A "Lean" Vision Drives Stanford Hospital & Clinics Performance: Q&A With CEO Amir Dan Rubin

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Stanford (Calif.) Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery and organ transplants. It is currently ranked No. 17 on the U.S. News & World Report's "America's Best Hospitals" list and No. 1 in the San Jose Metropolitan area.

Amir Dan Rubin discusses Stanford Hospital is also internationally recognized for translating medical breakthroughs into the care of patients. For instance, Stanford Hospital recently became the first hospital in Northern California to have the Solitaire FR, a new FDA-approved device to remove blood clots, available for use.

Amir Dan Rubin leads Stanford Hospital as president and CEO. Previously he served as COO of the 832-bed UCLA Health System in Los Angeles, where he oversaw an operating budget of $1.6 billion. Since his appointment in 2011, Mr. Rubin has maintained Stanford's reputation as a leading healthcare provider.

Here he discusses how focusing on the organization's vision rather than finances, transparency and a "Lean" approach to performance improvement help him guide Stanford into a future that is better than its past 50 years.

Q: You became CEO of Stanford Hospital & Clinics in January 2011 during what could certainly be called an uncertain time in healthcare with reform and payment issues. How have you approached your role as CEO in light of those issues?

Mr. Rubin: Fundamentally as CEO, I focus on our core mission and vision. Our mission is to care, educate and discover. Our vision is to heal humanity through science and compassion one patient at a time. While we must be thoughtful with what's going on in the regulatory and payment environment, our core focus needs to always be on providing outstanding care to each and every patient we serve. We constantly focus on that ideal.

Stanford's mission and vision guide how I approach my CEO role as well, and all other factors are seen as contributing criteria or factors which we need to address. However, these factors need to be secondary issues to our goal of healing humanity, one patient at a time.  While in my role, it is important to be thoughtful and mindful about what's changing in the environment around us, it doesn't fundamentally change who we are or what we do.

Q: You mentioned Stanford's longtime mission and vision of healing humanity one patient at a time. Does Stanford have any other current goals driving its outcomes and care?

ADR: Stanford has enjoyed great success. Over the last 50 years, we have had five Nobel prizes, carried out the first heart-lung transplant in the world, and were the first in the world to use a linear accelerator for cancer treatment, among other notable accomplishments. Our big vision now is trying to have as great of an impact on the world of healthcare, if not a greater one, over next 50 years. We are working on sequencing human genomes, conducting innovative stem cell research, and we were one of the earliest adopters of electronic health records in the country. Overall, we are focusing how to visualize and advance improved, evidence-based healthcare.

Q: I imagine that working to produce outcomes to rival the great accomplishments Stanford has had in the past can be challenging. How do you encourage an environment conducive to improvement and advancement in healthcare treatment, research and technology?


ADR: I have learned to try to understand the core operations and processes beneath things, to not just accept them at face value and move on. Often when you do that, you find there isn't a lot of logic to why things are the way they are. So why not change it for the better? Here at Stanford we use the "Lean" process improvement approach or methodology. It derives from the Toyota Production System. It engages people to improve their performance and the performance of the hospital. You look at the hospital processes and identify which area is adding value, which area is delivering great value and which area is a waste of time. The Lean Process follows the idea that by systematically and continuously improving processes, and by engaging the team, we can develop an organization that is focused, every day, on being better than it was before.  

Q: Stanford is currently building a $2 billion hospital facility. A project of that scale must require a lot of hard work and dedication from you, administration and employees. How have you approached your leadership through such a large project?

ADR: The administration and I approach the project in a very collaborative and transparent way, with great rigor and discipline. From the beginning, it has been transparent. We welcomed all the necessary constituents to be involved in the design. We had teams of physicians, nurses, staff and community members thinking about the design, workflow and how to make the facility a safe and healing environment. Our project approval process was also very transparent. We probably had 100 open community meetings that presented the design of the new hospital and the key components. We had great participation from all types of constituents. As we move forward and operationalize the design, we are still thinking about the team members, the patients and the families.

We also have had a lot of engagement with Silicon Valley organizations such as Oracle, Hewlett Packard, Apple, Cisco and others. As we think of the future with the new hospital, we wanted it to be a test bed and innovation center. It has been incredible to leverage the expertise and capabilities here in California's Silicon Valley.

Q: I imagine with all the involvement of constituents and stakeholders that you received lots of perspectives and varying feedback. How do you work through all those opinions and suggestions?

ADR: First, we sorted and grouped the feedback based on the different constituent voices. We learned many great things from staff and physicians. Then we tried try to incorporate the ideas into the design itself — how the facility will flow and how patients and families will interact with the facility. We took the feedback, and at the end of the day, it is memorialized in the bricks, in the mortar, in the processes and in the information technology of the new hospital.

Q: Stanford has been able to maintain very positive revenues despite a challenging healthcare environment and while building a large new hospital facility. What has helped Stanford to maintain such positive financial management?

ADR: We think primarily about patient care.

We seek to deliver both leading edge and coordinated care — we seek to deliver the Stanford Edge as we call it. Our focus is on delivering the absolute best care possible in quality and patient satisfaction. We make sure we are delivering the most effective treatments and incorporating the latest insights to ensure the patient's best chance for surgical healing. We consider what the patient's access is like and what our delivery to meet their needs is like. We question whether we are delivering value in demonstrable performance.

That is where it all starts. If one doesn't focus on outstanding care, innovative treatments, coordinating care for patients and delivering a good care experience then you are not going to do well financially. If we focused on financial management, I think we wouldn't have our eye on the ball. We have to focus on care and then, we are thoughtful about our financial management.  

Q: What advice would you give other executives who are looking to lead their hospitals and health systems to the standards of care that Stanford has achieved?

ADR: I think being a leader in healthcare starts with a love and passion for what you do. Take the opportunity to meet with people — talk to patients, talk to staff. Understand the world through other people's eyes. Ask questions. Why are things they way they are? How are things from another's perspective? Understand the underlying processes and try to be of help and do so with great respect for others and their work. Ultimately, it is important to have a passion for what you do. Respect people and be here to serve humanity.

Additionally, being a leader of a successful healthcare organization means focusing on a vision. The organization and all of its leaders must then model values and approaches that are in line with that vision. It is about setting clear objectives and engaging team members in those efforts. For instance, for us at Stanford, it is about having big visions, big aspirations and having significant impact in the world. Meeting healthcare demands today means engaging team members, defining best practices, developing those best practices, training team members on them, redesigning processes around them, recognizing performance and then continuously improving. That approach has been effective in my career.

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