Beyond Medical School: Stanford Holds SOS Training for Physicians

In January of this year, Stanford Health Care (SHC) leadership launched a six-week course targeted at physician and administrative leaders. The course spanned six months and was led by hospital leaders such as Amir Dan Rubin, James Hereford and Bryan Bohman, MD. The goal, according to Bohman, was to reach as many leaders in the organization as possible with fundamental principles of improvement and management as applied to health care.

"We are aiming for a major shift in the way we look at clinical processes throughout the organization," adds Bohman, associate chief medical officer. "There's a dawning understanding in medicine that there needs to be fundamental changes in how we deliver care."

Crash course in leading improvement efforts

The course brought the basics of the Stanford Operating System (SOS) to a targeted group of 200 physician and administrative leaders, according to one of the course creators, James Hereford, chief operating officer.

"The goal was to develop a common set of knowledge and expectations regarding the Stanford Operating System," says Hereford, "And to help attendees understand the leadership expectations within it and the improvement methodologies implied by it."

The first session, known as the core class, began with an overview of the mandate for change, and covered the basic tenets of the management system, focusing on leadership and the key principles/behaviors that are expected from leaders. The second session focused on the role of physicians as team leaders in this model, with strategies for coaching, change management, behavioral change and leading improvement events.

Subsequent sessions reviewed the lean principles being employed throughout the hospital such as 5S, visual control, value stream mapping, A3 thinking/problem solving and group cause analysis, as well as applying improvement methodologies to the clinical care process.

Why SOS?

But how does this current improvement methodology differ from other efforts launched by SHC in the past? According to Hereford, the one big difference is that SOS includes and engages management. "A fundamental part of the Stanford Operating System is the role that leadership and management play in sustaining, supporting and driving ongoing improvement," he says.

For many of the physician attendees interviewed for this article, the fact that the courses were taught by hospital leadership was powerful. Having Rubin and Hereford presenting sent a signal to everybody, says Paul Maggio, MD, assistant professor of surgery. Clinical Associate Professor of Medicine Lisa Shieh, MD, agrees. "Having your leaders come out and organize and be part of this type of thing is really valuable."

But some physicians such as David Spain, MD, chief of acute care surgery, went into the training with a good deal of skepticism. He'd seen Stanford launch a number of quality improvement initiatives over the years, and watched as these efforts were replaced with the newest QI fad. "The question is," says Spain, "Is this stuff going to stick? Is it going to be different this time?"

Spain says many of the principles covered really resonated with him. He especially appreciated the idea that leaders must define their expectations of others and hold people accountable as a sign of respect. He also sees a real need for some level of standardization of processes in medical care at Stanford. "There's a culture of innovation and individualization here," he says. "That's why so many things have come out of Stanford." But a lot of what we do can be standardized, he adds. "If you standardize 80 to 85 percent of the routine stuff we do, then that frees you up to be creative and innovative in that 15 to 20 percent of patients or situations that really need it."

With the training concluded in June, Hereford believes that physician attendees are now equipped to support the ongoing improvement efforts in their areas as well as the larger scale efforts underway in the organization. They also have the tools to identify new areas for improvement and drive new improvement efforts.

"We're not actually taught these skills in medical school or residency," says Shieh, who uses active daily management and visual production boards to track discharges. "Learning them now is really useful."

Beyond managing processes

In a continuation of the physician SOS training, the hospital is launching a new course in October – Clinical Effectiveness Leadership Training or CELT. The CELT course is based on many of the same principles as the rest of the SOS, but is less focused on workflows and more on improving the medical decision-making process.

"We don't want to just get really efficient and reliable at delivering suboptimal medical care," says Bohman, who is developing the course. In the past, our care processes have mostly relied on doctors to know what to do in all circumstances and to get it right every time, he adds. But medicine has become too complicated.

"We have to have better processes around medical decision-making: guidelines, clinical pathways, order sets and protocols," says Bohman. "Medicine is a very old profession, but a very young industry," he adds. "If physicians want to remain the leaders of health care in this country, we really need to lead this kind of work. That's why we're hoping our colleagues will engage in this huge effort and drive it forward. Frankly, if they don't, the whole thing will fail."

Stanford is currently recruiting participants for the ten-session CELT course, which will start in October and conclude next spring.

By Grace Hammerstrom