Delivering Excellence: How Stanford Health Care Uses Analytics to Improve Outcomes

amir-rubinAmir Dan Rubin is President and CEO of Stanford Health Care, a $3.5 billion academic health system affiliated with Stanford University in California. Stanford Health Care seeks to serve humanity through science and compassion, one patient at a time, through its commitment to care, educate, and discover.

Amir Dan Rubin’s calling into health care began somewhat serendipitously when a class about health care economics happened to fit nicely into his schedule during his junior year at UC Berkeley. But the course ended up resonating with him because the profession presented unique opportunities and challenges, and fundamentally it was about helping people. That’s what ultimately launched his career into the field.

Fast forward a few years and it’s clear his passion for helping patients has only strengthened over time. As President and CEO of Stanford Health Care, he has worked with a broad team to raise patient experience scores to the 95th percentile in the nation, advance quality performance, grow a regional network of inpatient and outpatient settings, launch health plan offerings, advance digital health innovation, and deploy the Stanford Operating System for Lean management.

As the foundation of their success, Rubin cites the “pretty big vision” the team has of healing humanity through science and compassion, one patient at a time. Stanford Health Care’s strategic approach is to deliver leading edge and coordinated care. At some level, he says, considering health care in the U.S., or anywhere in world, patients might come across leading edge treatments or sometimes engage with relatively coordinated care delivery centers, but often it is difficult to find the combination of the two—the latest in care innovations delivered in a highly coordinated, compassionate, patient-centered approach.

“So it doesn’t deliver the ultimate patient experience,” Rubin says. “We set a goal to deliver the absolute best patient experience anywhere and that has been our guiding light.”

Delivering an outstanding patient experience at Stanford involves several components. First of all, Rubin points out the “amazing, talented physicians, nurses, and staff,” with their exceptional levels of technical and interpersonal expertise. Woven into this fabric of great talent are threads of great processes and communications. To deliver great processes, Stanford uses Lean principles as part of their management philosophy in a highly-regarded program called the Stanford Operating System (SOS). The Stanford Operating System involved engaging physicians, staff and leaders in a highly respectful way to continuously improve. It includes an approach to strategy and goal development and alignment, techniques for value stream or process improvement techniques, and active-daily-management leadership practices to sustain performance.

To support its focus on delivering the absolute best patient experience, Stanford Health Care engages patients, family members, staff, and medical staff in improvement efforts. Moreover, Stanford consistently pursues great communications via its Stanford C-I-C-A-R-E patient experience philosophy. This philosophy advocates the best way to communicate with patients and involves a number of components:

  • Hiring “wonderful” people (what are the criteria, how they are brought on board, how are they trained)
  • Best practices for communications and developing those with team members (doctors, nurses, radiology techs, lab techs, environmental services)
  • Coaching best practices in the field, in the unit, and in the clinic
  • Rewarding, recognizing, and incentivizing

Each letter in the C-I-C-A-R-E patient care philosophy also stands for what caregivers should do when they are engaging clients or customers:

C Connect with patients by addressing them by their proper name (e.g. Mr./Ms.) or the name that they prefer

I Introduce yourself and your role

CCommunicate what you are going to do, how long it is going to take, and how it will impact the patient

AAsk and anticipate patient needs, questions or concerns

RRespond to patient questions or requests with immediacy, and anticipate needs

E Exit courteously and/or with an explanation of what will come next, and ask if there is anything else you can do for them.

Stanford Health Care started with a basic concept of great processes and communication, and then applied it to each and every role in the organization. They have their administrative and medical leaders coach and observe staff in the field, including medical staff, and department faculty.

Rubin notes that they built upon best practices used everywhere in many industries, service or manufacturing, when constructing their program. They conducted a lot of site visits—including a trip to U.S. airbag manufacturer, Autoliv—while learning what would work best in health care.

“We use a lot of what’s called ‘design thinking’, where we use professors from the design school at Stanford,” Rubin says. “We engage patients; we have about 150 patients on various advisory groups giving us insights. We observe patients in clinics and at home. We try to understand, through empathy mapping or ethnographic studies, what’s going on in their lives and then we try to solve for that.”

Stanford Health Care is seeking to make a dent in healing humanity through transformational science and through innovating patient care delivery. In addition to having seven Nobel Prize winners on faculty, they are designing new facilities and advancing processes to bring clinical innovations to patients in highly coordinated ways. For complex conditions, they have co-located key specialties so that a patient can organize multidisciplinary care with a “one call or one click does it all,” approach, as Rubin likes to put it. For example, they recently opened a 100,000 square-foot state-of-the-art cancer center 22 miles south of their main cancer center with medical, radiation, and surgical oncology all under one roof. Moreover, the concept of multiple disciplines reviewing a case was pioneered at Stanford, as it was the first organization to launch the “tumor board” concept. Stanford has extended these multidisciplinary case reviews to other specialties, including the neurosciences, where later this year they are opening a center with 27 neuro specialties in one building. This will follow an integrative approach where a single patient can get a dozen physicians stating their cases with a single call. They are truly developing and delivering the best possible treatments.

Rubin really wants to transform care, both through science and compassion, which includes redesigning health care delivery. He is doing that not only for complex care, like cancer, cardiac, and neurosciences, but he is also building a regional network of care.

“We’re redesigning how primary care is delivered, focusing more on health and wellbeing, including delivering care in the home, as well as in the clinic,” Rubin says. “We are innovating virtual care. We were the first to do video visits in Epic and we have developed our own unique applications for patients.”

In population health and accountable care, Stanford has developed their own health plan and commercial ACO offering, where patients can enroll, get care, get opinions if they are traveling anywhere in the world, get a second opinion for their parents in Japan, get it translated, talk to that physician, and have great care for the entire family. This is unique care, simplifying delivery in an increasingly complex health care world.

Rubin is proud of the impacts that Stanford is making on patients and on broader society, including nurturing Nobel Laureates and creating environments that allow inventions like the linear accelerator for radiation, the CyberKnife, and genomic sequencing breakthroughs. However, with all of the academic and medical achievements that surround Rubin and Stanford Health Care, he always manages to bring the focus back to the reason why they all matter: “Our most important patient is the next one we have the privilege of serving.”

Listen to Amir Dan Rubin speak at the second annual Healthcare Analytics Summit on Wednesday, September 9, at 3:30pm, as he tells the story of Delivering Excellence at Stanford Health Care.

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