Stanford, long known for its innovation and excellence in research and medical education, is in the midst of transforming its clinical care delivery. The hospital has adopted a lean management philosophy known as the Stanford Operating System, and it is engaging its physician leaders, the very people who work with front line staff, to guide these changes.
"To date, we have involved physicians sporadically as we targeted improvement efforts within their service lines," says Christina Saint Martin, vice president, Performance Excellence and Guest Services. "But we have not had a high-level training or education program for our physician leadership. That is what we aim to do with our program in January."
Beginning next month, Stanford is launching a series of educational sessions for physician and administrative leaders to learn the principles of the SOS, and to better understand their role in guiding and sustaining improvements. The training will provide an overview of lean concepts and how to apply these improvement methodologies to the clinical care process, with the ultimate goal of improving quality, safety and value for patients.
"Great organizations remain great through innovation and evolution, anticipating and responding to a changing landscape ahead of peer institutions," says Chief of Staff Ann Weinacker, MD. "Stanford has always excelled at this on the research and teaching fronts, and now it's time for us to grasp the opportunity to be leading edge in delivering clinical care as well."
Why SOS? Why now?
Rising costs, declining reimbursements and unreliable quality/outcomes are at the crux of the national health care debate. And the situation at Stanford is no different. While there are pockets of excellence in clinical care throughout the hospital and clinics, there still remains wide variability in practice and care processes, says Saint Martin.
"For the Stanford Operating System to improve the quality of our work and of the care we deliver, our staff and physicians must be able to apply the principles of continuous improvement, standard work, daily management and innovation to create clinical and operational processes that will produce exceptional results," she says.
Stanford has selected the lean management approach based on its demonstrated success in engaging staff, reducing variation and creating an environment conducive to continuous and sustainable improvement. Engaging physicians in the process is at the crux of this new training.
"On the clinical side, innovation will transform the way we do our work—and it must be driven by those providing care on the frontline," says Norm Rizk, MD, who together with COO James Hereford, is sponsoring the upcoming physician training. "To become clinically preeminent, we need a management system that is efficient and effective," he adds. "The Stanford Operating System is designed to be just that."
A convert in our midst
The successful transformation of Stanford's Emergency Department (ED) has become a model for implementing the Stanford Operating System throughout the hospital and clinics. Today, the ED's Press Ganey scores have never been better, even though it continues to experience the highest patient census in its history.
But just two years ago, that was not the case. In the fall of 2011, the Stanford ED was at a crossroads. With a rising patient census, a facility under construction, difficulty admitting patients to an overcrowded hospital and long wait times, patient satisfaction was declining, and staff morale was at an all-time low.
So when Performance Excellence approached Bob Norris, MD, about trying a new approach—adapting lean management philosophies used in the automobile industry to improve efficiency and processes in the ED—he was open but somewhat skeptical about its chances of success.
The team started by developing a value stream map of the entire ED process, looking at every step of a patient's journey, identifying where value was added and where value was wasted.
"We took an analytical approach to the problem, using the value stream map to identify and then eliminate waste," says Norris, chief, division of emergency medicine. The team cleaned up its workspace and supply closets using the 5S approach. It held multiple one-day Kaizen workshops to address a variety of specific problems. And active daily management, including huddles and Gemba walks (going to the place where the work is actually done), became part of the culture.
"I was a little skeptical that this was just another approach that wouldn't necessarily achieve the sustainable gains that we needed," recalls Norris. "But it really has. It has allowed us the opportunity to look at the issues and approach them in an analytical fashion. I have become a real believer."
The SOS training for physician and administrative leaders begins in January, but will be an ongoing effort through June. In all, Saint Martin says that every physician at Stanford will be trained in lean principles, either through formal educational workshops like the ones in January, or during departmental process improvement efforts that will continue to take place throughout the hospital and clinics.
By Grace Hammerstrom