Meet the Expert

David Larson, MD is an Associate Professor of Pediatric Radiology and Vice Chair of Education and Clinical Operations with the Department of Radiology at Stanford University, School of Medicine.  Dr. Larson is also one of the co-founders of the CELT and RITE program at Stanford Medicine, and currently oversees both programs.  We had the opportunity to ask him some questions regarding the programs.

Meet the Expert – Dr. David Larson

The Office of Research had the pleasure of interviewing Dr. David Larson about two programs he co-founded here at Stanford Health Care, the Clinical Effectiveness Leadership Training (CELT) and the Realizing Improvement through Team Empowerment (RITE) programs.  Here is what he had to say about these innovative and solution-based programs.

Q: Can you tell me about your role and what you do at Stanford?

A: I am a Pediatric Radiologist and the Vice Chair for Education and Clinical Operations in the Department of Radiology at Stanford. I also oversee a number of our quality improvement programs at Stanford Medicine, including the CELT and RITE programs.

Q: How did the CELT/RITE programs come to be?

A: The CELT program was conceived of Dr. Bryan Bohman, who was at the time the outgoing Chief of Staff, and was looking for a way to bring greater capability for improvement to Stanford. He enrolled in the Advanced Training Program, then led by Dr. Brent James at Intermountain Healthcare. Dr. James is now on faculty here at Stanford and wanted to bring a similar training program to Stanford, so Michelle DeNatale, Executive Director of Strategic Initiatives at SHC, spearheaded a workgroup to design and implement the program. I had recently arrived from Cincinnati Children’s Hospital, where we had a similar program, so I joined forces with Bryan as the co-Director of the program. Michelle was the Administrative Director of the program for the first several cohorts as it got on its feet, and then handed over the reins to Ben Elkins, Director of Performance Improvement.

The RITE program was started in the Department of Radiology as part of a Research and Education grant, sponsored by the Radiological Society of North America (RSNA). When our department was looking at the many projects we wanted to accomplish for the year, we found that there were far too many for a single person or quality team to tackle. We needed to engage and support the frontline staff to be able to do these projects. However, our staff had minimal experience in quality improvement methods, and we did not have a structure to support dedicated improvement projects at the time. So we combined the project management elements with the training elements into a single program, which we called “Radiology Improvement Team Education,” or RITE. After a couple of successful cohorts, the program expanded to include the entire medical center. At that time, we kept the acronym, but changed the title to “Realizing Improvement through Team Empowerment,” which we feel better represents the program.

Q: What are the goals of each program and how do they differ?

A: The goals of each program are two-fold: 1) to enable meaningful and sustained improvement in organizational performance through team-based projects, and 2) to train and empower teams and individuals to be effective improvement leaders.

The RITE program is more focused in that it consists of 10 two-hour sessions over a period of 18 weeks, whereas the CELT program consists of 10 full-day sessions over the same period. In addition to focused project execution, in the CELT program, we bring in nationally renowned speakers to provide a greater background in areas complementary to improvement such as adaptive leadership, human factors engineering, and complex adaptive systems management. The CELT program is, essentially, “RITE plus,” in that the morning consists of visiting speakers and the afternoon consists of RITE.

Q: What are some of the major accomplishments from these programs?

A: Project teams have made a number of important improvements in the organization, ranging from decreasing the time from onset of stroke symptoms to treatment, increasing the number of primary care patients referred to mammography, to decreasing inappropriate use of our intermediate care facilities.

Here are our to-date projects and breadth of participation so far:  

  • Current Projects: 21
  • Current Participants: 143
  • Upcoming publications/posters: 10
  • Total number of completed Cohorts: 11
  • Number of graduates: 340
  • Projects completed: 67

Q: What challenges have you faced running these programs and what were they?

A: Believe it or not, the biggest challenge we have is finding a room to hold the RITE sessions!

The challenges we have faced in running the programs are mainly those that you would expect in running any program over a long period of time. There are constant logistical challenges. We also are constantly working to ensure that we are meeting a real need in the organization and providing real value. But we have been delighted to see the broad support from leadership and faculty and staff at every level across the institution in supporting these programs.

In addition to ensuring the quality of the programs, we also work hard to ensure that the programs nicely complement’s other efforts in the medical center. We do not want to have a program for the sake of the program, and we definitely want to avoid competition between programs. We are in constant communication with institutional leaders, especially quality leaders and those leading other training programs to ensure alignment and reduce duplicate work.                                                                  

Q: What is one big takeaway you hope people get from completing these programs?

A: Our goal is that those who complete these programs will have a whole new perspective on how to improve performance in a complex environment like healthcare. We hope that participants will better appreciate the power of teams, better understand how organizations work as systems where systems tend to break down, and be able to interpret and use fact-based performance data to drive improvement. We want to help people become better problem-solvers, both as individuals and as teams.

People often tell us that they have been working on a problem for many years and had given up hope that they could solve it. Through the program, they were able to solve this problem that seemed unsolvable, and also gained the ability to solve other problems. That is exactly what we are trying to accomplish.

Q: As you continue to expand the program, what advice do you have for potential applicants looking to take part?

A: The primary points of advice we give to those entering the program are:

  • Improvement is often harder than you think it should be, so plan to put in some real effort.
  • Many aspects of improvement are counterintuitive, but improvement methods can be learned.
  • To be effective at improvement, you need to trust and follow the process.

If you have further questions about the CELT or RITE program, or if you want to be on the e-mail list for the next call of projects, please e-mail celt@stanfordhealthcare.org.

Article By: Monique Bouvier & Sana Younus

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