STANFORD HEALTH CARE
A PUBLICATION FOR EMPLOYEES OF STANFORD HEALTH CARE
SPRING / SUMMER 2018
THE INTEGRATED STRATEGIC PLAN REDWOOD CITY OPENING UHA AND VALLEYCARE
AROUND SHC More than 2,000 members of the community came out for Health Matters in May. This free community event featured interactive exhibits, hands-on attractions, lectures and health talks on a variety of topics. Even the PAWS dogs were on display. Our furry four-legged friends from the Pet Assisted Wellness at Stanford program provided a cuddle session for attendees at Health Matters. Another popular activity was the movement and athletic performance screenings from a Stanford athletic trainer … Stanford celebrated Nurses Week in May with events throughout the week that put a spotlight on the great work and compassionate care our nurses provide our patients each day. One of the week’s events was a brunch that also included presentations for the Daily Awards and nursing scholarships. They also celebrated with a Caritas Fair, complete with music, art, games and more … During the recent Stanford Medicine Alumni Day, guests learned about Stanford Hospital’s past and future on a tour that included Stanford Hospital history and a virtual reality tour of the rooms within the new hospital.
from the CEO Dear Colleagues, When the Integrated Strategic Planning process (ISP) was launched last year, Stanford Health Care embarked on an exciting journey. Working on a unified strategic plan for the first time, our medical school and each of the hospitals took part in a highly collaborative and inclusive process that incorporated feedback from more than 4,000 people, at all levels and functions, across all three institutions.
Together, we identified three shared priorities: Value Focused, Digitally Driven, and Uniquely Stanford. We plan to build on our strengths and accomplish specific goals in each of these priority areas, which will ensure our preeminence and unique position to lead the biomedical revolution in Precision Health. The ISP is expected to be approved soon. But the work isn’t over. As we pursue selected initiatives and tactics to achieve our strategy—and engage in an annual planning process—we will need the ongoing support and input of the wider Stanford Medicine community to bring these priorities to life. In this issue, you can read about some of the people who participated in the 13 ISP workgroups that made this all possible.
ON THE COVER: It’s been more than a year in the making with thousands of employees from Stanford Health Care, School of Medicine and Stanford Children’s Health all participating and offering their thoughts to the Integrated Strategic Plan. At Open Houses and Town Halls, employees gathered to share their views and perspectives.
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My heartfelt thanks go out to all who contributed to this process, and I hope that you will continue to share your ideas as we seek to implement our vision for the future. DAVID ENTWISTLE PRESIDENT & CEO
STANFORD HEALTH CARE PEOPLE is produced by the Corporate Communications Department. Send comments to communications@stanfordhealthcare.org.
UNITED BY A POWERFUL SENSE OF
SHARED
PURPOSE THE INTEGRATED STRATEGIC PLAN BRINGS TOGETHER STANFORD MEDICINE AS A COMMUNITY
“T
HE WHOLE IS GREATER THAN THE SUM OF ITS PARTS.” STANFORD MEDICINE TOOK A NOD FROM ARISTOTLE’S PLAYBOOK WHEN IT BROUGHT TOGETHER ITS THREE ENTITIES—STANFORD HEALTH CARE (SHC), STANFORD SCHOOL OF MEDICINE (SOM) AND STANFORD CHILDREN’S HEALTH—TO CREATE AN INTEGRATED STRATEGIC PLAN. For the first time, these three entities worked together for more than a year to create an aligned path for their shared future. “As we worked together in this process, I have been so impressed with the collaboration that we achieved,” said David Entwistle, president & CEO of Stanford Health Care. “We did this together as Stanford Medicine, and that is important. The potential for what we can achieve with this
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THE INTEGRATED STRATEGIC PLAN WAS DEVELOPED WITH INPUT FROM THOUSANDS OF EMPLOYEES. THROUGHOUT THIS PAST YEAR, SCHOOL OF MEDICINE DEAN LLOYD MINOR, MD (FAR LEFT), AND SHC PRESIDENT AND CEO DAVID ENTWISTLE (SECOND FROM LEFT) HOSTED AN OPEN HOUSE AND TOWN HALLS TO CAPTURE FEEDBACK FROM THE STANFORD MEDICINE COMMUNITY.
plan is quite limitless,” he said. “It creates the opportunity for us to focus on those things that will differentiate us moving forward.” The culmination of their work, the Integrated Strategic Plan (ISP), was presented to the Stanford Health Care Board of Directors in the spring and will be presented to the Stanford University Board of Trustees for final approval this summer. “The integrated strategic planning process brings us together as a community of faculty, students and trainees, hospital leadership and staff,” said School of Medicine Dean Lloyd Minor, MD. “In early 2017, we embarked on a journey to create this plan, assessing how our collective enterprise can best continue to generate and harness extraordinary
advances in biomedical research, care, training and technology here at Stanford and beyond.”
‘Human-Centered and Discovery Led’ The decision to create an Integrated Strategic Plan for Stanford Medicine recognizes Stanford’s unique position as an academic medical center that is integrated with a research university and a growing network of tertiary, specialty and primary care facilities. It includes a shared mission, vision and values for Stanford Medicine, all of which are guided by one overarching theme— to be “Human Centered and Discovery Led.” The plan includes three pillars that act as its very foundation— to be Value Focused, Digitally Driven and Uniquely Stanford.
THE MAKING OF THE INTEGRATED STRATEGIC PLAN DEVELOPING AN INTEGRATED STRATEGIC PLAN (ISP) REQUIRED REAL INTEGRATION BETWEEN FACULTY AND STAFF FROM EACH OF THE THREE STANFORD ORGANIZATIONS. TO CREATE THIS COLLABORATION, 13 WORK GROUPS WERE FORMED, EACH FOCUSED ON A SPECIFIC STRATEGIC AREA, WITH REPRESENTATIVES FROM ALL THREE ENTITIES PARTICIPATING. EVERY MONTH, TEAMS CAME TOGETHER TO SHARE EXPERIENCES, IDENTIFY KEY ISSUES AND SHARE STRATEGIC RECOMMENDATIONS TO INFORM THE DIRECTION OF THE ISP.
EMPLOYEE FEEDBACK WAS AT THE CENTER OF THE MAKING OF THE ISP.
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By focusing on value, the ISP outlines a path for Stanford Medicine to deliver high-quality, personalized care at a competitive cost. It also sets the organization toward a path to be Digitally Driven, to lead the digital transformation of health and health care delivery. And lastly, the Integrated Strategic Plan hinges on being uniquely Stanford, to harness the power of Stanford’s seven schools to accelerate fundamental discovery, advance translational medicine and improve global health. “It’s a great time to have an Integrated Strategic Plan to make sure that we are collectively leveraging these opportunities,” said Minor. “We are uniquely poised to be able to bring transformative discoveries to the benefit of our patients here and change the course of biomedicine across the country and around the world.”
STANFORD MEDICINE INTEGRATED STRATEGIC PLAN
HUMAN CENTERED
AND
DISCOVERY LED VALUE FOCUSED
Historic Collaboration The Integrated Strategic Plan was developed with input from thousands of employees. The process began in early 2017 and has been ongoing for more than a year. As a starting point, the ISP team first surveyed staff and faculty at all three entities, an effort that garnered nearly 4,000 responses. That was followed by interviews with more than 100 members of the Stanford Medicine community. From that data-gathering process, the ISP team honed down its focus to 13 strategic areas and formed work groups with representatives from all parts of Stanford Medicine. These integrated work groups provided the in-depth perspective needed to inform strategic
DIGITALLY DRIVEN UNIQUELY STANFORD
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“It was a great collaborative effort,” said Anita Girard, RN, Magnet Program Director, who served as a member of the People, Culture and Community
said the process “gave us focus and an opportunity to provide transparency into our shared future goals.” Monthly meetings were active discussions, with
Medicine look to become more digitally driven.” This team will have an immediate focus on integrating telehealth into primary care and targeted
work group. “I’ve been at Stanford for 25 years,
participants hashing out how to solve common
specialty areas and to launch a virtual second
and it was so exciting to see for the first time all of
issues. The collaboration fostered in these work
us coordinating, collaborating and communicating
groups not only informed the ISP, but created new
opinion program.
together to really define our strategic priorities for
partnerships across the organization where none
the organization and how we could move those
had occurred before.
forward in a systematic manner.” Each work group was tasked with delivering a
Chris O’Dell, Director of Digital Health Strategy and Alliances, described a disconnect that existed
The director of Health Education, Engagement and Promotion, Marissa Duswalt Epstein, found the opportunity to work across the organization inspiring. As a result of the new relationships formed working on the Digital Health Innovation work
white paper outlining their recommendations and
between the School of Medicine research and
how to achieve them. “These documents make us
innovation engine and the Stanford Health Care
accountable to our recommendations of how we
delivery system. The Digital Health and Innovation
to integrate its operations with those of Stanford
are going to lead value improvement at Stanford
work group has changed that, he said. “I think the
Children’s Health. “At the end of the day, our ability
Medicine,” said Michelle DeNatale, Executive
result of this collaboration will be a much more
to build an integrated strategy and then deploy it
Director of Strategic Operations. As a member of
coordinated digital health effort as Stanford Children’s
tactically across these organizations ends up being
the Safety, Quality and Value work group, DeNatale
Health, Stanford Health Care and the School of
a big win for patients and families,” she said.
group, Epstein’s Patient Education team has begun
STANFORD HEALTH CARE PEOPLE / 5
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“While we all share a commitment to improving human health, many of us would like more clarity about how we’re going to achieve our vision. The integrated strategic planning process allows us to set out specific goals to create a road map for our future.”
EMPLOYEE SURVEYS, INTERVIEWS, TOWN HALLS (ABOVE) AND AN OPEN HOUSE (BELOW) PROVIDED VALUABLE INSIGHT THAT FORMED THE FRAMEWORK FOR THE ISP.
planning. Each met independently to assess their current state as a collective enterprise, share best practices, develop key priorities and lay out a vision for a more integrated future. Throughout the year, leaders from the school and the hospitals held Town Hall meetings and Roundtable discussions to glean employee feedback at every step in the process. In each of these gatherings, they stressed that the Integrated Strategic Plan is a living, breathing document, not something that will sit on a shelf collecting dust. The plan includes key performance indicators that will allow the team to measure progress across strategic priorities and deliverables, and revisit them periodically. “A critical component to successful execution of our strategy will be an annual planning process,” said Denny Lund, Chief Medical Officer and Interim CEO at Stanford Children’s
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Health. “The outcomes of this process will form a working plan to reflect the evolution of our strategy and provide deeper direction to our entire organization.” “We face many external pressures and challenges in biomedicine and health care today,” said Minor. “To effectively address those challenges and be true to our mission and values, we have to have an integrated plan, and then we have to be able to execute on that plan.”
A ‘Shared Sense of Purpose’ The ISP process uncovered one undisputed truth—Stanford Health Care, Stanford Children’s Health and Stanford School of Medicine are “united by a powerful sense of shared purpose,” said Priya Singh, Chief Strategy Officer for Stanford Health Care and Senior Associate Dean for the School of Medicine. “While we all share a commitment to improving human health, many of us would like more clarity about how we’re going to achieve our vision. The integrated strategic planning process allows us to set out specific goals to create a road map for our future.”
FROM HR Taking HealthySteps to Wellness: Spotlight on Wellness Champions Wellness Champion since January 2018
MARISA YURIAR, Lead Payer Authorization Coordinator–Patient Financial Clearance Marisa Yuriar originally joined the program for the employee wellness incentives, which included money toward health savings accounts and reimbursement plans. But soon after joining the program, she realized she could help make healthy changes to her lifestyle and encourage her co-workers to do the same. She has helped implement small changes around the office, including replacing candy bowls on desks with healthy snacks, encouraging “walk and talk” meetings instead of sitting around a table and a no-elevator challenge, which reminds fellow employees to take the stairs. The most popular healthy technique has been the ‘Fit Bell.’ “At the sound of an hourly desk bell, everyone gets moving. Our daily stretch is no longer than two minutes,” said Yuriar. “Staff each share stretching ideas during our morning department huddle.” The Fit Bell has made a big impact on her team, providing a gentle reminder for people to get up and move. Being a Wellness Champion has given Yuriar a sense of achievement and has helped her to stay motivated to be healthy with the support of her co-workers.
Wellness Champion since February 2017
PHILLIP MARTIN, Training Specialist, Stanford Blood Center Phillip Martin signed on as a Wellness Champion because he wanted to strengthen bonds between his team members and learn positive life lessons
LET’S TALK
EMPLOYEE ENGAGEMENT Stanford Health Care’s Human Resources department will conduct an Employee Engagement Survey this summer, its first in over two years. HR Talent Development Architect Dave Simpson shared his thoughts on employee engagement and the importance of employee feedback with SHC People. 1.What is employee engagement? Employee engagement taps into our sentiments about the workplace environment and our experience at Stanford Health Care. In a recent survey, employees defined employee engagement as a positive work environment, one that contributes to their positive effect and vitality. I think we all want to experience our work as meaningful, connected and challenging. That’s when we do our best. 2. Why does SHC conduct Employee Engagement Surveys? The Employee Engagement Survey helps us check in on how we’re doing now, so we can continue to align our employee experience strategy with
while reinforcing healthy habits. He often leads breathing exercises and easy stretches using resistance bands during morning huddles. Martin has also implemented a daily walking program, so he and co-workers can get outside and move during breaks. His team participates in recurring 15-minute HealthySteps to Wellness sessions on Fridays, which include activities like meditation. The classes have been so well attended that they’ve had to move to larger rooms to accommodate all the participants. “Being a part of the Wellness Champion program fills me with pride and
employees’ desires. The survey allows us to have more focused and frequent conversations about our employee experience and enables us to continuously improve. 3. How does SHC use the results? Survey results are shared with everyone and generate insights for employees at every level— senior leaders, managers and staff. They allow each of these groups to think about what they can do to continue to improve. We now have the capability to conduct annual surveys, receive results within days and conduct “pulse checks” throughout the year. These results will let us know how we’re doing to achieve the goals we’ve set. 4. Why Should Employees Take the Time to Complete the Survey? We all have a responsibility for engagement. The 2018 Employee Engagement Survey is integral to our preparation for the new hospital. It’s not just a survey; it’s part of our strategy. What kind of experience do we want for our employees and patients as we move into the new hospital?
responsibility,” said Martin. One of his favorite parts of being a Wellness Champion is introducing new employees to the benefits of the program. “I feel responsible for providing life tips that extend past work and can benefit someone’s whole family,” he said. “I’ve been able to share much of what I’ve learned from the program with my family, establishing healthy habits including exercise and eating.” HealthySteps to Wellness is a comprehensive wellness program designed to help employees achieve their personal health goals. There are currently over 1,300 Wellness Champions, role models for healthy behavior within their department, supporting the program and a broader culture of wellness. For more information about Wellness Champions, including how to register, visit wellness.healthysteps4u.org/champions STANFORD HEALTH CARE PEOPLE / 7
THE
NEW 500P Operating
Rooms
NEW TECHNOLOGY WILL MAKE SURGERY MORE PRECISE AND SAFER
20 STATE-OF-THE-ART OPERATING ROOMS ARE TAKING SHAPE INSIDE THE NEW STANFORD HOSPITAL.
ACTIVATION ALL-STARS FOR
500P LICENSING More than 10 years of planning, design and building have brought the new Stanford Hospital at 500 Pasteur Drive to within a year of completion. As each new construction and licensing milestone is met, the Transition Strategy team has begun to celebrate the “wins along the way” with its new “Path to Activation All-Stars” Award. This new award recognizes the efforts of SHC employees to help open the doors to 500P. At the March Management Meeting, SHC President & CEO David Entwistle honored Nerissa Ambers, Grace Hsu, Jennifer Romer and Preet Saini, as Path to Activation All-Stars. The four employees were honored for their 8 / STANFORD HEALTH CARE PEOPLE
The three acres of surgical floor space in the new Stanford Hospital were built to accommodate surgical advancements used today, and technologies yet to be invented. The space, known collectively as the interventional platform, includes 20 operating rooms and eight interventional/radiology rooms with fixed image guidance, all co-located within a large sterile zone. The space includes two MRIs, one CT and one intra-operative MRI (iMRI). At 800 to 1,000 square feet each, the new ORs are more than double the size of those in 300P. Overhead booms hoist lights, monitors and fixed equipment off the floors, freeing up floor space for movable medical equipment, robots and medical teams and trainees. “Traditional operating rooms are giving way to interventional platforms that can support new techniques and technologies,” said George Tingwald, MD, AIA, Director of Medical Planning for the new hospital, who holds both an MD degree and an AIA designation as a professional architect. Physicians from multiple medical specialties—surgery, interventional imaging, angiography and cardiac catheterization —can work together side-by-side in these new facilities. “The new ORs have the most advanced technology, making surgery more precise and safer,” said Mary Hawn, MD, MPH, FACS, Chair, Department of Surgery. “We will have the ability to route images to any screen in the
role in successfully submitting the licensing application for 500P. Additional members of the team who were instrumental in the licensing application process were also recognized, including Rosie Adams, Gretchen Brown, Jeanneth Chew, Steve Chinn, Elise Drakes, Cyndi Parke and Tina Perry-Finau. After more than a year of compiling materials, the team submitted the licensing application to the State of California. This documentation defines many aspects of how the building will be utilized and, in essence, closes the building design to future changes. “It was truly a group effort with contributions from many departments from operations, the New Stanford Hospital team and Transition Strategy,” said Helen Wilmot, Vice President, Facilities Services & Planning. “The construction and activation of 500P is
room and view radiographic images alongside laparoscopic images.” New glare-reducing green lighting allows surgeons to see images clearly without plunging the OR into darkness. An adjacent iMRI allows patients to be scanned during surgery and then returned to the OR with the images necessary to complete the procedure. Two copper-lined rooms provide radio-frequency shielding for procedures such as deep brain stimulation that require micro-electronic recordings of brain signals, without interference from nearby cell phone or equipment signals. “The new operating rooms were designed to be flexible and accommodate future technologies not yet discovered,” said Jennifer Romer, Senior Project Manager, Planning, Design + Construction. “Did we think of everything? Probably not. But we tried to provide the space, the technology, and the power, data and gases necessary to incorporate new technologies as they become available.”
PICTURED FROM LEFT TO RIGHT: HELEN WILMOT, VICE PRESIDENT, FACILITIES SERVICES & PLANNING; DAVID ENTWISTLE, CEO; NERISSA AMBERS, SENIOR PROJECT MANAGER, TRANSITION STRATEGY; PREET SAINI, SENIOR QUALITY CONSULTANT, QUALITY, PATIENT SAFETY & EFFECTIVENESS; JENNIFER ROMER, SENIOR PROJECT MANAGER, PLANNING DESIGN & CONSTRUCTION; QUINN MCKENNA, CHIEF OPERATING OFFICER.
a long path. This licensing submittal is a key milestone on that path.” Future “Path to Activation All-Stars” will be honored at monthly management meetings.
PAVILION D (FAR LEFT) INCLUDES CO-LOCATED CLINICS FOR QUICKER DIAGNOSIS AND TREATMENT OPTIONS (SECOND FROM LEFT), A NEW BRANCH OF THE HEALTH LIBRARY (SECOND FROM RIGHT), AS WELL AS SPECIALIZED EOS IMAGING (FAR RIGHT) TO SUPPORT ORTHOPAEDIC CARE. SHC IS THE ONLY ORGANIZATION ON THE PENINSULA OFFERING EOS TO PATIENTS.
Redwood City’s Pavilion D to Open in July On July 9, 2018, Pavilion D in Redwood City will open for patient care, bringing an additional 112,000 square feet of clinical space to the Stanford Health Care Outpatient Center. More than three years in planning, design and construction, the three-story Pavilion D was stripped down to its outer shell and transformed into the clinical home of Digestive Health, Pelvic Health and Orthopaedics. A 300-car parking garage opening in mid-August will complete the campus. “We created a space that’s centered around the patient,” said Aimee Walters, administrative director of ambulatory clinics. “We really took into consideration the input of our patient advocates and physicians and tried to create a space that feels welcoming and safe for our patients.” “As architects and designers, we translate how people work into space for them to work,” said Rachel DeGuzman, Director, Capital Projects, Planning, Design + Construction. “We challenged project teams to think outside the box to develop a better, more efficient way to provide care.”
Digestive Health Center The Digestive Health Center, including a state-of-the-art endoscopy unit, takes up the largest footprint of Pavilion D. The Digestive Health Center has been
bulging out of its current space at Blake Wilbur Drive and will bring over 39 gastroenterologists, including 12 hepatologists, to the new space. Staffing is more than doubling, from 34 to nearly 70 medical assistants, advanced practice providers, nurses, clinical care coordinators and patient testing techs. “The new space promotes wellness,” said Ray Kim, MD, Chief, Division of Gastroenterology & Hepatology. “We designed the Center with patient convenience and welfare in mind.” Physicians and staff will be grouped together in collaborative workspaces in the center of each clinic pod. Surrounding the work cores are large exam rooms, with an onstage entrance for patients and an offstage entrance for providers. The Center also includes private consultation rooms for telemedicine visits, patient-provider discussions, and patient education, and six procedure rooms, many of which are equipped with private bathrooms for patient comfort and privacy. “Our guiding principle was always, what is best for the patient clinically and emotionally?” said Uri Ladabaum, MD, Clinical Chief, Division of Gastroenterology & Hepatology. The third floor is dedicated to endoscopy. The most innovative feature of the design is that patients
are prepped in a private room right outside the procedure room and can walk directly into the procedure area when they are ready. After their procedure is complete, patients are wheeled through a second set of doors to the recovery area on the other side.
Pelvic Health Center Adjacent to Digestive Health is the interdisciplinary Pelvic Health Center. Here, a team of clinicians, including uro-gynecology, urology, colorectal, GI, physical therapy, and pain are co-located in a shared work space designed to foster collaborative discussions and consults. “Pelvic Health involves a series of disorders that crosses disciplines, so it makes sense to work as a group,” said Brooke Gurland, MD, Medical Director, Pelvic Health Center. “Our new space allows us to provide multidisciplinary care, which benefits patients with complex medical conditions.”
Orthopaedics As the largest specialty clinic at Redwood City, Orthopaedics moved its Spine Center, Tumor Center, and Foot and Ankle Center from Pavilion A to the first floor of Pavilion D to keep pace with its continued growth. “Orthopaedics has grown tremendously,” said Jack O’Malley, Assistant Director of Orthopaedic Surgery. When he joined the division in 1989, orthopaedics provided care for 300 to 400 patients a month. “Today, we see 300 to 400 patients a day in Redwood City alone,” he said. STANFORD HEALTH CARE PEOPLE / 9
FOCUS ON… Patient Education In January, Stanford Health Care launched a digital-first approach to patient education. Rather than hand out fliers and brochures to patients at discharge or after medical appointments, medical care teams can now easily populate patients’ discharge instructions and clinic visit summaries with detailed, condition-specific information in Epic. Through this new Patient Education Library, care teams can search for a term or click on a topic from an automatically populated list of suggestions. Patients can access the digital library through My Health, and search for information on approximately 200 different conditions on their phones, tablets and computers.
This digitally delivered patient education system resulted from the work of a cross-functional team in Patient Experience, IT and Cancer Center Operations led by Marissa Duswalt Epstein. When she joined Stanford as Director of Health Education, Engagement and Promotion three years ago, she found a paper-intensive, laborious system— photocopied fliers spilling out of filing cabinets and closets stuffed with outdated information. “Both our patients and care teams wanted to take a different approach,” she said. “We asked ourselves, ‘What would it look like to be digitally forward, progressive and push the envelope of innovation?’ ” “We wanted to create a sustainable, system solution that would scale across the organization and provide evidenced-based information to patients before, during and after their treatment to help empower them to make better decisions for themselves,” she said. “Patient education is a very content-heavy, often-overlooked intervention in patient care. But it’s also one of our safest and most affordable interventions.”
THE HEALTH EDUCATION TEAM HAS TRANSITIONED FROM A PAPER-INTENSIVE PROGRAM TO A DIGITALLY DRIVEN PATIENT EDUCATION SYSTEM.
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STANFORD PHYSICIANS ARE STARRING IN NEW, PATIENT-FRIENDLY VIDEO CONTENT.
In the past, materials were supplied by multiple vendors, messaging was inconsistent and the information lived outside the Epic system. Together with providers, the Health Education team selected one vendor for all patient education content, and then worked with doctors in multiple specialties to customize the education to reflect how care and treatment are delivered at Stanford. That education was then integrated into Stanford’s first-ever Patient Education Library, a hybrid catalogue of custom and vendorprovided content. Now, information is current, consistent across the hospital and clinics and increasingly available in multiple languages. The team is preparing to deliver a library of educational videos this summer. As part of the Cancer Transformation efforts, these videos will be available to patients receiving cancer services and will be expanded to other departments in the future. “Video is the only media that allows people to assess the empathy and integrity of our care team,” said Kathryn Kennedy, Manager of Health Education Communications. “With video, patients can project themselves into a care experience, evaluate care team members, and decide, can I trust these people with my care? No handout or web bio is going to do that.”
FOCUS ON… Clinical Genomics Program In a ribbon-cutting ceremony in late March, Stanford Health Care and Stanford Children’s Health officially launched the Clinical Genomics Program, which offers whole-exome sequencing and analysis to children and adults with undiagnosed genetic conditions. The promise of wholeexome sequencing lies in its ability to uncover the underlying genetic basis for a patient’s condition. This knowledge can provide important information to guide a patient’s medical care. “Sequencing the genomes of patients and families represents the state of the art in genetic testing for patients today,” said Euan Ashley, MD, Co-medical Director of the Clinical Genomics Program. “It is the essence of precision health: understanding disease at a deeper level so that we can treat it more precisely. You are essentially looking at someone’s DNA and figuring out exactly what is wrong with them.” The Clinical Genomics Program is an integrated, collaborative effort led by a multidisciplinary team with vast experience in clinical genomics. Medical Directors Dr. Euan Ashley, Stanford Health Care, and Dr. Louanne Hudgins, Stanford Children’s Health, work together with a team of licensed genetic counselors—Megan Grove, Emma Smith and Shana White—and collaborate on cases weekly with molecular genetic pathologists, clinical
MEGAN GROVE, MS, LCGC (RIGHT), LEAD GENETIC COUNSELOR FOR THE CLINICAL GENOMICS PROGRAM, HELPS A PATIENT UNDERSTAND THE RESULTS OF HER WHOLE EXOME SEQUENCING.
data scientists, bioinformaticians and wet lab scientists in the sequencing lab, as well as referring providers. “Whole-exome sequencing allows us to make accurate diagnoses in 25 to 30 percent of cases,” said Hudgins. “This has been a total boon to what we do clinically. And it has been a total boon for gene discovery.” Patients who undergo whole-exome sequencing have often undergone other genetic studies that have not been informative. “They are still searching for an answer,” said Smith, LCGC, who works with children and their families at Stanford Children’s Health. “The goal of offering wholeexome sequencing is to try to find a genetic cause of their condition to better shape their medical management in the future, and discuss how that might affect the family at large as well.”
The Power of Whole-Exome Sequencing Whole-exome sequencing examines the approximately 21,000 protein-coding genes that are most likely to cause disease. From those, a Stanford-built software platform narrows down the results to about 100 gene variants. Molecular genetic pathologists, together with laboratory genetic counselors and clinical data scientists, analyze and interpret the data manually, comparing
each gene variant with those found in scientific literature. “In the 70 percent of cases where we do not find an answer today, we can look at that data again in the future and see if the medical field or literature has identified new genes that could explain this patient’s disease,” said Grove, LCGC, who works in the clinic with adult patients and also in the laboratory to help interpret sequencing data. Stanford’s Clinical Genomics Program first started a research pilot in 2014 in the context of undiagnosed disease. Now, the Program has launched its first in-house clinical genetic test— whole-exome sequencing. This test brings the genomics team responsible for interpreting the data in close communication with the patient’s care team and medical record. This communication is critical to ensuring the most meaningful result possible, said Grove. WHOLE EXOME SEQUENCING RELIES HEAVILY ON MANUAL ANALYSIS AND INTERPRETATION OF THE DATA TO IDENTIFY THE UNDERLYING GENETIC CAUSE OF A PATIENT’S CONDITION.
STANFORD HEALTH CARE PEOPLE / 11
UHA Providing care and compassion, one patient at a time. Unorthodox Approach Calms Anxious Patient When Renu Kulkarni, MD, shuttled between exam rooms, seeing patents on a busy day at the Bay Valley Medical Group in Danville, she noticed one of her patients sitting on the floor in the clinic hallway, visibly upset. The patient, a young woman with Down syndrome, was anxious and crying. “We don’t know what the trigger was that day, but she refused to enter the exam room,” said Kulkarni, a family medicine provider with Bay Valley since 2006. “So, I just sat down and thought, I’ll examine her here, where she is.” Kulkarni talked with the patient calmly before getting her a glass of water and taking her vital signs. The exam room was just steps away, but Kulkarni didn’t want to risk further upsetting the patient, RENU KULKARNI, MD PROVIDES CARE TO AN UPSET DOWN SYNDROME PATIENT ON THE FLOOR IN THE CLINIC HALLWAY.
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who she has known for a long time. So, she conducted her exam in the hallway. “She is minimally verbal and has a harder time when she’s not feeling well,” said Kulkarni. “We did what we needed to do to attend to her medical and emotional needs.” By the time the exam was over, the patient had stopped crying and was back to her normal self. “Dr. Kulkarni went above and beyond to provide outstanding care to an upset patient,” said Bay Valley Practice Manager Julie Fulton, MD. “It was heartwarming to witness her compassionate approach to caring for the patient.”
BHOOMIKA KAMATH, MD, (TOP ROW, CENTER), MADE A HOUSE CALL TO HER PATIENT ON HER 89TH BIRTHDAY.
Making a House Call An Epic alert inspired one Bay Valley Medical Group doctor to make a house call. When Bhoomika Kamath, MD, realized one of her elderly patients was celebrating her 89th birthday, it inspired an idea. She asked medical assistants Leslie Vasquez and Karina Contreras to join her on their lunch hour and surprise the patient with a birthday cake, gift and flowers. The patient suffers from dementia and resides in an assisted living facility two and a half miles from the Danville clinic. Kamath, a family medicine provider, had formed a bond with the patient and her 91-year-old husband, who brings her to all her appointments. “The couple’s grown children live out of the area. It broke my heart to think about them being all by themselves on her birthday,” said Kamath, who has been with Stanford Health Care–University HealthCare Alliance since 2011. “They are a very sweet couple,” she said. “It was nice for us to see them in a non-clinic setting and talk about their lives. They have been married 62 years, and I think it’s hard for him to watch her decline.” For Kamath, this house call was not an isolated incident. “I do visit patients at home sometimes,” she said. “A lot of our providers do.”
UHA
AT A GLANCE
1/1/2011
FORMED JANUARY 1, 2011
70+
LOCATIONS IN 4 COUNTIES: ALAMEDA, CONTRA COSTA, SAN MATEO & SANTA CLARA
350+
PHYSICIANS
1MM+
OVER 1 MILLION PATIENT VISITS IN 2017
300,000+
PATIENTS
27
PROVIDES TREATMENT ACROSS 27 SPECIALTIES
Q & A 1
WITH...
Michael O’Connell Senior Vice President, Operations, University HealthCare Alliance
Michael O’Connell joined Stanford’s University HealthCare Alliance on February 1 as its Senior Vice President of Operations. Prior to joining UHA, O’Connell held several leadership positions at Cleveland Clinic and was a health care consultant for the Advisory Board Company.
What drew you to Stanford’s University HealthCare Alliance?
As a consultant for the Advisory Board Company, my first assignment was to spend six months at UHA as its Interim Executive Director. I was tasked with leading the medical foundation, developing the team, conducting benchmarking and developing strategy. When we presented our vision and strategy to the UHA Board of Directors, they were so supportive of our recommendations, it made me want to work here. I was so impressed with the collaboration and commitment that exists between the Stanford School of Medicine, Stanford Health Care and UHA. It’s wonderful to be part of an organization that is so committed to innovation and doing things to improve patient outcomes and the patient experience.
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What are the top priorities for UHA?
We are working on five strategic areas of focus for UHA: access, partnership, lower cost structure, population health, and research and education. Through our community-based providers and the IPA, we have the capacity to care for thousands of patients, and last year we provided over one million patient visits. Our footprint in the East Bay, South Bay and the Peninsula provides a convenient alternative for many patients, and decompresses the burden on our faculty clinics where access remains a challenge. We are always looking to collaborate and create alliances with managed care plans, accountable care organizations, payers and employers to be able to deliver care in the community. Most recently, Stanford became the medical provider for 5,300 Google employees. While Stanford Health Care is aggressively working to lower its cost, UHA has a head start operating at a lower cost in a clinical environment. Our cost
structure allows us to be competitive in the marketplace and helps us provide a large network of care. When patients do need tertiary or quaternary care, we can get them into the system of phenomenal world-class medical care that Stanford provides. UHA has a number of initiatives to improve population health and quality. As we gain experience working in population health management, we become critical to the vitality of Stanford’s Senior Advantage and Alliance plans, and to its goal of delivering precision health. UHA providers also conduct research and have clinical trials in oncology and cardiology. And our South Bay clinics actively educate residents.
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Health care is constantly changing. Where do you see UHA evolving in the future?
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As a lifelong Midwesterner, how do you like California?
We want to continue to optimize our current delivery model and services and improve clinic operations and provider productivity. Our goal is to ensure a consistent patient experience across all our locations. We are also working to better integrate our care delivery model with services provided by Stanford faculty. And we are looking to add imaging and ambulatory surgery to our network of care.
I’m fascinated by the numerous plants and flowers that grow here, and I love the microclimates. I also love the diversity here—the diversity of thought, the diversity of opinion, the diversity of background. It provides such a richness of culture.
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VA LL EY CA RE 14 / STANFORD HEALTH CARE PEOPLE
LEADING THE WAY TO VALLEYCARE’S EPIC GO LIVE WERE (LEFT TO RIGHT): CHIRANJEEVI IKKURTHY, SHANNON STEWART, RN, SUPERUSER EFFIE MATTISON, RN, AND DAVIS GUNDERSON.
ValleyCare Go Live: Nearly 1,600 new users on the SHC EMR With the flip of a switch at 4:44 a.m. on March 3, all four locations of the Stanford Health Care–ValleyCare system shed their dependence on paper and implemented the Epic Electronic Medical Record (EMR) system. While the cutover happened on March 3, it was preceded by more than two years of integrated planning, designing, building, testing and training to ensure that patient care and hospital and revenue operations would be enhanced with the move to an EMR. “We are now a system that’s connected,” said Davis Gunderson, Manager of Strategic Initiatives, Stanford Health Care– ValleyCare. “This is an exciting milestone event that further integrates ValleyCare into the SHC network.”
hospitals and clinics. The network was also upgraded to maintain reliability for 166 different integrated applications to enhance care delivery—everything from clinical care and patient charting to registration and scheduling and billing.
Infrastructure Upgrade
Planning
Readying ValleyCare for the Epic implementation required a complete overhaul of its digital infrastructure. The IT team deployed 3,800 new end-user devices such as computers, workstations, bar code scanners and printers throughout both of the ValleyCare
Over the past two years, 50 to 60 percent of SHC’s IT staff have worked on ValleyCare’s large-scale EMR implementation. That’s about 600 people in all, said Chiranjeevi Ikkurthy, IT Program Director, “Our role was to provide ‘soup to nuts’ IT delivery for ValleyCare.” Planning
VALLEYCARE involved the creation of 35 work groups, each with a clear scope and a detailed resource plan.
Design and Build Across every department, work groups formed to document current processes and then develop new workflows for an electronic environment. In nursing, that meant looking at every row of every flow sheet, comparing ValleyCare workflows with Stanford Health Care workflows, and building documentation tools as necessary. “The process took a year and a half to plan and build and test,” said Shannon Stewart, RN, Manager, Staff Development.
Training Starting in January, ValleyCare began training 1,598 new Epic users—318 providers and 1,280 staff—an undertaking that required more than 3,200 hours of classroom training delivered in nearly 900 training sessions. “The Epic Education department taught all staff in an eight-week period of time,” said Stewart. “They had classes going from 7 a.m. through 10 p.m., six days a week, with 13 classrooms running simultaneously.”
Go Live At Go Live, there was a team of support personnel on the floors to help staff as they logged in and used the live system for the first time. This included technical staff from Epic and IT, but also a team of SuperUsers—ValleyCare employees who underwent extra Epic training to help colleagues at Go Live. SuperUsers Effie Mattison, RN, a staff nurse on 1 West, underwent 16 hours of training to provide elbow-to-elbow support for the nurses on her floor. All of the planning and preparation for the ValleyCare Epic implementation paid off, said Ikkurthy. “There is a lot of pride around the hospital because the implementation went so well.”
HONORS
TENURED EMPLOYEES At the annual Employee Service Awards Luncheon, held in May, Stanford Health Care–ValleyCare recognized the career milestones of its employees, honoring employees for every five years of service. On May 18, 170 employees received awards, some for the first time, and others who have devoted their entire careers to ValleyCare. Here are the stories of two of ValleyCare’s most tenured employees.
40 Years JEANNE MARTIN, RN, PACU DEPARTMENT When Jeanne Martin was just 7 years old, she and her best friend dreamed of becoming nurses. As high school seniors, they completed nurse’s aide training, and Jeanne began working every other weekend at ValleyCare. After graduation, she completed vocational training and worked as an LVN. Ten years later, she became an RN, going to school during the week, and working at ValleyCare on weekends. While she has moved from the medical floor to Med/Surg to the Post Anesthesia Recovery Unit (PACU), she never changed her commute. “ValleyCare feels like family,” said Martin. “Throughout my career, I’ve had great managers and co-workers who’ve supported me. That is probably the biggest reason I’ve stayed.” Martin has seen a profound change in nursing throughout her 40-year career. “Jeanne has grown up with ValleyCare. She has grown from a CNA to LVN to RN watching this small community hospital blossom into what it is today after its affiliation with Stanford,” said Jolene Duffey, RN, Nurse Manager. “She is a team player, a patient care advocate and an amazing nurse.”
35 Years LARRY MELIM, DIRECTOR OF ENGINEERING & SAFETY DEPARTMENTS As Director of Engineering & Safety for ValleyCare, Larry Melim wears many hats. Technically trained early in his career as a licensed stationary engineer, Melim is responsible for maintaining the utility, building and maintenance facility operations for the ValleyCare campuses. He started his ValleyCare career as the Jeanne Martin Assistant to the Director of Engineering in 1982 and quickly , RN PACU Departm , ent rose to the top spot just five years later. He has been leading the department ever since. “Our job is to make sure that our plant operations and equipment do not fail, and to provide a safe, risk-free environment,” said Melim. His team of 17 manages approximately 500,000 square feet of space on the Pleasanton and Livermore campuses. “Larry knows more about what’s behind the walls than anybody else,” said ValleyCare Chief Operating Officer Tracey Lewis Taylor. “Not only does he have the facilities and engineering experience, but he has important institutional knowledge as well.” For Melim, the fact that “no two days are the ering & e in g n E same” has kept him captivated and engaged. “Health ctor of lim, Dire care is such a unique profession,” he said. “I enjoy the Larry Me artments ep Safety D camaraderie of my colleagues and the stimulation that comes from working with such productive, intelligent people.”
40 YEARS
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THE STANFORD STORYBANK
OUR PATIENTS NOW
A Stroke of Good Luck On the night of April 23, 2017, Cindi Dodd, a 46-year-old graphic designer who lives in Salinas, California, went to bed around 10:30 p.m., anticipating a 5 a.m. wake-up from her husband, as she was scheduled for outpatient surgery at Stanford. She did arrive at Stanford the next morning—not as an outpatient, but as the victim of a massive ischemic stroke. “My husband woke me up at 5 o’clock as planned, and when I started to speak to him, I couldn’t talk. I knew what I was trying to say in my mind, but it had nothing to do with the sounds that were coming out of my mouth,” Dodd said. Her left side was also paralyzed. Her husband called 911. An ambulance rushed Dodd to Salinas Valley Memorial Hospital. But because she’d had the stroke while asleep, the “clock” determining whether she could be administered a clot-busting medication or undergo a clot-removing surgery had already started ticking. For stroke patients, the clock starts at the last time they are seen well, and for Dodd, that was 10:30 the previous night. It was already too late for either of these treatments, the attending physicians explained.
But an emergency room doctor told her husband about an ongoing study at Stanford and coordinated her transfer by helicopter to Stanford Hospital. By the time Dodd’s husband and son arrived, she was already out of surgery. Seven days later she was discharged. Dodd was treated at Stanford as part of a 38-center clinical trial led by researchers at the Stanford University School of Medicine. Brain-imaging software developed at Stanford identified that she could benefit from a surgical procedure called a thrombectomy to remove the clot in her brain, despite the number of hours that had elapsed since she suffered the stroke. The Stanford stroke study has shown that far more people than previously thought can benefit from an emergency procedure for acute ischemic stroke. “Nearly half of all patients treated between six and 16 hours after the onset of their symptoms were largely spared from the consequences of their stroke,” said the trial’s principal investigator, Gregory Albers, MD, the Coyote Foundation Endowed Professor of Neurology and Neurological Science and the director of the Stanford Stroke Center. The number of stroke patients who died or were confined to nursing homes was nearly cut in half, the biggest improvement seen in any stroke-related trial to date. Key to the study’s findings is a growing understanding that strokes spread through individual brain tissue at different rates, Albers said. It’s not so much the amount of time elapsed since a stroke began as the amount of salvageable brain tissue that determines who will benefit from stroke therapy.
CINDI DODD AND HER HUSBAND, RICK, FEEL FORTUNATE THAT CINDI WAS TREATED AT STANFORD AS PART OF THE CLINICAL TRIAL LED BY RESEARCHERS AT THE SCHOOL OF MEDICINE.
At a follow-up appointment, Dodd’s doctors showed her before-and-after images of her brain. “Before the thrombectomy, it looked like half of my brain was gone. There was no blood supply whatsoever,” she said. “After, it looked like a tree of life. My brain lit up with veins and arteries. I wouldn’t have survived without the treatment.” Ischemic strokes occur when blood supply to part of the brain is cut off by a clot in a blood vessel in the brain. The resulting lack of oxygen and glucose quickly kills brain tissue in the immediate vicinity, and the affected area continues to expand until blood supply is restored. “By the grace of God I was chosen for the study,” said Dodd, who after a year of intensive rehabilitation has returned to work part time, and is talking, walking and driving as before. “I am literally standing on this Earth as a wife and a mother because of that procedure. It saved my life.”