Frail geriatric patients pose unique challenges to the provision of high-quality care in and out of the hospital due to functional limitations and cognitive impairments, which at times leave them homebound. To address their needs, Stanford Health Care (SHC) designed the Stanford Home-Based Senior Care program, which provides primary care for older homebound patients who are high utilizers of SHC services. It is accompanied by a three-year evaluation of its effectiveness and quality improvement. This project is a partnership between the SHC Office of Research Patient Care Services and the Evaluation Sciences Unit in the Division of Primary Care Population Health at the Stanford University School of Medicine. The evaluation will compare patients in the home-based program to a comparable group of clinic-attending patients and will gather qualitative information about the patient and caregiver experience in the program to inform operations. This talk will discuss the development of the program, progress to date, and lessons learned about partnered quality improvement evaluations.
Maria Yefimova is a nurse scientist with the Office of Research Patient Care Services at Stanford Health care, supporting ambulatory care nursing and patient care service professionals in their research. Her work is grounded in her interest in improving care for frail older patients through systematic change in care delivery. Dr. Yefimova obtained her B.S., M.S., and PhD in nursing from the University of California, Los Angeles (UCLA). Her postdoctoral fellowship training followed in the National Clinician Scholars Program at UCLA/VA Greater Los Angeles and she was the 2018-2019 Academy Health Delivery Science Fellow, gaining skills in implementation science and learning health systems at VA Palo Alto. She is an instructor with the division of Primary Care Population Health at Stanford School of Medicine.
Anna Sophia Lestoquoy serves as the research manager for this evaluation. She is currently a Research Operations Program Manager in the Evaluation Sciences Unit within the Primary Care and Population Health Division at Stanford University School of Medicine. Her previous experience in health services research has included work on chronic pain in underserved patients, evidence-based integrative health approaches, and cross-cultural mental health at the Boston Medical Center and Cambridge Health Alliance. She holds a B.A. from Wellesley College and a Master of Public Health from the Boston University School of Public Health
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.