Unabashedly enthusiastic and optimistic, Amir Dan Rubin frequently emphasizes the theme that, “At Stanford, we are focused on healing humanity through science and compassion, one patient at a time.”
Since becoming the president and chief executive officer of Stanford Hospital & Clinics in 2011, he has strengthened the hospital’s reputation as a leading health care provider and been a driving force in a major modernization project to develop new state-of-the-art facilities. He has also been instrumental in the hospital’s efforts to adopt “Lean” performance improvement practices, which are derived from the Toyota Production System, and integrate best practice patient communication approaches known as “C-I-CARE.”
This fall at Medicine X, Rubin will teach a Master Class on Stanford Hospital & Clinics’ approach to performance management. Although his Master Class is sold out, you can still sign up for the waiting list during registration. In the following Q&A, Rubin discusses the involvement of patients in developing C-I-CARE, how the initiative has enhanced communication approaches and patient care and his motivation for teaching a Master Class at Medicine X.
Q: What prompted the development and implementation of C-I-CARE at Stanford Hospital & Clinics?
A: When I joined Stanford Hospital & Clinics in early 2011, efforts were already underway to improve the patient experience. The primary points of focus were telephone etiquette, way-finding and service recovery, and each department had identified templates specific to their areas. These were positive starts, yet our patient satisfaction scores were still lagging. So I challenged our managers to expand our efforts to reach every patient, every time, via every employee. The approach we took is a communications and care-delivery framework called C-I-CARE, which stands for Connect, Introduce, Communicate, Ask, Respond and Exit. Each of those steps is designed to establish relationships with our patients based on recognition and respect for them as individuals.
Q: What role did patients and their families play in shaping the C-I-CARE communication approaches?
A: Patients are at the very heart of our efforts. According to a J.D. Powers and Associates study released last year, interactions with health care professionals had a major influence on patients’ overall satisfaction with their in-patient experience. Those interactions were much more important than other factors, such as the quality of the hospital’s facilities. It was also notable that interactions with caregivers in outpatient settings had an even greater impact on their satisfaction levels.
To assure patients’ perspectives were reflected in C-I-CARE, we created a patient advisory council to solicit feedback. Moreover, each day an employee from our performance excellence team speaks with four to five patients about their care, their interactions with staff, and their overall hospital experience. Every interaction we have with our patients teaches us something new, and we’re continually incorporating those learnings in our approaches.
Q: You introduced C-I-CARE in March 2011. What are some examples of how the initiative has enhanced patient communication approaches in an effort to deliver optimal care?
A: Some of the most obvious and quantifiable improvements we’ve achieved are seen in the results of our patient surveys, administered by Press Ganey. For instance, one year after implementing our C-I-CARE practices, the likelihood of a patient to recommend care at Stanford’s Cancer Center skyrocketed from 22 percent to 72 percent. And in the hospital’s inpatient units, the likelihood to recommend climbed from 73 percent to 92 percent.
Additionally, we regularly receive patient letters praising our staff for their caring and compassion. The most illuminating examples are those from repeat patients who write to tell us that their most recent experience was a significant improvement from past visits.
Q: Looking forward, how is Stanford Hospital & Clinics expanding on this initiative and continuing to use “Lean” methodology to improve and mange performance?
A: C-I-CARE is an introduction to “standard work,” which is the basis for lean management. A basic understanding of Lean is that you must have standards in order to have improvement. Our process begins with orientation for every new employee and is supported with annual training requirements. Moreover, our managers participate in monthly C-I-CARE rounds, during which they visit both clinical and non-clinical areas across the enterprise to observe and coach employees, and provide rewards and recognition. We also speak with patients and their families to learn what’s working and where we need to improve, and then report back to the larger group. This feedback loop allows us to monitor our progress and identify new areas in need of attention. The key is to continuously practice and model this behavior so that it becomes woven into the fabric of our culture.
Q: In teaching a Master Class at Medicine X, how do you hope to impact the current conversation about health care?
A: At present, the media is filled with stories about the high costs of health care, and those are important conversations to be had. However, when we focus entirely on costs, we run the danger of losing sight of our ultimate goal of healing patients. There are many ways to reduce expenses in health care but most of them involve reducing the level of care we provide, rather than improving it. I believe initiatives like ours will improve both patient satisfaction and the quality of care delivered, while reducing the inefficiencies that drive up unnecessary costs. We are creating a genuine win-win situation at Stanford Hospital & Clinics, and it can be replicated throughout health care.