- Pediatric Hospital Medicine
Faculty Director, Stanford Medicine Center for Improvement (2019 - Present)
Associate Chief Quality Officer, Stanford Children's Health (2018 - Present)
Vice President, Performance Improvement, Stanford Children's Health (2017 - Present)
Associate Medical Director, Acute Care, Lucile Packard Children's Hospital Stanford (2014 - 2019)
Fellowship Director, Stanford University Clinical Excellence Research Center (2011 - Present)
Medical Director, Performance Improvement, Stanford Children's Health (2012 - 2017)
Physician Lead, Lucile Packard Children's Hospital Performance Improvement (2010 - 2012)
Honors & Awards
Faculty Honor Roll for Clinical Teaching, Department of Pediatrics, Stanford University School of Medicine (2017)
Educational Feedback Award of Excellence, Department of Pediatrics, Stanford University (2014)
Faculty Teaching Honor Roll with Letter of Teaching Distinction, Stanford University School of Medicine (2013)
Faculty Teaching Honor Roll with Letter of Teaching Distinction, Stanford University School of Medicine (2012)
Faculty Teaching Honor Roll, Stanford University School of Medicine (2011)
Kevin A. Kelly Leadership Scholar and Emerging Physician Leader Award, Michigan State Medical Society Foundation (2009)
Boards, Advisory Committees, Professional Organizations
Fellow, American Academy of Pediatrics (2011 - Present)
Programs and Partnerships Committee Member, Lucile Packard Foundation for Children's Health (2016 - Present)
Fellow, American College of Physicians (2011 - Present)
Board Certification: American Board of Pediatrics, Pediatric Hospital Medicine (2019)
Medical Education: University of Michigan GME Training Verifications (2005) MI
Residency: University of Michigan Health System (2010) MI
Residency: University of Michigan Health System (2009) MI
Internship: University of Michigan Health System (2006) MI
Board Certification: American Board of Pediatrics, Pediatrics (2009)
Current Research and Scholarly Interests
Terry Platchek, MD is a Clinical Associate Professor of Pediatrics and Internal Medicine at the Stanford University School of Medicine and serves as the Fellowship Director of the Clinical Excellence Research Center. He is also Associate Chief Quality Officer and Vice President for Performance Improvement at Stanford Children’s Health. Dr. Platchek’s career focuses on reducing the cost of outstanding healthcare with an emphasis on using Lean management to improve quality, safety, service, appropriateness and cost in healthcare delivery. Dr. Platchek is co-author of the book Advanced Lean in Healthcare and is co-author to over a dozen peer reviewed publications describing improvements in healthcare delivery and advocating for higher value models of care. He is specifically interested in the education and engagement of physicians in improving healthcare delivery systems and the development of innovative models for delivering higher value healthcare.
Dr. Platchek has been active nationally and internationally in promoting physician engagement in Lean healthcare management. He is a founder and co-convener of the international Lean Healthcare Academic Conference and has advised health care systems across the United States and Australia on performance improvement, including the Departments of Health in Victoria and Western Australia which have adopted junior doctor healthcare redesign programs using a continuous improvement model. He is an active speaker with over 50 invited presentations and abstracts across the United States and internationally.
In 2011, with Dr. Arnold Milstein, Dr. Platchek created the Clinical Excellence Research Center Fellowship which engages elite post-doctoral clinicians and scientists in value incentivized healthcare delivery innovation using human centered design methodology, bright spots research and cost analysis. The CERC fellowship is the first of its kind, focused primarily on lowering the cost to deliver great healthcare. The care models produced have been published in top journals and many are in use across the United States. Dozens of fellows have graduated from the program and have gone on to take leadership positions in universities, healthcare delivery systems, professional services firms, and venture based healthcare startups.
Are cost advantages from a modern Indian hospital transferable to the United States?
American heart journal
2020; 224: 148–55
BACKGROUND: Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals' cost advantages to US peers remains unclear.METHODS: Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH's cost savings.RESULTS: After removing non-transferable sources of efficiency, NH's residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH's high annual CABG volume facilitates such supervised work "downshifting." The study is subject to limitations inherent in case studies, does not account for the younger age of NH's patients, or capture savings attributable to NH's negligible frequency of re-admission or post-acute care facility placement.CONCLUSIONS: Most transferable bases for a modern Indian hospital's cost advantage would require more flexible American states' hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms.
View details for DOI 10.1016/j.ahj.2020.04.009
View details for PubMedID 32402701
- Health Care Is Failing the Most Vulnerable Patients: Three Underused Solutions. Public health reports (Washington, D.C. : 1974) 2020: 33354920954496
The approach to improving patient experience at children's hospitals: a primer for pediatric radiologists.
2020; 50 (11): 1482–91
Increasing attention is being given to improving patient experience in health care. Most children's hospitals have a patient experience office or team that champions and measures patient experience and partners with operations to optimize performance in this area. We outline the activities that our patient experience team undertakes at our pediatric health system to advocate for, measure and improve the experience of our patients and families. The framework we propose for such activities includes those that are proactive in improving patient experience as well as those that are reactive to when patients and families have had a poor experience. Those reactive practices are often centered on the management of patient complaints and grievances and early intervention into patient complaints so that they do not become grievances.
View details for DOI 10.1007/s00247-020-04781-3
View details for PubMedID 32935239
Automatic detection of hand hygiene using computer vision technology.
Journal of the American Medical Informatics Association : JAMIA
Hand hygiene is essential for preventing hospital-acquired infections but is difficult to accurately track. The gold-standard (human auditors) is insufficient for assessing true overall compliance. Computer vision technology has the ability to perform more accurate appraisals. Our primary objective was to evaluate if a computer vision algorithm could accurately observe hand hygiene dispenser use in images captured by depth sensors.Sixteen depth sensors were installed on one hospital unit. Images were collected continuously from March to August 2017. Utilizing a convolutional neural network, a machine learning algorithm was trained to detect hand hygiene dispenser use in the images. The algorithm's accuracy was then compared with simultaneous in-person observations of hand hygiene dispenser usage. Concordance rate between human observation and algorithm's assessment was calculated. Ground truth was established by blinded annotation of the entire image set. Sensitivity and specificity were calculated for both human and machine-level observation.A concordance rate of 96.8% was observed between human and algorithm (kappa = 0.85). Concordance among the 3 independent auditors to establish ground truth was 95.4% (Fleiss's kappa = 0.87). Sensitivity and specificity of the machine learning algorithm were 92.1% and 98.3%, respectively. Human observations showed sensitivity and specificity of 85.2% and 99.4%, respectively.A computer vision algorithm was equivalent to human observation in detecting hand hygiene dispenser use. Computer vision monitoring has the potential to provide a more complete appraisal of hand hygiene activity in hospitals than the current gold-standard given its ability for continuous coverage of a unit in space and time.
View details for DOI 10.1093/jamia/ocaa115
View details for PubMedID 32712656
- A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care JOURNAL OF GENERAL INTERNAL MEDICINE 2019; 34 (9): 1693–94
An Improvement Effort to Optimize Electronically Generated Hospital Discharge Instructions.
OBJECTIVES: The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI.METHODS: We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content.RESULTS: Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001).CONCLUSIONS: Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
View details for DOI 10.1542/hpeds.2018-0251
View details for PubMedID 31243058
A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care.
Journal of general internal medicine
View details for PubMedID 31011978
- Improving the Value of Medical Care for Patients with Back Pain PAIN MEDICINE 2019; 20 (4): 664–67
- Systems Delivery Innovation for Alzheimer Disease AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY 2019; 27 (2): 149–61
- Improving Patient Flow: Analysis of an Initiative to Improve Early Discharge JOURNAL OF HOSPITAL MEDICINE 2019; 14 (1): 22–27
Improving Communication with Primary Care Physicians at the Time of Hospital Discharge.
Joint Commission journal on quality and patient safety
2017; 43 (2): 80-88
Communication with primary care physicians (PCPs) at the time of a patient's hospital discharge is important to safely transition care to home. The goal of this quality improvement initiative was to increase discharge communication to PCPs at an academic children's hospital.A multidisciplinary team at Lucile Packard Children's Hospital Stanford used Lean A3 problem solving methodology to address the problem of inadequate discharge communication with PCPs. Emphasis was placed on frontline provider (resident physicians) involvement in the improvement process, creating standards, and error proofing. Root cause analysis identified several key drivers of the problem, and successive countermeasures were implemented beginning in August 2013 aimed at achieving the target of 80% attempted verbal communication within seven days before or after (usually 24-48 hours) on the pediatric medical services. Run charts were generated tracking the outcome of PCP communication.On the pediatric medical services, the goal of 80% communication was met and sustained during a seven-month period starting October 2013, a statistically significant improvement. In the eight months prior to October 2013, hospitalwide PCP communication prior to discharge averaged 59.1% (n = 5,397) and improved to 76.7% (n = 4,870) in the seven months after (p <0.001). Fifteen of 19 specialty services had a significant increase in discharge communication after October 2013.Lean improvement methodology (including structured problem solving using A3 thinking), intensive frontline provider involvement, and process-oriented electronic health record work flow redesign led to increased verbal PCP communication at around the time of a patient's discharge.
View details for DOI 10.1016/j.jcjq.2016.11.005
View details for PubMedID 28334566
Birth Center Model of Care.
2017; 317 (6): 646
View details for PubMedID 28196250
Safety Analysis of Proposed Data-Driven Physiologic Alarm Parameters for Hospitalized Children
JOURNAL OF HOSPITAL MEDICINE
2016; 11 (12): 817-823
Modification of alarm limits is one approach to mitigating alarm fatigue. We aimed to create and validate heart rate (HR) and respiratory rate (RR) percentiles for hospitalized children, and analyze the safety of replacing current vital sign reference ranges with proposed data-driven, age-stratified 5th and 95th percentile values.In this retrospective cross-sectional study, nurse-charted HR and RR data from a training set of 7202 hospitalized children were used to develop percentile tables. We compared 5th and 95th percentile values with currently accepted reference ranges in a validation set of 2287 patients. We analyzed 148 rapid response team (RRT) and cardiorespiratory arrest (CRA) events over a 12-month period, using HR and RR values in the 12 hours prior to the event, to determine the proportion of patients with out-of-range vitals based upon reference versus data-driven limits.There were 24,045 (55.6%) fewer out-of-range measurements using data-driven vital sign limits. Overall, 144/148 RRT and CRA patients had out-of-range HR or RR values preceding the event using current limits, and 138/148 were abnormal using data-driven limits. Chart review of RRT and CRA patients with abnormal HR and RR per current limits considered normal by data-driven limits revealed that clinical status change was identified by other vital sign abnormalities or clinical context.A large proportion of vital signs in hospitalized children are outside presently used norms. Safety evaluation of data-driven limits suggests they are as safe as those currently used. Implementation of these parameters in physiologic monitors may mitigate alarm fatigue. Journal of Hospital Medicine 2015;11:817-823. © 2015 Society of Hospital Medicine.
View details for DOI 10.1002/jhm.2635
View details for Web of Science ID 000389420100001
View details for PubMedID 27411896
Opportunities to Improve the Value of Outpatient Surgical Care
AMERICAN JOURNAL OF MANAGED CARE
2016; 22 (9): E329-?
Nearly 57 million outpatient surgeries-invasive procedures performed on an outpatient basis in hospital outpatient departments (HOPDs) or ambulatory surgery centers (ASCs)-produced annually in the United States account for roughly 7% of healthcare expenditures. Although moving inpatient surgeries to outpatient settings has lowered the cost of care, substantial opportunities to improve the value of outpatient surgery remain. To exploit these remaining opportunities, we composed an evidence-based care delivery composite for national discussion and pilot testing.Evidence-based care delivery composite.We synthesized peer-reviewed publications describing efforts to improve the value of outpatient surgical care, interviewed patients and clinicians to understand their most deeply felt discontents, reviewed potentially relevant emerging science and technology, and observed surgeries at healthcare organizations nominated by researchers as exemplars of efficiency and effectiveness. Primed by this information, we iterated potential new designs utilizing criticism from practicing clinicians, health services researchers, and healthcare managers.We found that 3 opportunities are most likely to improve value: 1) maximizing the appropriate use of surgeries via decision aids, clinical decision support, and a remote surgical coach for physicians considering a surgical referral; 2) safely shifting surgeries from HOPDs to high-volume, multi-specialty ASCs where costs are much lower; and 3) standardizing processes in ASCs from referral to recovery.Extrapolation based on published studies of the effects of each component suggests that the proposed 3-part composite may lower annual national outpatient surgical spending by as much as one-fifth, while maintaining or improving outcomes and the care experience for patients and clinicians. Pilot testing and evaluation will allow refinement of this composite.
View details for Web of Science ID 000384740300004
View details for PubMedID 27662397
Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness.
Healthcare (Amsterdam, Netherlands)
2016; 4 (1): 57-68
Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
View details for DOI 10.1016/j.hjdsi.2015.09.001
View details for PubMedID 27001100
View details for PubMedCentralID PMC4805882
Hospital-Affiliated Outpatient Birth Centers: A Possible Model for Helping to Achieve the Triple Aim in Obstetrics.
2016; 316 (14): 1441–42
View details for PubMedID 27727390
Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol.
2015; 5 (8): e008765
Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery.We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA.All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings.
View details for DOI 10.1136/bmjopen-2015-008765
View details for PubMedID 26307621
View details for PubMedCentralID PMC4550711
- Implementation of Data Driven Heart Rate and Respiratory Rate Parameters on a Pediatric Acute Care Unit IOS PRESS. 2015: 918
- Better Health, Less Spending Delivery Innovation for Ischemic Cerebrovascular Disease STROKE 2014; 45 (10): 3105-?
- Better Health, Less Spending: Stanford University’s Clinical Excellence Research Center Health Management, Policy and Innovation 2014; 2 (1): 10-17
- Advanced Lean in Healthcare CreateSpace. 2014
- Lean Health Care for the Hospitalist HOSPITAL MEDICINE CLINICS 2012; 1 (1): E148–E160