It’s often said that patience is a virtue. If you ask healthcare executive Amir Dan Rubin, however, the bigger virtue is patients—caring for them, that is. As president and CEO, Rubin leads one of the top academic health systems in the United States: Stanford Health Care, in Stanford, California, which includes three hospitals, 855 licensed beds, 10,000 employees, 1,700 faculty and medical group physicians, 1,000 interns and residents, 1,000 volunteers, and tens of thousands of lives in its health plan and IPA operations.
What’s most impressive about Stanford Health Care, however, isn’t its size—or even its volume, which includes more than a million ambulatory visits every year. It’s its organizational vision—“Healing humanity through science and compassion, one patient at a time”—and the lengths to which it’s going to fulfill it.
During a recent conversation with American Healthcare Leader, Rubin discussed those lengths, which include a clear vision, an innovative “lean” performance-improvement management system, and a leading-edge communication framework that’s transforming the “user experience” in the tech-based tradition of Stanford’s Silicon Valley neighbors.
How did you become interested in healthcare in the first place?
Amir Dan Rubin: I studied business and economics as an undergraduate in college. While I had some exposure to hospitals through prior community-service volunteer opportunities, I didn’t really become aware of the potential for a career in healthcare administration until I took a health-economics class at the University of California–Berkeley, just because it fit in with my schedule. That opened my eyes to this exciting and impactful field. I realized, “Wow! You get to work with amazing and talented people and deal with something that’s really important: people’s health and well-being. Plus, there are a lot of challenges; it’s complex.” I decided then that healthcare would be an exciting place where I could make a difference.
You’ve had an impressive career. Not only do you have an MBA and a master’s in health administration, but you’ve also worked for some very prestigious medical institutions, including Memorial Hermann Health System in Texas, Stony Brook University Medical Center in New York, and UCLA Health in Los Angeles. What is it about academic medical systems, in particular, that appeals to you?
ADR: I am drawn by the broad mission of trying to fundamentally improve the world through excellence in patient care, education, and research. Moreover, the people are so incredibly talented and committed—including, literally, Nobel Prize winners. These amazing physicians, faculty, staff, leaders, and board members are there to make fundamental impacts on healthcare and society. I also like the complexity of the multiple missions and the drive for constant innovation. I like the change and the opportunity to make significant impacts in the world of healthcare. Also, academic health systems are very complex organizations, so there is often a lot of opportunity to improve performance, process, service, and execution, and that really appeals to me as well.
It’s clear why you, personally, are attracted to academic health systems. But what do those systems contribute to the larger healthcare landscape? What do they, uniquely, bring to the healthcare table?
ADR: Great question. They bring a lot. I think I’ll answer that by sharing a little bit about Stanford. We’ve got a pretty big vision here. Our vision is: “Healing humanity through science and compassion, one patient at a time.” We also have a mission, which is to not only care but also to educate and discover. The linear accelerator for radiation therapy was invented here, for instance. The CyberKnife [Robotic Radiosurgery System] was invented here. The first heart-lung transplant in the world was done here. Balloon angioplasty was developed here. One of the first targeted cancer treatments using monoclonal antibodies was developed here. The blood-forming stem cell was identified here. A lot of the breakthroughs in genomics have been discovered here. So, in terms of “healing humanity,” I think we’re making a dent in that with health innovation and health technology.
However, we are also seeking to heal humanity through compassion, one patient at a time. To that end, Stanford Health Care has a strategic goal of delivering leading-edge and coordinated care—combining the best in innovative treatment and delivering highly coordinated and compassionate care to patients. Stanford Health Care pursues its leading-edge and coordinated-care strategy across four strategic domains, and we’re innovating across all of them with new approaches. In our “Complex Care” domain, we seek to coordinate treatment of very complex conditions, leveraging multidisciplinary panels of clinicians to determine diagnoses. In fact, the “tumor board” concept of a team of doctors and staff reviewing new cancer cases was first launched at Stanford. To coordinate such complex care, Stanford Health Care has developed integrated programs and facilities where teams of oncologists, neuroscience specialists, and cardiac experts converge around patients rather than having patients traverse multiple appointments across numerous facilities.
In our “Network of Care” domain, we are seeking to redesign ambulatory and regional care. Using lean- and design-thinking approaches, we are undergoing a “Primary Care 2.0” redesign, where physicians and care team members work together in new ways to manage both population health and precision care delivery.
In our “Virtual Care” domain, we deliver online care and operate employer on-site clinics. For example, we were the first to deliver video visits fully integrated into Epic, which is one of the big electronic health record systems.
Finally, there’s our “Accountable Care/Population Care” domain. Here we leverage Stanford’s talents in big data as well as care management to operate our own health-plan offerings for commercial business and our own Medicare Advantage plan.
In general, what we seek to do here at Stanford Health Care is to innovate, deploy, and then spread new ways to heal and care. Along with other organizations, we see ourselves as part of an innovation ecosystem.
“In general what we seek to do here at Stanford Health Care is to innovate, deploy, and then spread new ways to heal and care. Along with other organizations, we see ourselves as part of an innovation ecosystem.”
What allows you to be such a big part of that innovation ecosystem?
ADR: At our core, innovation is part of our mission and vision, which includes research and education alongside patient care. We have the unbelievable privilege of being part of Stanford University, which provides our overarching framework for seeking to make positive impacts on society. We have the great fortune of attracting incredible faculty and staff who are aligned to our mission and vision. And then, of course, it’s incumbent on us to put in place the processes and systems to support these people and execute. So it’s three things, really: it’s mission, it’s people, and it’s processes.
How about you as a healthcare executive? What’s your role in all of this? How have you leveraged your management background to activate, catalyze, and otherwise enable all of this innovation?
ADR: I’ve always said to myself, “I want to make a significant, positive impact on health and healthcare delivery.” That’s at the core of what motivates me. To that end, at Stanford Health Care we try to achieve these aims through our approach to management, which we call our Stanford Operating System. The Stanford Operating System is based off of lean-thinking approaches and also leverages approaches from human-centered design thinking and insights from behavior-change concepts.
The Stanford Operating System includes three broad categories of approaches of how we all try to lead and manage at Stanford Health Care, not just how I seek to operate. The first category is what we call “Strategic Alignment and Deployment.” That’s a fancy way of saying: What are we trying to accomplish? What are our goals, and are we on the same page—whether it’s in a department, in a division, or across the broader health system? The second component is “Improvement,” or “Value Stream Improvement”: how do we improve our processes and operations, and how do we engage each of our team members or staff in improving the process? The third area is what we call “Active Daily Management”: what do we need to do each and every day to sustain our performance and to support continuous improvement? Thanks to our talented team members working in our Stanford Operating System, although we’ve doubled in size over the last few years, our quality scores, service scores, and employee-engagement scores have never been higher.
Does it also help that you’re in Silicon Valley? Are you able to leverage your geography to advance your mission and vision?
ADR: Sure. We are impacted by, influenced by, and part of the Silicon Valley ecosystem. One way that comes out is in our focus on the patient experience and our leveraging of human-centered design-thinking approaches pioneered here in Silicon Valley and at Stanford—and used by many of the great technology companies here in the Valley. We’ve used lean concepts, design thinking, and user-centered design, where we engage patients in process improvement. In fact, we have probably 150 patients on various different improvement committees. We also have what’s called ethnographic approaches and empathy-mapping approaches, where we have mapped out the experience for patients by observing them not only in hospitals or clinics but also in the home—sometimes even at work— and trying to solve for core problems. Employing the lean approaches and design-thinking approaches that other innovative companies here in Silicon Valley use is very helpful.
Your point about the patient experience is really interesting. What’s wrong with the patient experience in general, and how is Stanford Health Care improving it?
ADR: In general, in healthcare, we say, “Patients, we’ll let you know when you’re satisfied.” That’s been the historic model. It’s not that healthcare professionals weren’t outstanding and caring but that the whole system didn’t come together for patients.
Let’s say you want an appointment, for instance. How do you get an appointment? Who should you get the appointment with? Now let’s say you have a complex condition and you need multiple appointments and treatments. How do you organize that? Furthermore, do you know who you’re talking to? Do you know who’s on the team? Have they introduced themselves to you? Do you know what’s going to happen to you? Do you know what’s going to happen next? Do you know where to go if there are any issues or challenges? We are trying to own all of that complexity for the patient—and design processes and experiences around it.
At a basic level, that requires great processes. That’s where lean principles, process improvement, and user-centered design come in. We’re engaging patients to find out how we should design things, whether it’s new buildings or new ways of communicating.
For example, we use a philosophy called C-I-CARE, which stands for: (C) connect with people by calling them by their proper name or the name they prefer; (I) introduce yourself and your role; (C) communicate what you’re going to do and how long it’s going to take; (A) ask permission before doing something; (R) respond to concerns and anticipate needs; and (E) exit courteously, explain what happens next, and ask people if there is anything else you can do for them. We’ve taken this basic concept and applied it multiple places. For example, what should a nurse do when he or she comes into your room? What about a doctor? How should residents introduce themselves? Or a faculty member? We’ve had teams of doctors, nurses, and housekeepers define best practices in communication, and we’ve built those into our hiring practices, our onboarding processes, and our training. We’ve now sought to transparently share our performance with our patients and their families. Indeed, they can go to our website, search a doctor, and see doctor-specific patient-service scores and direct, verbatim patient-feedback comments—good and bad.
To have a great patient experience, we believe we need outstanding people supported by great processes, best-practice communications approaches, and excellent facilities—all designed with the needs of patients and families in mind. We need to hire, train, standardize, coach, reward, and recognize around these concepts. When we do these things, our patients truly appreciate it, as evidenced by our patient-satisfaction “likelihood to recommend” scores, which have increased from the 43rd percentile in the nation to the 95th percentile.
That’s great. What’s the end goal? What are these efforts leading to?
ADR: The goal is to deliver the absolute best patient experience anywhere. Period.
Editor’s Note: At the time of publication, Amir Dan Rubin had accepted a new position at UnitedHealth Group.