system into a continuous learning system so that the experience and lessons from every patient lead to the improvement of that experience for every subsequent patient. She completed pediatrics residency, cardiology fellowship, and QI fellowship at Stanford.

Andrew Shin

Andrew Shin, MD is Clinical Professor in Pediatrics (Cardiology). He is the Executive Medical Director of Innovations & Clinical Effectiveness and Medical Director of Systems Utilization Research for Stanford, combining high throughput analytics/informatics with value-based care. He completed his residency, chief residency, along with dual fellowships in cardiology and critical care at Boston Children’s Hospital.

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.