CELT Graduates Lead Quality Improvement Efforts throughout Stanford
Members of the Stanford primary care team at the CELT graduation (from left to right): Doris Chen, MD, Internal Medicine Doctor, Stanford Primary Care, Los Altos; Thanh Nguyen, BSN, RN; Kirsti Weng, MD, MPH, Director, Stanford Express Care; and Ria Paul, MD, Medical Director, Stanford Senior Care.
After completing 72 hours of coursework and countless hours developing and implementing quality improvement projects, more than 50 members of Stanford Health Care, Stanford School of Medicine, University HealthCare Alliance (UHA) and Lucille Packard Children’s Health graduated from the Clinical Effectiveness Leadership Training (CELT) Program on Sept. 1. Since it began in 2014, CELT has trained 241 clinical and administrative leaders in the fundamentals of improvement science, and armed them with the knowledge and tools needed to solve problems in complex organizations and support continuous improvement.
“CELT was developed to provide physicians and other health care professionals with the skills and knowledge needed to lead clinical improvement initiatives,” said David Larson, MD, Co-Executive Director of CELT. “High quality care consists of more than clinician-patient interactions. It relies on the integration of multiple systems and care teams working in unison to optimize patient outcomes.”
The seeds of the CELT program were planted by Bryan Bohman, MD, who felt compelled to bring this training to Stanford after he completed the Advanced Training Program at Intermountain HealthCare more than four years ago. He enlisted the help of continuous quality improvement expert Michelle DeNatale, Executive Director of Strategic Initiatives. At the time, Stanford was launching lean management, and the pair believed a team-based approach, one led by physician leaders, would be essential to gaining traction around quality improvement at Stanford. They enlisted Dr. Larson and other Stanford Medicine faculty to help design and launch the course.
“There are now more than 200 CELT-trained people out there doing great work and contributing to the critical mass we need to conduct and sustain improvement work across all of Stanford Medicine,” said Bohman, Co-Executive Director of CELT.
CELT is unique in that it requires participation by a team with an identified quality improvement project. Lecture style learning from thought leaders is combined with flipped classroom learning modules, covering a variety of topics such as quality improvement methods and tools, current challenges in health care delivery, data management, evidence-based practices, complex adaptive systems and change management. For many participants, CELT is their first experience leading a clinical improvement effort.
“As physicians, we are not trained to do improvement work,” said Joceliza Chaudhary, MD, a family medicine doctor at Samaritan Family Practice, who attended CELT with a team from her clinic (part of UHA). Their group sought to improve how they communicate delays to their patients, a gap identified in their clinic’s quality metrics. “There are physicians in every CELT group because we need to know how to be part of the quality improvement process,” said Chaudhary.
A multidisciplinary team from primary care tackled the issue of inappropriate Emergency Department (ED) visits. Ria Paul, MD, a physician at Stanford Senior Care, noticed a troubling trend—90 percent of patients were going directly to the ED without first calling their physicians. “I wanted to get involved in this project so I could connect with other departments and have their buy-in,” said Paul, who participated in CELT with colleagues from Express Care, Patient Access and the Nurse Advice Line. Together they developed a new system for informing patients how to access the 24-hour nurse advice line and the Express Care Clinic, and were able to reduce the number of patients going to the ED for non life-threatening medical conditions. “CELT opens your eyes to the bigger picture and what you can do,” said Paul.
A Cancer Center team used the CELT course to revamp its patient appointment scheduling process to reduce the number of trips patients have to make to Stanford. Its goal was to combine clinic visits with infusion treatments 90 percent of the time. Although team member Donna Healy said the process was difficult to implement, the team has exceeded its goal. Today, 92 percent of all patient clinic and infusion visits are coupled. “CELT taught us to embrace tensions between competing objectives,” said Sri Seshadri, Vice President of Cancer Services who completed the CELT training with his clinic teams.
These are just some of the quality improvement wins fueled by CELT training. CELT alumni from the first four cohorts continue to lead improvement work, and cite their CELT training as invaluable.
“One of the things that has been so transformative over the past several years with this course and others like it is that we have stopped complaining about ‘problems’—we’re looking at ‘opportunities’ to make our workplaces better, to make our patients’ lives better and to make our care better and more valuable,” said Ann Weinacker, MD, SHC’s interim Chief Quality Officer, who participated in the very first CELT Cohort at Stanford. “We are coming together in multidisciplinary groups, learning how to work in teams, learning to standardize what we do and learning to listen to each other.”