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\nClinical Professor of Medicine (PCPH) Associate Chief Medical Officer  \nSenior Medical Director for Quality  \nCONFIDENTIAL QA DOCUMENT  \nPROTECTED BY SECTION 1157 CALIFORNIA EVIDENCE CODE  \n􀁠 To gain awareness of the need to achieve higher performance in patient care, research ad education  \n􀁠 To be able to apply all parts of A3 problem solving methodology in creating improvements  \n􀁠 To acquire useful skills & tools for leading a project improvement team  \n􀁠 To adopt a schedule for project work that can achieve reportable results by May 2021  \nConfidential– For Discussion Purposes Only  \n2  \n􀁠 Case for change  \n􀁠 A3 problem solving methods:  \n− Problem statements  \n− SMART Goals  \n− Fishbones diagrams  \n− Pareto diagrams  \n− Key drivers  \n− PDCA  \n􀁠 Leading improvement project teams  \n􀁠 Project work schedule  \nConfidential– For Discussion Purposes Only  \n3  \nUS Health Care Delivery System  \n􀁠 Cost:  \n− Highest $$/capital and % GDP in the world: 18% vs 6-10% other countries 1 − $4 trillion  \n􀁠 Quality:  \n− 28th of 44 countries in life expectancy 1  \n− 33rd of 44 countries in infant morality 1  \n− 37th of 44 countries in childhood immunization rates 1  \n− 3rd highest prevalence of diabetes 1  \n− 4th highest incidence of cancer 1  \n− Leading country where out of pocket costs is a barrier to needed medical care2 − Lowest patient satisfaction rate with the system among 11 countries 3  \n− Highest rate of medical mistakes, medication errors or lab errors among 7countries  \n1Source: Organization for Economic Co-operation & Development (OECD) Health At a Glance 2017  \n2Source: Commonwealth Fund 2010  \n3 SOURCE: Davis k, [et.al. Mirror](et.al. Mirror), Mirror on the Wall: How the performance of US HealthCare System compares internationally.  \nCommonwealth Fund. June 2014  \n4 Source: Commonwealth Fund  \nConfidential– For Discussion Purposes Only 4  \nGuideline Adherence – Recent Examples  \n\n| Guideline | % | First Author/Journal/Year |\n| --- | --- | --- |\n| Test creatinine and K+ at onset and 1 yr after ACE/ARB Rx | 47% | Schmidt M, BMJ Open, 2017 |\n| Inpatient COPD management | 41% | Says D, COPD, 2017 |\n| Hepatitis A & B vaccines in chronic cirrhosis: Safety net hospital | 74% | Sclair SN, Dig Dis Sci, 2016 |\n| Facuty practice | 30% |  |\n| Hepatocellular CA suveillance in cirrhosis: Safety net hospital | 79% |  |\n| VA hopsital | 50% |  |\n| Faculty practice | 42% |  |\n| Chronic syst HF >50% of recommended dose: ACE | 72% | Chin KL, Heart Fail Rev, 2016 |\n| ARB | 51% |  |\n| BB | 49% |  |\n| Prescription of opioids to HIV patients: Treatment contract | 56% | Starrels JL, Subst Abus, 2016 |\n| Urine testing | 61% |  |\n| Follow up uric acid test in Rx gout | 50% | Doghramji PP, Post Grad Med, 2016 |\n| Acute bacterial sinusitis-offers obervation as an option | 36% | Darrat I, Ear Nose Throat, 2014 |\n| AVERAGE OF STUDIES | 53% |  |\n\nConfidential– For Discussion Purposes Only 5  \nDEFECTS PER MILLION OPERATIONS  \n1,000,000  \n100,000 10,000  \n1,000 100  \n101  \nIRS Phone-In Tax Advice  \nMammography Screening Antibiotic Overuse  \nInpatient Medication Accuracy  \nLow  \nBack  \nTx  \nAirline Baggage Handling  \nPost Heart Attack Medications  \nPreventable Hospital Deaths Prescriptions Written By Doctors  \nAnesthesia During Surgery  \nDomestic Airline Flight Fatality Rate  \nSIGMA LEVEL 􀃆 1 2 3 4 5 6  \nConfidential– For Discussion Purposes Only  \n6  \nNIH Appropriations  \nSOURCE: [https://www.faseb.org/Portals/2/PDFs/opa/2019/NIH%20Funding%20Trends%20Slide%20Deck%202019%20Update](https://www.faseb.org/Portals/2/PDFs/opa/2019/NIH%20Funding%20Trends%20Slide%20Deck%202019%20Update) pdf  \nConfidential– For Discussion Purposes Only 7   \n􀁠 New ways to make medical training more patient-centered.  \n􀁠 How to exclude redundant information from a redesigned curriculum.  \n􀁠 Strategies for increasing ","cbCaigrEUqQsbhai","https://ap.wps.com/l/cbCaigrEUqQsbhai","pdf",2383615,114,"English","# A3 Project Management\n## Case for change\n## A3 problem solving methods\n## Leading improvement project teams\n## Project work schedule\n## US Health Care Delivery System metrics\n## Guideline adherence examples\n## Defects per million operations\n## NIH appropriations trends","[{\"question\":\"What A3 problem-solving methods are included in this material?\",\"answer\":\"It lists problem statements, SMART goals, fishbones diagrams, Pareto diagrams, key drivers, and PDCA.\"},{\"question\":\"What kinds of outcomes does the document aim to achieve?\",\"answer\":\"It focuses on creating improvements in patient care, research, and education by applying A3 methodology to project work and producing reportable results by May 2021.\"},{\"question\":\"How does the document justify the need for change?\",\"answer\":\"It presents performance issues in the US health care delivery system, including cost, quality, life expectancy and mortality rankings, immunization rates, chronic disease prevalence/incidence, patient satisfaction barriers, medical mistake rates, and outpatient/inpatient error signals.\"}]","A3 Project Management - Stanford Leadership Development Program – FY21 - Confidential QA Document | PDF",1792980651,287]