Stronger together

Walking down the long, sunny first-floor corridor that connects Stanford Health Care to Lucile Packard Children’s Hospital Stanford, Lloyd Minor, MD, the then-newly named dean of the School of Medicine, noticed something unusual. Along the ceiling, clustered in triplets about every 50 feet, were three sets of Wi-Fi routers.

Minor, who had arrived just months earlier in October 2012, soon learned that the School of Medicine, the adult hospital and the children’s hospital each had its own, separate Wi-Fi system. It was, Minor thought, a metaphor for how siloed the three entities were. “I realized we had a lot of work to do,” he said.

He wasn’t the only one who sought a more cohesive environment. That organizational need was championed by faculty and staff, and led to an unprecedented milestone for Stanford Medicine’s three entities: In January 2017, the three leaders of Stanford Medicine — Minor; David Entwistle, president and CEO of Stanford Health Care; and Christopher Dawes, then-president and CEO of Stanford Children’s Health — kicked off a process to form an integrated strategic plan.

All academic medical centers engage in research, education and clinical care, and Stanford Medicine’s leadership sought to braid these objectives together. The medical school and both health care organizations all embrace the mission to lead the biomedical revolution by bringing precision health to people around the world.

Their leaders know that this will require collaboration between the researchers, educators and clinicians at their institutions as well as scholars across the university. But without a framework for ongoing cooperation, their efforts would fall short.

“It was a bold and achievable vision that also pulled in some of the related academic areas in both pediatrics and obstetrics.”

Stanford Children’s Health had already recognized the need for this type of framework in 2015, when it developed its own 10-year strategic plan to help guide the organization beyond the opening of the new Lucile Packard Children’s Hospital Stanford. “It was a bold and achievable vision that also pulled in some of the related academic areas in both pediatrics and obstetrics,” Minor said.

In 2016, Entwistle joined Stanford Health Care as the president and CEO. He was vocal in his enthusiasm for creating a joint plan, and his energy and vision galvanized the process.

“We have some of the brightest, most creative minds in the world right here at Stanford,” said Entwistle. “What we needed was to organize and collaborate in a way that would enable us to not only adapt to a rapidly changing future, but to play a major role in shaping that future. It was exciting to join the organization just as it was fully harnessing its potential.”

Together, the three organizations got down to basics: What are our shared values? And where do we want to be in 2025? Where are we today with regard to our aspirations? With those questions in mind, a diagnostic phase began. In January 2017, the integrated strategic planning team — led by Priya Singh, senior associate dean for the School of Medicine and chief strategy officer for Stanford Health Care, and Sean Hennessey, chief planning officer for the School of Medicine — sent a diagnostic survey to 16,000 individuals across the three organizations. By April, they had nearly 4,000 responses.

“During that phase, we wanted to find out: How do people feel? Do they even see a need for a strategy?” said Singh. “And we were thrilled that people really did. From the survey responses and from the one-on-one interviews we did, what we heard consistently was that the people at our organizations were hungry for strategic direction.”

The survey responses were measured on a scale of 1 (lowest) to 5 (highest). The highest responses reflected enthusiasm from faculty and staff for Stanford Medicine’s purpose, which received an average score of 4.1, and its activities and roles, which scored 3.7. The lowest scores were in decision making, and in processes and systems/information technology, both at 3.1.

“We found that there was remarkable convergence and support for our mission, our vision and our values,” said Entwistle. “But there was a need for clarity — clarity about the relationship among the three entities, clarity about our priorities and clarity about how decisions were going to be made moving forward.”

Singh, Hennessey and the team analyzed the survey results, sorted the responses into 13 subject areas, and created workgroups — each with two to four faculty or administrative co-leaders — to write in-depth reports on the challenges and opportunities in each area. Starting in August 2017, each group met at least twice a month, focusing on its area, such as digital health and innovation; promoting fundamental discovery; precision health; safety, quality and value; people, culture and community; and translational medicine.

“Our key measure of impact lies in the discoveries we make right here at Stanford that go on to help people the world over and to move health care forward.”

The faculty workgroup for promoting fundamental discoveries, for example, reflected on Stanford’s remarkable history of discovery in the basic sciences — from the biochemistry of DNA replication and repair in the 1960s, to research in the 1990s that led to complete genome sequencing and genetic treatments. “Although our foundations in basic science are strong, we can’t take them for granted,” said Suzanne Pfeffer, PhD, professor of biochemistry and co-leader of the workgroup.

“We had to address several challenges for the coming years: decreasing federal support, increasing costs and competition for resources. Amid those challenges, we’re drafting recommendations that will augment Stanford’s existing vitality in research, support foundational discoveries in basic science that lead to cutting-edge clinical diagnostics and therapeutics, and enable new insights that can benefit the health worldwide.”

Sanjiv “Sam” Gambhir, MD, PhD, professor and chair of radiology, saw the inherent value of capturing Stanford’s worldwide influence in improving health. “Our key measure of impact lies in the discoveries we make right here at Stanford that go on to help people the world over and to move health care forward,” Gambhir said. “Discovered here, used everywhere.”

Enthusiasm for the process was building along the way, with new ideas emerging in the town hall meetings, open house events and retreats — attended by hundreds of stakeholders, and often hosted by Entwistle and Minor. Faculty and staff were essential participants, raising questions and issues and providing their input and influence. The collective effort to shape the future of Stanford Medicine — and of science and medicine itself — was catching on.

“What makes this such an exciting process is not only are we trying to improve what we are now and how we take care of our patients now, but we’re also trying to anticipate where medicine is going, and how we’re going to be a high-value organization for patients in the future,” said Dennis Lund, MD, interim president and CEO of Stanford Children’s Health since Dawes’ retirement in March 2018. “The way we deliver health care in 2025 is not going to be the way we deliver health care today. And so we’re trying to anticipate that. Like the old Wayne Gretzky saying, we’re trying to skate where the puck is going, not where the puck is.”

“The way we deliver health care in 2025 is not going to be the way we deliver health care today. And so we’re trying to anticipate that. Like the old Wayne Gretzky saying, we’re trying to skate where the puck is going, not where the puck is.”

From December 2017 through January 2018, the strategy planning team analyzed the white papers from the workgroups and began to pull the themes together. “That’s when the three big priorities emerged,” said Hennessey, “and our set of potential initiatives for the strategy.”

Those priorities — value focused, digitally driven, uniquely Stanford — now provide the heart of the plan, the basis for guiding future initiatives, tactics and decision-making for all three institutions.

“Finishing” the plan wasn’t — and isn’t — part of the plan, said Singh. “There is no such thing, we hope, as the ‘final stage.’ We absolutely do not want the strategic plan to be final in a way in which we can say, ‘Oh, it’s done,’ and it sits on a bookshelf and starts to gather dust. We hope it will be a living, breathing guide to this organization on an ongoing basis.”

What they have created is a roughly 2,000-word document enunciating the strategic priorities, goals and performance measures and outlining an annual planning process. This spring Stanford Medicine’s leadership shared the plan at a town hall meeting and with the university’s board of trustees. 

For Mary Leonard, MD, professor and chair of pediatrics and physician-in-chief of Lucile Packard Children’s Hospital Stanford, the integrated strategy was “a very ambitious step,” she said. “It addresses everything from promoting fundamental discovery all the way to health care delivery models in this changing environment.”

In June, the plan was already in motion: Stanford Medicine announced the formation of a team working on digital health care integration for Stanford Health Care, which will first focus on telehealth and a virtual second-opinion program. A new leadership position was also created at the School of Medicine, associate dean of industry relations and digital health, to focus on developing relationships with corporate entities, investors and foundations that accelerate innovation related to digital health.

“We’ve set a road map for the next five to 10 years ahead. It’s a dynamic process that will evolve as our ideas and thinking evolve, as the market changes, and as faculty and staff personalize it to their individual work areas.”

“We’ve set a road map for the next five to 10 years ahead,” said Entwistle. “It’s a dynamic process that will evolve as our ideas and thinking evolve, as the market changes, and as faculty and staff personalize it to their individual work areas.”

Meanwhile, the workgroup meetings have had a lasting impact. Since serving on the safety, quality and value workgroup, Christine Cunningham, administrative director of patient experience for Stanford Children’s Health, and her counterpart at the adult hospital, Alpa Vyas, vice president of patient experience, have drafted shared standards and goals for patient experience at both hospitals, and presented updates at the monthly committee meetings.

“Before this, Alpa and I would bump into each other at conferences and say, ‘We need to get together! We need to get together!’ and rarely found the time,” Cunningham said. “We are now forced — in a good way — to spend time together talking about how we’re different, how we’re the same and how can we look at the continuum of care together.”

Robert Harrington, MD, professor and chair of medicine, and co-lead on the workgroups for precision health and care delivery models, remarked, “Throughout the entire process of creating the integrated strategic plan, there was engagement of faculty and staff across all entities of Stanford Medicine. The discussions were data-driven and collegial, and all voices were heard. It was a great example of the collaborative working environment that is Stanford University.”

In 2017, the university began its own long-range planning process, which was an opportunity for the university and Stanford Medicine to develop a shared future. The long-range plan builds on precision health and focuses on developing solutions with regional partners for preventive and population health. “The collaboration between Stanford Medicine and the rest of the university has really deepened in the past few years,” said Persis Drell, PhD, provost of Stanford University.

“When we’re all rowing in the same direction, can you imagine how much stronger we’ll be?” 

Together with the university, Singh embraces the idea of the three entities synchronizing their strokes. “When we’re all rowing in the same direction, can you imagine how much stronger we’ll be?” she said. “I think our impact and our ability to do more for human health, and for humans in general across the globe, will be even more powerful.”

“We’re looking to change health care for the better, across the Bay Area, across the country, across the world,” Cunningham said. “The message I hope our patients, families and communities get is: We are one Stanford — even though we have different pockets and different tentacles — and these things are really important to us: to be uniquely Stanford, value-focused and digitally driven.”

For Minor, it’s a far step ahead from his first days at Stanford Medicine. “Several people who have been here for years have come up to me and said, ‘You know, the School of Medicine and the hospitals have never worked as well together as they are now,’” said Minor. “And that’s very meaningful to me. That holds promise not just for Stanford Medicine, but for all the lives we hope to improve.”