STANFORD HEALTH CARE
A PUBLICATION FOR EMPLOYEES OF STANFORD HEALTH CARE
ISSUE TEN / WINTER 2015
THE STANFORD OPERATING SYSTEM PHARMACY & SECURITY OUR PATIENTS NOW
from the CEO
PAGE TWO News and Notes From Around SHC...
Dear Colleagues, I am pleased to introduce you to this issue, which features a cover story on our Stanford Operating System. The Stanford Operating System is our approach for aligning our strategies and goals, improving our value streams and processes, and pursuing active daily management and C-I-CARE. Moreover, the Stanford Operating System is based on a core foundation of seeking continuous improvements and showing great respect for people. As we advance together in our Stanford Operating System, we can further position ourselves to reach new heights in leading edge and coordinated care. Also inside, you will read a fascinating example of the kind of “medical mystery” that brings many patients to SHC in search of answers. In this case, thanks to the persistence, collaboration, and innovation of our clinical team, a U.S. Navy
Have you seen the SHC television commercials? They are airing throughout the fifth season of Downton Abbey, as well as during other popular shows like The Tonight Show Starring Jimmy Fallon, Saturday Night Live, CSI, The Good Wife and House Hunters … You may have noticed that the new hospital continues to rise out of the ground and is now five stories and counting. It’s 25 percent complete and on schedule. We’ll be celebrating the completion of the building frame in March. This will be a significant milestone for the project, as the last steel beam will be placed at the top of the building … Construction of the 70,000-square-foot Stanford Cancer Center–South Bay continues on schedule, with a planned opening in July 2015 … Thirty-four teams at SHC and eight at UHA have been recognized for their outstanding achievement in their Likelihood to Recommend scores for the
six-month reporting period between May and October 2014. Three SHC teams reached the 99th percentile sustained level, meaning their LTR scores have been at the 99th-percentile for six months or more. Those teams are the Dermatology Surgery Center, Positive Care Clinic and Stanford Coordinated Care clinic … Wear pink and show your support for breast cancer awareness at the Stanford vs. Cal women’s basketball game on February 22 at Maples Pavilion. Go to gostanford.com for tickets … The first annual Stanford Heart Fair will be held on February 28 at the Crowne Plaza Hotel in Palo Alto. Screenings for common heart disease risk factors will be available during the four-hour event. Guests will also have an opportunity to hear presentations and ask questions of Stanford Medicine heart experts. Register by calling 650-736-6555 or visit stanfordhealthcare.org/heartfair.
pilot who was grounded for seven long years was finally able to return to the skies. You will also learn about a dedicated team of colleagues who volunteer their free time to helping
STANFORD HEALTH CARE PEOPLE IS PUBLISHED BY
SHC OFFICE OF COMMUNICATIONS
those less fortunate in our communities. I hope you find insights and inspiration in this issue. Thank you for your continued efforts to heal humanity, through science and compassion, one patient at a time.
GARY MIGDOL EDITOR, DIRECTOR OF INTERNAL COMMUNICATIONS KATIE LIPOVSKY COMMUNICATIONS SPECIALIST GRACE HAMMERSTROM CONTRIBUTING WRITER JAMES LARKIN DIRECTOR OF CORPORATE COMMUNICATIONS/PR SARA WYKES CLINICAL AFFAIRS WRITER NORBERT VON DER GROEBEN PHOTOGRAPHY
Sincerely, AMIR DAN RUBIN PRESIDENT & CEO
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STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015
Send comments and story ideas to communications@stanfordhealthcare.org
ON THE COVER: Top row (L to R): Aileen Molina, RN; Chad Hannah; Mala Mandyam, MD; Sophia Loo, RN. Center photo: Jason Hom, MD, participating in on-unit team rounds.
from the CEO
PAGE TWO News and Notes From Around SHC...
Dear Colleagues, I am pleased to introduce you to this issue, which features a cover story on our Stanford Operating System. The Stanford Operating System is our approach for aligning our strategies and goals, improving our value streams and processes, and pursuing active daily management and C-I-CARE. Moreover, the Stanford Operating System is based on a core foundation of seeking continuous improvements and showing great respect for people. As we advance together in our Stanford Operating System, we can further position ourselves to reach new heights in leading edge and coordinated care. Also inside, you will read a fascinating example of the kind of “medical mystery” that brings many patients to SHC in search of answers. In this case, thanks to the persistence, collaboration, and innovation of our clinical team, a U.S. Navy
Have you seen the SHC television commercials? They are airing throughout the fifth season of Downton Abbey, as well as during other popular shows like The Tonight Show Starring Jimmy Fallon, Saturday Night Live, CSI, The Good Wife and House Hunters … You may have noticed that the new hospital continues to rise out of the ground and is now five stories and counting. It’s 25 percent complete and on schedule. We’ll be celebrating the completion of the building frame in March. This will be a significant milestone for the project, as the last steel beam will be placed at the top of the building … Construction of the 70,000-square-foot Stanford Cancer Center–South Bay continues on schedule, with a planned opening in July 2015 … Thirty-four teams at SHC and eight at UHA have been recognized for their outstanding achievement in their Likelihood to Recommend scores for the
six-month reporting period between May and October 2014. Three SHC teams reached the 99th percentile sustained level, meaning their LTR scores have been at the 99th-percentile for six months or more. Those teams are the Dermatology Surgery Center, Positive Care Clinic and Stanford Coordinated Care clinic … Wear pink and show your support for breast cancer awareness at the Stanford vs. Cal women’s basketball game on February 22 at Maples Pavilion. Go to gostanford.com for tickets … The first annual Stanford Heart Fair will be held on February 28 at the Crowne Plaza Hotel in Palo Alto. Screenings for common heart disease risk factors will be available during the four-hour event. Guests will also have an opportunity to hear presentations and ask questions of Stanford Medicine heart experts. Register by calling 650-736-6555 or visit stanfordhealthcare.org/heartfair.
THE
STANFORD OPERATING SYSTEM
Our Approach for How We Do Our Work at SHC
W
pilot who was grounded for seven long years was finally able to return to the skies. You will also learn about a dedicated team of colleagues who volunteer their free time to helping
STANFORD HEALTH CARE PEOPLE IS PUBLISHED BY
Thank you for your continued efforts to heal humanity, through science and compassion, one patient at a time.
OF GOALS BY MOBILIZING HUMAN CAPABILITIES IN A PLANNED,
GARY MIGDOL EDITOR, DIRECTOR OF INTERNAL COMMUNICATIONS KATIE LIPOVSKY COMMUNICATIONS SPECIALIST
COLLABORATIVE WAY.
GRACE HAMMERSTROM CONTRIBUTING WRITER
That concept is at the heart of the Stanford Operating System. SOS,
JAMES LARKIN DIRECTOR OF CORPORATE COMMUNICATIONS/PR
Hereford says, is “a mindset that creates an environment where all
NORBERT VON DER GROEBEN PHOTOGRAPHY
Sincerely,
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THE WORK DONE SOLELY BY ADMINISTRATORS OR
SENSE, ONE THAT APPLIES TO ALL OF US: THE SYSTEMATIC PURSUIT
SARA WYKES CLINICAL AFFAIRS WRITER
AMIR DAN RUBIN PRESIDENT & CEO
OPERATIONS LEADERSHIP, HE IS NOT TALKING ABOUT
MANAGERS. HE IS USING THESE WORDS IN THEIR MOST UNIVERSAL
SHC OFFICE OF COMMUNICATIONS
those less fortunate in our communities. I hope you find insights and inspiration in this issue.
HEN SHC’S COO, JAMES HEREFORD, TALKS ABOUT
Send comments and story ideas to communications@stanfordhealthcare.org
ON THE COVER: Top row (L to R): Aileen Molina, RN; Chad Hannah; Mala Mandyam, MD; Sophia Loo, RN. Center photo: Jason Hom, MD, participating in on-unit team rounds.
A COMMON OCCURRENCE AT SHC IS THE FORMATION OF A MULTIDISCIPLINARY TEAM TASKED TO WORK THROUGH A CRITICAL ISSUE USING THE SOS APPROACH. HERE, THE PATIENT FLOW VALUE STREAM IMPLEMENTATION TEAM DISCUSSES IMPROVEMENTS TO PATIENT PROGRESSION.
SHC employees are engaged as active problem solvers in a continuous improvement process leading to exceptional performance.” CONTINUED ON PAGE 4
STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015
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CONTINUED FROM PAGE 3
there is a common approach to aligning goals, improving value streams and pursuing active daily management with C-I-CARE. “SOS blends all our efforts together to create a harmonious end result that resonates for patients, staff, faculty and society,” he said.
LUPE HOGAN, LIVER TRANSPLANT PROGRAM MANAGER IN FRONT OF HER TEAM’S VISIBILITY WALL.
SOS addresses how work is done at SHC, whether that’s
“SOS truly enables the partnership of leaders and front-line staff to problem-solve together.”
space use in the Emergency Medicine Department or how multidisciplinary rounding takes place on nursing units. First exposure to SOS has often come from staff engagement in improvement initiatives in their areas. Many managers and staff have participated in training programs in the SOS approach. Ultimately, development of the SOS will integrate all employees as partners in improvement initiatives through education, training and improvement work. “The Stanford Operating System is our approach for engaging our organization to continuously manage and improve our performance,” said President and CEO
In a clinical metaphor, not using the Stanford Operating System is similar to a heart beating with atrial fibrillation, said Janet Rimicci, SHC’s Vice President, Performance Excellence and Operations. “The heart works very hard, but because the chaos of the rhythm, the output is low. Once the heart is converted to a standard normal sinus rhythm, as SOS provides, the effort decreases, the output increases, and the body is healthier,” she said. Understanding the need for a more systematic method
Amir Dan Rubin. “It encapsulates how we define and align
of management, like SOS, is not difficult. “Health care
around goals, improve our value streams and operations,
happens in a complex operating environment,” Hereford
and pursue active daily management to support outstanding
said. “Ours is a highly regulated and litigious world at
results to each and every person we have the privilege
local, state and federal levels. Our best outcomes are
of serving,” he said.
accomplished when our patients are highly involved in
SOS is designed to build a culture of quality work maintained by continuing improvement. “SOS brings transparency to problems and engages all the staff and leadership in pursuing improvements,” said Mino Sastry, a director in Facilities Services and Planning. All employees now use the Stanford Operating System in some way—whether through goal setting, value stream improvement, A3 works, or active daily management activities of huddling, reviewing metrics on visual walls, rounding and practicing the C-I-CARE philosophy. “My mental model is that the Stanford Operating System
the process of their care. There are thousands of people working together to deliver care, and that care is highly dependent on communication and management of complex information. There is little room for error because our mistakes can have life-and-death consequences for our patients.” Addressing those many challenges with a mindset that never stops addressing problems or developing innovations is where SOS begins. One key element that enables the best SOS outcomes is “establishing and fostering trust
is like the conductor of a symphony providing a framework
between the patient and the caregiver through work
that brings together the various instruments in an orchestra,”
that is predictably excellent,” said SHC Vice President,
said Sridhar Seshadri, SHC’s Vice President, Cancer and
Ambulatory Care Tim Engberg. “SOS also gives SHC
Cardiovascular Services. “With SOS we all understand that
employees a chance to know their work so well that they
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can begin anticipating patient needs in ways that will
#StanfordOperatingSystem
surpass patient expectations.” Engberg is referring to the SOS concept of standard work and the collaboration through which those standards are built. “SOS truly enables the partnership of leaders and front-line staff to problem-solve together,” said Tim Seay-Morrison, Administrative Director, Support Services. “The SOS management system provides an environment
#StanfordOperatingSystem was created to achieve our mission and vision, uphold our values and execute our strategy.
and structure for our staff to be involved on a daily basis— and it’s an approach that shows respect for their experience and knowledge,” said Shirley Weber, Interim Executive Director, Laboratory, Pharmacy and and Radiology Services. “Every day thousands of people come to Stanford Health
We respect others, making every effort to understand each other, and taking responsibility to do our best and to build mutual trust. This is a principle of the #StanfordOperatingSystem
Care because they need our care,” said Doug Gunderson, Vice President, Operations–Diagnostic and Treatment Services. “The Stanford Operating System allows us to treat every patient with leading edge and compassionate
#StanfordOperatingSystem is our approach for how we do our work at SHC. It aligns purpose with people and performance.
care of consistently high quality.” As SOS evolves and becomes the SHC way of life, practiced by all, Seshadri said, “it will dramatically improve the experience for the patient, make health care more cost
The principles of the #StanfordOperatingSystem are continuous improvement and respect for people.
effective, and enable each of us to learn and grow in what we do at work.”
“My mental model is that the #StanfordOperatingSystem is like the conductor of the symphony who brings together various instruments,” —Sridhar Seshadri, SHC VP.
Supply Chain improvement events using #StanfordOperatingSystem tools netted SHC an annual savings of approx. $12 million.
Wherever you do your work, you’re in the Gemba. At SHC, we go to the Gemba to find facts and understand how the work is done. #StanfordOperatingSystem
RUDY ARTHOFER, TRANSITION STRATEGY (LEFT), CAITLIN HAVER, SPACE PLANNING (TOP RIGHT) AND YAEL MARKLEY, PERFORMANCE IMPROVEMENT (BOTTOM RIGHT) BRAINSTORMING POTENTIAL FACILITY CHANGES DURING THE ED 3P DESIGN EVENT.
The #StanfordOperatingSystem is composed of two systems: the management system and the improvement system.
STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015
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Management System The Management System creates the environment to identify, support, and sustain our improvement activities. It’s our “doing” system. It is comprised of three systems designed around the patient: Strategic Deployment, Active Daily Management, and Value Stream Management.
STRATEGIC DEPLOYMENT How we share our plans and execute our goals and strategies to become preeminent.
ACTIVE DAILY MANAGEMENT Tools & methods that help us sustain our performance standards, such as huddles and visibility walls.
VALUE STREAM MANAGEMENT Methodology for designing and continuously improving our processes in order to deliver value in all our patients’ experiences.
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TOOLS Our tools, such as A3, 5S and C-I-CARE templates, help us continually improve processes.
SOS is our approach for how we do our work at Stanford Health Care. It’s a people development system. The principles of SOS are continuous improvement and respect for people. It is composed of two systems: the Management System and the Improvement System, with its foundation in C-I-CARE.
Improvement System Comprised of Leadership & Coaching, Tools, and Methodology. It’s our “thinking” system. It is how we develop our team to operate effectively in our management system by creating a mindset for improvement.
LEADERSHIP & COACHING By modeling the way, leaders and staff demonstrate how to lead within SOS, i.e. C-I-CARE.
A
P
C
D
METHODOLOGY It’s our systematic approach to problem-solving.
STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015 7
FOCUS ON Security From directing traffic flow and providing directions to investigating thefts and standing by for patients who may be a danger to themselves or others, the in-house Stanford Security Department is responsible for ensuring the safety of all persons coming onto the medical center campus and into its ancillary buildings. This includes the adult and children’s hospitals and clinics, the School of Medicine, the Cancer Center, and the UHA and PCHA clinics. “I liken the size of our jurisdiction to a small city,” says Aaron Salazar, Director of Security. The department, he says, is staffed as such with 95 employees, 72 of whom are uniformed officers. Twenty-four hours a day, a team of 15 officers patrols in vehicles, by foot and on bicycle, with a dispatch center
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team on the ground floor of the hospital monitoring information coming in from 800 security cameras and thousands of access card readers and alarm points. “It’s a challenging environment,” says Salazar. It includes retail, food, revenue collection, parking, banking, transportation and traffic flow. “Not only are we charged with protecting patients, families and staff,” he says, “but also researchers, students, visitors, guests, even intellectual property.” To manage the diversity, the department tailors its security to each unique location. Because of the sensitive patient population at the children’s hospital, security officers identify and badge every person who comes through its doors. The adult hospital is monitored by foot patrol officers and security
cameras, but its emergency room is protected by an officer and a metal detector, which Salazar says removes about 140 dangerous objects off people every month. Facilities that house sensitive material require authorized card access. As opposed to contract security firms, Salazar says, Stanford hires officers who can be proactive and autonomous in the field. They receive 10 weeks of training, learn verbal de-escalation techniques and do not carry firearms. “Our motto is to protect with integrity,” he adds. One such security officer, Art Carranza, returned to work at Stanford after military duty in Iraq. “People come to the hospital because something is wrong,” he says. “It’s nice to be the first person they see and help them with their situation and maybe even brighten their day.”
PROVIDING SAFETY AND SECURITY TO THE MEDICAL CENTER CAMPUS ARE DIRECTOR AARON SALAZAR (TOP PHOTO, RIGHT), OFFICER RUBEN LEDESM (BOTTOM LEFT), AND COMMUNICATIONS DISPATCHER STEVEN SIRIVAN (BOTTOM).
FOCUS ON Pharmacy Services Stanford Health Care Pharmacy Services touches nearly every patient who comes through its doors. With a team of approximately 70 clinical pharmacists and 60 pharmacy technicians, Pharmacy Services manages roughly 14,000 medications given to patients each day. All of that activity is generated through the central pharmacy on the ground floor of the hospital, multiple hospital satellite pharmacies, and three outpatient compounding pharmacies located in ambulatory care centers. “Our intent is to be entirely patientfocused, and each medication represents the trust our patients have bestowed on us with their care,” says Deepak R. Sisodiya, PharmD, MHA, BCPS, Director of Pharmacy. “We take
MARIA LUISA LABARDA, PHARMACY TECHNICIAN, HELPS MANAGE MEDICATIONS FOR PATIENTS.
TECHNICIANS, SUCH AS JONATHAN SCHULER, HELP ENSURE PATIENT SAFETY.
this responsibility very seriously and have implemented numerous controls to ensure each medication is truly the right therapy, both clinically and qualitatively, for that individual.” Multiple checks by technicians and pharmacists are conducted to reduce medication errors. On the floor, nurses use barcode scanning to ensure that the medication dispensed matches the physician orders. “Bedside scanning creates a closed circle for safety,” says Jonathan Schuler, lead pharmacy technician. Safety and efficacy are the department’s primary concerns, says Faye Tsung, PharmD, lead pharmacist for Oncology, but speed and efficiency are a close second. One way the department ensures rapid dispensing of common medications is to keep the most frequently used medications stored in automated dispensing Pyxis cabinets on all nursing units. The role of the SHC pharmacist is evolving; these clinicians are not only applying the most cutting-edge treatment therapies but are helping to ensure that patients have successful transitions regarding medication management, adds Sisodiya. Pharmacy technicians work to reduce negative medication interactions by conducting medication reconciliation with patients admitted through the Emergency Department. In some ambulatory
“Our intent is to be entirely patient-focused, and each medication represents the trust our patients have bestowed on us with their care.” practice settings, it is the pharmacist who manages the medication of chronic disease populations. Pharmacists also counsel many patients to ensure that they have a sound understanding of how to use their medication therapies correctly. In the Redwood City Infusion Treatment Center, Tsung and her team are able to meet with every chemotherapy patient for first-dose counseling. “I believe pharmacists need to talk to patients when they start chemotherapy,” says Tsung. “We can minimize the potential for adverse events.” STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015 9
KUDOS October Service Spotlight Award
GREG ROSELLINI, MD SHC’s critical care team had worked hard to save the life of a young man whose prognosis was uncertain. When he passed away despite the team’s best efforts, it was hard on everyone. Greg Rosellini, MD, a long-time Sacramento emergency medicine physician at Stanford for a critical care fellowship, wanted to do something that would ease the pain of the young man’s parents. At just the perfect moment, Rosellini delivered a cast of the young man’s hands to his grieving parents.
November Safety STAR Award NEETA GAUTAM, MD AND HELENE JERNICK, RN When front desk staff at Stanford Primary Care/ Portola Valley looked out the window and saw two cyclists, one struggling, they quickly asked Neeta Gautam, MD, and Helene Jernick, RN, (below) to help out. The two men had been
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training for a 40-mile bike race when one became dehydrated in the heat of the day. Gautam and Jernick immediately began giving the man fluids and monitoring his vital signs. Bobby Esquivel, MA, drove the other man to his van. By the time they returned, the first cyclist was feeling much better.
November Service Spotlight Award SHEAKH SAHIB The best patient experience begins with caring, competent people like Sheakh Sahib, which is why he was honored with the November Service Spotlight Award. A patient’s words may summarize the qualities Sheakh Sahib demonstrates at work: “He is one of the most valuable people in your hospital. He filled me with a sense that I was greatly cared for—and that feeling spilled over and colored my entire experience in your unit.”
December Service Spotlight Award TONI EDGEMAN When patients encounter difficulties navigating through a large organization, one person can make all the difference. Toni Edgeman, the winner of December’s Service Spotlight Award, is one such person. Edgeman, a supervisor for UM/CM at Affinity, recently went out of her way to address a patient’s questions, coordinated with others in her organization who could also be helpful and provided Stanford with documentation important for the patient’s care. This is not the first time Edgeman has gone beyond the call of duty—but it stands as an example of how Affinity, UHA and Stanford Health Care can successfully work together to create a consistently strong patient-centered experience.
December Service Spotlight Award ANGELA BINGHAM AND SOPHIA LOO SHC cardiac nurses Sophia Loo and Angela Bingham (above) were on a flight in December returning to the Bay Area. Before the plane left the ground, however, a flight attendant called out for help: A passenger needed medical assistance. Both nurses recognized that the passenger was in cardiac distress, and they immediately started CPR. Flight attendants brought them the automated external defibrillator. The AED showed that the man’s heart was in a life-threatening rhythm and advised a shock. Finally, paramedics arrived to help, too. By the time they hand-carried the passenger out of the plane—the aisle was too narrow for a gurney—he was conscious again.
FOLLOW US @SHCPride To celebrate you, our employees, we’re launching a new Twitter feed called SHC Pride. We’ll be sharing employee recognitions, awards, videos and photos that highlight the people and tremendous work being done on behalf of our patients at Stanford Health Care. You’ll also have an opportunity to recognize your teammates. Follow us @SHCPride. We’ll be live in February.
GOOD WORKS SHC DIRECTORS WORK WITH REBUILDING TOGETHER ANNUALLY ON A COMMUNITY PROJECT.
At SHC New Clinical Pathway Reduces Mortality From Sepsis To improve the hospital-wide sepsis mortality rate of 20 percent, a team of nurses, physicians and quality managers created a new clinical pathway for sepsis detection and treatment. The goal, says Andrea Segura Smith, RN, senior quality consultant, is “to detect sepsis earlier, decrease the variability of care and bring critical care resources to the bedside as quickly as possible.” Nurses continue to screen patients for sepsis at least twice each day but now complete the screening earlier, by 9 a.m. and 9 p.m. If a patient screens positive for simple sepsis, the nurse immediately contacts the physician and charge nurse. If it’s severe sepsis or septic shock, a specially trained crisis nurse is also called to the bedside to ensure that blood cultures
and a lactate test are ordered and that antibiotics and intravenous fluids are started within an hour. “The pathway created standard work and clearer expectations,” says Patricia Britt, RN, patient care manager of B3 and C3, where the program was piloted. “It also elevated the sense of urgency.” In September, there were zero deaths from sepsis on B3 or C3 for those patients who screened positive. The team met new screening guidelines 90 percent of the time and administered antibiotics to 100 percent of sepsis positive patients. The new pathway was rolled out to the entire hospital in November.
In the Community SHC Directors Come Together for the Community When Anna Dapelo-Garcia became a director at Stanford nine years ago, she
(L TO R): LISA SHIEH, MD, PH.D, PETYA ATANASOVA, RN, AND PATRICIA BRITT, RN, ARE AMONG THE TEAM MEMBERS WHO HAVE HELPED IMPROVE THE SEPSIS MORTALITY RATES ON B3 AND C3.
wondered why there were no avenues to network and get to know her peers. So together with Kate Surman and Buffie Wuestewald, she created the Director’s Forum. Today, in addition to networking opportunities, the group reaches out beyond the walls of the hospital to help in the community. Every April, a group of SHC directors volunteer their weekend time to a community project organized by Rebuilding Together–Peninsula to improve a personal residence or business in the Palo Alto community. Last year, 25 volunteers from Stanford repainted the interior of the MayView Community Clinic. The year before, they did a major yard cleanup and painting for a disadvantaged family. “What I love is the happiness and deep appreciation from the people we serve,” says Cindy DePorte, who helped organize volunteers for the program. “I’m also impressed with the level of work and service our employees deliver to the community.” The Directors Forum also supports the Adopt-a-Patient program at the Medical Respite Center in San Jose, a 15-bed transitional medical unit housed in a homeless shelter. In December, the group adopted 26 patients, providing them with personal gifts such as socks, hats, scarfs, gloves, rain ponchos, notebooks, gift certificates and pens. “We’re all very fortunate to be here, to be a director at Stanford,” says Lisa Meyer, who coordinated Stanford’s involvement in the Adopt-a-Patient program. “Many of us think we need to do more for our community. This program gives us a way to give back.” STANFORD HEALTH CARE PEOPLE / ISSUE TEN 2015
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OUR PATIENTS NOW
Navy Pilot Flying Again Even before Robert Buchanan graduated from high school, he had a vision of what he wanted his life to be. Like many others in 1987, he’d seen the movie Top Gun and fallen in love with the idea of being a fighter pilot. He worked hard for that dream—earned a bachelor’s degree in mathematics and was accepted to the U.S. Navy’s Officer Flight School in Pensacola, FL, where the characters in Top Gun had trained. “I remember the day I checked in and realizing that this was my dream come true,” Buchanan said. In the years that followed, he devoted himself to flying in the service of his country. Typically, he was at the controls of a Hornet, a supersonic jet aircraft that most people might recognize from the Blue Angels air shows. On March 20, 2006, that all changed. Buchanan, flying back from a mission at about 27,000 feet above the sea and 450 miles from the nearest base, noticed some powerful decompression surges in the normally pressurized cockpit of the jet. He was wearing an oxygen mask and, as all aviators do, knew the symptoms of oxygen deprivation and how to react. What he was feeling was very different. “I remember the feeling of incapacitation,” Buchanan said, “and then there was some sort of lapse.”
At 9,000 feet, Buchanan regained consciousness, but the incident left him with a strange constellation of symptoms: an irregular heartbeat and a cluster of issues on his left side—a drooping eyelid, dissimilarsize pupils, sensitized sinus on the left face, jaw pain and neck swelling. He was ruled not physically fit to fly. He was grounded for almost seven years. “Everyone who was around me then can attest to the fact that an aviator who is grounded is not a happy person,” Buchanan said. He was seen by dozens of doctors and none could pin down the problem—until he arrived at Stanford. At first, however, his Stanford doctors were also stumped. Edward Damrose, MD, chief of the Division of Laryngology, had never encountered anything like it in his 20 years of practice. Damrose enlisted Jayakar Nayak, MD, PhD, one of Stanford’s top sinus specialists; Andrea Kossler, MD, co-director of the Ophthalmic Plastic, Reconstructive Surgery and Orbital
Oncology Service at the Byers Eye Institute at Stanford; and a multidisciplinary team of other specialists. It was a mystery to all, but they kept looking, finally discovering that air was rushing into places in Buchanan’s head and neck where it wasn’t meant to be. After nearly two years of treatment, a slew of procedures (some developed for Buchanan’s condition) and more than two dozen incremental surgeries, Buchanan is flying again and now commands a squadron. His condition, never before documented, now has a medical name, and others can learn from his history. “My focus for the future is being a good commanding officer, making sure that the lessons I’ve learned I can impart to others,” Buchanan said. “That’s the pinnacle of an aviator’s career.”
Find more patient stories at stanfordhealthcare.org/now.