TownHall: How Lean Methodology Led to a Culture Change of Collaborative Problem Solving
Episode 2514th March 2023 • This Week Health: Conference • This Week Health
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Today on This Week Health

you have to lead with.

inquiry And not answers. Too often we were put on the spot to have answers, but problems are way more evasive today. And inquiry and empathy always brings you to the solutions because everyone will then engage more,

Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

Hello, I'm Sue Shade, principal at Starbridge Advisors and one of the hosts for the Town Hall Show. Today my guest is Ed Teki. Ed has been the c o at Stanford Children's Health, Lucille Packard Hospital for the past 14 years. Ed and I have known each other since, well before he took on that role. He has decades of experience in our industry and he is been a mentor and role model for many, including me, and I really have learned a lot from Ed over the years.

So I'm looking forward to our conversation today. Welcome Ed.

Thanks, Sue. Great to see you. And we're all mentors for each other and thank you for everything, Jill.

How true. We all learn from each other. Well, let's start by having you introduce yourself and describing Stanford Children's.

Yeah. Well, I've been very gifted.

e West Coast and came here in:


I mean, it's pretty amazing.

don't know why, but everywhere I. Things just multiplied. We are now the largest pediatric health system with over 60 locations in Northern California. And top 10 children's hospitals last three years in a row. Pretty amazing for only 30 year old institution.

Wow. I didn't realize it was that new.

Yes. Congratulations on all of that. So let's

you know,

I know you're retiring soon, so can you share some highlights on what you and your team have accomplished during your 14 years and some, as you just described, tenure at Stanford Children's?

Yeah. Well, I mean, it's really been an incredible place and


I recall the chairman of the board when he interviewed me, said to understand that this is about innovation and sharing it and.

Really an amazing place with the Stanford Medical School and campus and also the adult hospital. And it's really a place to discover new stuff and move the needle in science. But I think one of the best things we did early on was we said this is about a service culture. We're not a technology culture.

We're a service. And we changed our name like within a month of me coming here to Information Services. And we adopted and I helped launch Lean for the entire company lean Management System, which taught us all about being servant leaders and going to Gemba to find out what the real issues are and helping the front lines do problem solving.

I mean, so many things came together when I came here. It was just incredible, and that led us, I mean, we've quadrupled in size. We are now two and a half billion in revenue from 600 million and a hospital only When I came we launched, through partnerships heavy governance and partnerships we launch.

Really advanced digital health programs analytics program that is him seven level rated and really highlights the partnerships, the quality finance and research, not just the IT part. And it's already six years ago, but we tripled the size of our hospital and expanded it 200%.

new technologies in:

That's great. Can you comment on the digital health transformation roadmap a bit in terms of , what's in there that you haven't already done?

Well, I know I wanna distinguish digital health versus digital transformation. Okay. Digital health is only one aspect of. that we launched years ago. We were doing 30 or more percent of our visits during Covid were on telehealth and we've sustained it.

But digital transformation has to do with every aspect of the business. Efficiency, taking waste out, improving customer access return. Things,

you know,

predictable processes instead of manual variance. And so we did a complete opportunity assessment in the last three months across all of the organization leading, led with a digital taskforce.

So, rpa, robotic process automation. We have a couple pilots going. They're extremely successful already. At the same time, we're gonna be implementing a whole new e r P system in the next two. . And that's a huge opportunity to take takeaways and automate. So the DT roadmap is broader than just the digital health.

Got it. Okay. Thanks for the clarification really gets into all business aspects and processes. Right. Okay. Right, right.

But on the digital health front, not only did we advance telehealth, we do a lot of continuous monitoring now, more and more for patients cause we have the highest acuity.

Case mix and this in the country for children and a lot of our kids are long term, have to be cared for, have to come back. So we've developed monitoring tools in that to take out the variance of batch data. And we can see the predictions now when kids need to come back. So we're building that more and more in our digital health. 📍

tuations a family can face in:

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you know,

When you talk about DT digital transformation and the processes, it's a good segue into the topic of lean, which I wanna get into more. You've been a lean, leveraging lean methodologies. You mentioned that you actually brought it to the entire organization. I didn't realize that you can maybe describe that, but describe how you leveraged it in it in particular, but more broadly and what some of the key components were, because I think this is an area that a lot of people can learn.

when I came here, we were studying that, it was very early Seattle Children's had launched. We launched about my second year in the job and I was the exec sponsor and I partnered with the chief of Surgery who was our model line. So we developed it there and we trained the entire organization.

He became the leader the next year when he took over. Chief Quality Officer and then we spread it to the whole company. And in is we focused on couple core things. Like lean is very big. Yes. But what problems are you trying to solve? Then? What tools of lean are you gonna use? What we needed was to develop a service company with strong team in is.

And we used lean we launched it with visibility boards. Every person who reported to me plus me has a it's called, and for one hour each week, we round on those vis walls. We get seven minutes each, and it's reporting out variances and exceptions and. That was a culture change because a lot of people like to hold problems.

They don't like to expose 'em.

Mm-hmm. , ,

this was, oh no, problems are gold and it's a team sport. , you have to do it. And that led to, transparency was the other key ask. So visibility of data and transparency. and it became a weekly process. Well, what happened was my team came, which was seven or eight people, I think now we have nine boards, including security, including the cto, associate cio.

But all of their directors started coming immediately and key partners. So this became a thing to. The leadership, it was a leadership development thing around coaching, around inquiry.


Instead of top down decision making. We were consulting each other live.


Talking about these issues and that it wasn't owned just by that person.

It might have to be supported by two or three other groups. Most of the time it takes two or three groups in is


to solve issues. Right. Right. It ain't just the applications group or whatever. So I, it's incredible. We have, here's some of the outcomes, Sue. If number one, we implemented structured problem solving mean A three is a tool that is company wide.

, which is amazing. I mean, instead of all the emotion, and this is what I want. , we go through structured problem solving. I think the other thing that came out of it was, and I've been the exec leader to this day, we have an enterprise goal that's up at the CEO level and the board it's called and it, we titled it every day improvement ideas, but 80%.

Team members across the enterprise, the goal is 80% will be involved in an improvement in implementing an improvement, and we've hit the target the last three years. So that means 80% of every employee in the company. Has to participate in a team implementing an improvement. It is so we, that's the way you bring it home, right?

We encourage problem solving, we encourage transparency of problems, and we've built this great partnership culture with the clients from is as a result of this. Let me just say one other key aspect we did with it, which. Standard lean, but because of my consulting experience building markets, we have a service area leader named for every area of the business, whether it's the heart center the pharmacy, radiology, the business office.

And that service leader pre Covid had to go to that gemba twice a week to look for opportunities and partner and they. Single point of accountability for that service area with is, and then my team and I meet with those service area leaders every other week to hear what's going on in the company. So,


I'll stop there.

I do get excited about it, as you can tell.

I love it. I love it. No, it's your soapbox. And I remember, I can't remember what organization I was at, but I did a call with you at one point to kind of pick your brain about all this, because I was trying to roll out lean methodologies and visual boards within it at some of the organizations I was at and.

It's interesting to hear you describe it and how broadly it's been adapted within the whole organization. It's difficult when one part of the organization is trying to do it and it's not coming to, oh, you gotta have the whole company do it. Yeah. So I've been in organizations where it was.

Broader than it. And somewhere I've just, I've been the one kind of pushing it. But yeah. Excellent.. So for people who aren't familiar with all the terms, you mentioned gamba a couple times, not everybody might know what Gamba is.

What's your

Yeah. Sorry, we take it. Prescribed. Gemba is defined as the place where real value is produced. So you could say technically, Only the patient care areas are the real value. Right? That's what we're here for. Yes. That's exactly what we did when we renamed is we had every IS employee go on patient rounds.

Okay. That year. But you can define it also in your own department. For us. Standby is now. Department. And where is our value produced? Well, it's not produced in conference rooms. It's produced by the employees. And each team has their own bial in addition to the leadership ones.

And there's a huddle system where data rolls up daily. Yep. Even to the executive. We have an executive daily huddle for 10 minutes across the enterprise, and it's part of a tiered huddle system every day. Yep. Great. So information is flowing immediately. No more. Waiting for an email to get answered.

Right, right.

I've also been in organizations where we had that kind of structure in terms of the huddles. That's great. So, and with you leaving, and we'll get into that in a minute I'm certain that everything you just described is not gonna walk out the door with you as the leader who is retiring cuz it's so much part of the.

It's what people do. It's not dependent,

not only part of the culture of I us, it's part of the company culture and they really love it. They love our partnership. We have super high scores on every level you can imagine.

That's great. That's great. Well, let's switch gears again, Anne. I wanna talk a little bit about innovation.

So Stanford is in the San Francisco area, Silicon Valley. How have you been able to position. Your organization to develop innovative solutions for patients, families, and the business overall, and especially leveraging that proximity to so many start. Yeah.

Well first of all, I think we set up governance when I got here.

So we had is exec committee, the whole C-Suite is on that. And that goes on. And when we form new areas like digital, , they have their own standing committee and then they report up to IS exec. So that brings it going and we also for, 12 of the years I was here, we had a board committee for is, and people from the community and that's when we were going through a lot of the whole epic conversion and a lot of big investments.


And the building, it kind of made sense. We tracked off that. I think the other thing, Sue, is, the cult presence with the School of Medicine and Stanford we are leveraging their advanced data sciences groups in AI and machine learning.

And one of the things we recently published and studied was ability to use AI to look at imaging and do bone age assessment, which is very critical in, and those are one of the breakthroughs. Did here. We're also heavily involved with biomedical informatics at Stanford. And frankly we were the first AC G GME credentialed Clinical Informatics fellowship at Stanford.

And the host site is Stanford Children's. So our CMIO is leads it , and we're generating these people every year, two to three graduates every. and they work both in industry and with us in advancing things. And quite a few tools we've developed. Billy Rubin prediction and cutting off UV light so kids aren't getting too much.

, based on science and not just visual judgment. We were part of Natalie Pager's top door, cmio. Was named MD IT leader by Ames and HS two years ago. And she will carry on here as well when I leave. But she was very influential in getting Apple Health Kit to make their product viable for pediatrics cause their special needs when.

You're dealing with pediatric patients and families and privacy. That thing, didn't work for pediatrics for quite a few years and we now have integrated that with home monitoring for some of our patients with glucose and other things. We've also developed lot of innovative stuff with our building way, finding early on was developed in-house.

We now have a patient family mobile. Which includes way finding and scheduling and everything. And

you know,

one of the other things I like, and it's kinda simple, but we have a teen van and it goes out difficult areas and treats underserved and homeless kids. And it, and I helped raise money for it every year.

I've actually been out on it. We linked it With Epic. So it can get into MyChart and look where patients may have been. we also help kids access services through that. So that's actually a personal mission of mine. I'll continue in retirement kind of along with the opioid task force and stuff that we started in China.

But I, I'm very big on it and. really, it's one of those missions we need to do more of. We're very high end academic, but in communities right around us, there's homeless children and

you know,


you know,

really need help and we're a lifeline.

one is on CSO priorities for:

We have Eric Decker within our mountain, Shauna Hofer with St. Luke's Health System out of Boise, Idaho, and Vic Aurora with Hospital four Special Surgery. And we are gonna delve into what are the priorities for security? What are we seeing? What are the new threat? What is top of mind for this group? If you wanna be a part of these webinars and we would love to have you be a part of them, go ahead and sign up.

You can go to our website this week,, top right hand corner, you'll see our webinar. And when you get to that page, go ahead and fill out your information. Don't forget to put a question in there. one of the things that we do, I think that is pretty distinct is we. like for today's webinar, we had 50 some odd questions that we utilized, in order to make sure that the conversation is the conversation that you want us to have with these executives.

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That's great. see the passion in your face when you started talking about it and you did mention the opioid task force with Chime, which I know is another passion.

You were instrumental in establishing it and have been co-chairing it. Tell us a little bit more about that.

Well, we had a personal tragedy and I am an engineer, I need to do something about stuff. So I said to some friends at the table when they, we were out here and something's gotta happen better.

And so we built it , five years ago. We basically said, look, what can we do from time? I mean, we can't be end all. We're not everything can't boil the ocean, but we can leverage technology and we can connect people and we can, we're connectors.

And so we built this action center, a website, public website called the opioid Action. And it's running today. And we're doing, it's basically for sharing leading practices around the country. And number one, we built a playbook for hospitals to get opioid stewardship under management better.

And it's being rewritten now and updated cause things evolve over five years.

Mm-hmm. ,,

there's a lot more work now in harm Re. That needs to take place because we're not winning the war. , the opioid crisis has now gotten worse with the fentanyl stuff and we're now leading places are really advancing medication that assisted treatment, but also harm reduction techniques.

And I can talk more about that. That's all on there. We do, we're doing at least a new podcast every month. We are interviewing people around the country. And leading places like Cooper Health that broke barriers and are moving the needle on helping people with addiction and getting them into recovery and keeping them there.

We have a clinical task force, some group on the opioid taskforce made up of emergency docs pain management, addiction specialists, and they're bringing things together for. And we're now then exchanging that with our leading EMR vendors, epic, Cerner, Meditech, and we're looking at advancing functionality to help people.

For example, this year, it's required by law that anybody treating Medicare is supposed to have an automated interface to their. Prescription drug monitoring program, pdmp. . And that's where we track use of pain meds and things. And if anybody has any kinda problems in that. And it's basically before you prescribe one of these meds, now you're supposed to check the state pdmp and it's supposed to be an electronic interface.

So these are some of the things we're pushing. We also have an advocacy arm in. That we've used to promote data sharing transparency et cetera. So,


and also just provisions around opiate prescriptions and bupenorphine prescriptions. So a lot of advances going on, but the problem has gotten worse, especially through covid.

And as a result of the fentanyl yeah, infusion and everything right now. .

Yeah. And I trust that you're gonna continue working with that taskforce.

I committed and I mean, I think


we're helping people and we're learning. Yeah. And if we're helping people learning and we're sharing everything's gonna rise.

Right, right. That's great. And how can people get to the Opioid Action Center if they don't know?

You can just Google Opioid Action Center and it'll come up great. And it's open to the public.

Excellent. Last question I wanna get into is, as you get ready to retire you've had an amazing career.

the Chime CIO of the year in:

Well, I think you and I are prime examples of this. The first two things I'd say is, build trust in relationships always, and network. , we learn so much from each other. You look at the stuff, we launched Chime, we launched a couple of other things. Children's Hospital has a CIO community


And you learn from each other and nobody can be the expert because the space is evolving. Right, I think the other thing is always take on not an expert attitude, but servant leadership. You, what you do for others comes back always. it's really about helping and not just your peers, everyone.

somebody just stopped. by My office to say goodbye today. And, just so heartwarming that time meant something to him all along the way,

you know,

and I'm here to help him. And it's always been that way and that kind of thing. I think work to develop others and I think one of the things I learned, Sue, I think as a cio, first I didn't know so much, but when I went into consulting you have to lead with.

inquiry And not answers. Too often we were put on the spot to have answers, but problems are way more evasive today. And inquiry and empathy always brings you to the solutions because everyone will then engage more, and then I just say finally, and as an example of the opioid taskforce, a lot of people went way beyond their.

job when they started, they volunteered there and you can go beyond your job and contribute on a broader level. You have the opportunity to do that in our role. And in a huge way. Yeah. So I, will hope to do that as I go into retirement. I'm gonna be on a couple boards and stuff like that and


my other passion and my mission here.

That's great. Well, you have a lot to be proud of in everything you've accomplished. I bet you will have many more people coming by your office this final week giving you heartwarming thank yous and stories for your leadership and everything you've done. So, that's awesome. Is there anything else you wanna highlight before we close?

I just am really grateful for.

You know,

Being in the healthcare business over 40 years and a couple different aspects grow. Relationships and teams that I'll stay connected to for a long time. Yeah. So, like I hope with you as well, Sue, so

Absolutely. We'll stay connected. I hope I know how to get to you besides your Stanford email address.

We can follow up on that. So thank you so much, ed. It's been a pleasure, truly. Thank you.

Thank you, Sue. Really appreciate your help and support and all you're doing too.

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