Stanford Medicine's Improvement Science Blog

Imagine what we could all learn from each other if we took the time to share it!

Get your thoughts out there!

Welcome to the SMCI’s Blog!

The mission: To provide a venue for improvers to share experiences, reflections, opinions, and contemplations to advance our understanding of Improvement Science.

All share, all learn! The goal is to make what we know about improvement science bite-sized and accessible for those who share and those who read.

We are accepting submissions!  smci@stanfordhealthcare.org

Rules of the road:

Keep it short & sweet! 1000 words or less, less than a five minute read.

Let pictures do some talking, too! Include non-copyright protected images with your submission.

Help us stay out of trouble:

  • Ensure Protected Health Information (PHI), Protected Personal Information (PPI), or any information that would violate the Health Insurance Portability and Accountability Act (HIPAA) is not included.
  • Use percentages of progress/improvement but do not use dollar amounts or specific numbers of defects reduced.
  • Obtain written consent of individuals in photos.
  • If you include a link to an article, it must be open access.

Failing to Make Discharges Happen by Noon

Hurley Smith

We failed to improve discharges by noon.

You read that right, we failed. That is if your sole measure of success is achieving a SMART goal. Our team was successful from the perspective of knowledge gained about our care delivery system. This article is this author’s attempt to preserve our lessons learned and normalize writing about projects that don’t go the way we want them to. Imagine how your project might be different if you could read a blog post from team’s that have tried to solve your problem before! If we all share, we all learn, and we all become better at solving problems. Here’s to making blogging about improvement work popular.

The Problem

Our journey began with helpful discussion about the problem statement itself, casually referred to as a “discharges before noon project”. 

 

Cut to the Chase!

Jake Mickelsen

“An earlier version of the phrase (recorded 1880–1940) was
Cut to Hecuba. This refers to the practice of shortening matinée performances of Hamlet by cutting the long speeches before the reference to Hecuba in Act II, Scene ii.” So basically we have been saying this for over 100 years. I have witnessed too many times a presenter spending the majority of their time on the uninteresting background dialogue, and in the end never getting to the chase scene of their project. What’s sad about this is it hurts the adoption of the work and can even make the project more complex due to the multitude of questions and misunderstandings. Simply stated: We often increase the complexity of improvement through our ineffective presenting of projects.

Did COVID-19 Kill the Kaizen?

Hurley Smith

Kaizen is a Japanese word that means “change for better.” Social distancing measures which accompanied the pandemic rendered in-person activities next-to-impossible. Did COVID-19 kill the Kaizen? Natural history teaches us that when environments change drastically, the habitants face two choices: adapt or perish. Here, I argue that not only has pre-pandemic Kaizen survived this shock, but has evolved to become stronger. Observations are now more intentional, there is less waste in the process of problem solving, and new, more effective tools have been discovered to solve complex problems.

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.