Leading Quality Change at Stanford Surgery with Amin Etemad, MBA
Amin Etemad is the first staff member featured on Scrubcast and a vital contributor to quality improvement (QI) at Stanford Surgery. Amin shares his journey from growing up in a medical family to pursuing an MBA in Medical Management. He discusses the importance of QI in the surgical field, how QI is structured within the department, and the critical role data plays in enhancing patient outcomes and communication among healthcare providers. Amin also highlights innovative initiatives like SurgIQ, a program designed to involve surgical residents in quality improvement early in their training. Tune in to discover how Amin and his team are making a lasting impact in healthcare delivery and patient experiences.
Transcript
Rachel Baker: [00:00:00] Welcome to Scrubcast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today we're speaking with Amin Etemad. Welcome to the show
Amin Etemad: Thank you, Rachel. Thank you so much for having me on Scrubcast.
Rachel Baker: It is great to have you here. Amin is the first staff member we've ever had on the podcast. Congratulations.
Amin Etemad: Thank you. Feels great to be here. A little surreal, honestly, especially as a non-surgeon as you said, you know, to represent some of the work that happens behind the scenes in surgery, and particularly in operations and quality improvement.
So, thanks again for having me.
Rachel Baker: Indeed! Well, so despite not being in a lab, you do a ton of research as our quality programs manager here at Stanford Surgery. Let's talk about your path. How did you get involved in quality improvement? Did you always know you wanted to be in healthcare and in [00:01:00] surgery?
Amin Etemad: Well, so quick background first. So I grew up in a medical family. Both my late parents were medical doctors and professors at the School of Medicine, and chiefs of their own division. So I think we got 15 of them doctors, that is, in both mom and dad's side. I don't know. I lost count. So I was exposed to that world, both academia and medicine and private practice especially, very, very early on.
And so I always thought I would end up in healthcare in some way, and it, as you can imagine, shaped my childhood. So fast-forward about two and a half decades after moving four countries and three continents, through Asia, Europe, and North America, I got my MBA in Medical Management in Minnesota, and I started my early, uh, work at Allina Health, focusing on quality improvement for Allina's four metro hospitals and 95, I think, 95-plus clinics that they have throughout Minnesota and Western Wisconsin.
I'm also an ex-Amazonian, Rachel, [00:02:00] and so we probably need-
Rachel Baker: I didn't know that.
Amin Etemad: Yeah, so we probably need a separate podcast for me to, you know, tell you all about what I learned and witnessed in that environment in fulfillment and transportation. So that's really where I built the foundation for thinking in terms of, you know, systems and performance.
So in 2020, this is how it all started with Stanford. In 2020, I was in Minnesota, and I relocated to the Bay Area with my wife and two daughters, right at COVID. And I joined Stanford Radiology back then, on the SHC side, also in quality improvement. So that was a unique time to enter healthcare here, as you can imagine, so because there was so much evolving in real time, and importance of adaptability.
So after about three years in radiology, I had this great opportunity to transition over to the Stanford Surgery within the School of Medicine, so continuing the same line of work, but now working much more closely with faculty and surgical teams. So honestly, that was probably one of the best decisions I've ever made.
Hesitant at [00:03:00] first, but no regrets since. So, to answer the question globally, I guess I'm not in the OR, but I work around the OR a lot. So it became very clear early on that what happens before and after surgery, whether it's discharge planning, whether it's communication, whether it's coordination, those system-level pieces have a huge impact on outcomes, and that's where I come in.
Rachel Baker: Absolutely. Well, I feel like quality improvement has always been a part of what we do here, but the process became much more organized right around the time when you arrived.
Amin Etemad: Mm-hmm.
Rachel Baker: How is QI organized today within the Department of Surgery?
Amin Etemad: Well, great question. I mean, when I first transitioned into surgery from SHC, from radiology, there was already a lot of really good quality improvement work happening.
So my colleague Tara, Lahiji-Neary, and Dr. Ron Dalman are the true pioneers of our QI work in surgery. And so, when I [00:04:00] came on board in '23, supporting our performance improvement leader, Dr. Joe Forrester, who had just been appointed, it all took shape. So over time, I guess we've become much more intentional, I would say, about how we structure that work.
So quality improvement in general, Rachel, in Stanford Medicine, including obviously our Department of Surgery, is organized around a set of core operational pillars. Things like patient experience, and financial strength, and wellness, and quality safety, patient equity, and I guess the overall operational performance.
And so each of those has clearly defined goals that we track annually through our ICDP process. So what it really does here is it creates this alignment, uh, with the entire department that includes all these divisions. And so we've built a more, a consistent rhythm around it since I came on board, so regular reporting, leadership engagement, you know, more [00:05:00] transparency with dashboards and how we look at performance across the depart- especially at monthly M&Ms where faculty and residents are present, so good exposure of that information to them.
So I would say, you know, instead of a collection of individual projects, it's really much more of a coordinated system nowadays. So less reactive, more proactive, led by our clinical first you know, pilots I call them, who fly this massive aircraft every fiscal year.
Rachel Baker: Awesome. So you, you mentioned these pillars, like patient experience. How do you bridge the gap between the data that you're seeing and actually helping clinicians improve?
Amin Etemad: I love that question because it's really the core of the work, especially with patient experience, where it can easily become very data-heavy without actually changing anything. So what we've done ... You know, let me explain.
So what we've done is, you know, [00:06:00] we try to make the data very visible and very relevant to our faculty, especially to our division chiefs, who play a pivotal role here. But we, you know, use a physician dashboard here that was created by our PER team, patient experience team. Bless them, they're wonderful.
And, you know, this dashboard helps our faculty members see their own performance, so both for in-person and video visits. So the primary measure here we're focusing on, this year at least, is overall MD rating. That's what it's called. So it's very clear- it's very transparent, and it has, I think, become very consistent across the department.
But to answer your question, that's just a starting point because the way I think about it is, you know, this dashboard gives us just a diagnosis, right? So it tells us where the gaps are, where there's variation, where we need to focus. And from there, I think where the great work comes in is we work [00:07:00] very closely with our ACES team.
So ACES stands for Advancing Communication Excellence at Stanford. So the ACES team supports our faculty in developing their competencies behind those scores. So if there's an opportunity, let's say, in communication, or in setting expectation, or in closing the loop, we focus on helping that particular faculty member, or a group of them, um, through their leaders, build those skills.
Rachel Baker: Got it.
Amin Etemad: Yeah.
Rachel Baker: So how do you decide what you're gonna work on every year? You must have mountains of data. How do you decide that this year it's gonna be communication?
Amin Etemad: That's such a great question, and that's really something that comes up almost weekly, I would say, when we sit together with, you know, Ron Dalman, Joe Forrester, and our clinical affairs.
So it's really a mix of leadership direction, I would say. A lot of organizational level [00:08:00] priorities, so very heavily SHC driven, and lots of data-driven insights. But the key here, Rachel, as, as I said earlier, is alignment. Alignment and focus. Mm. So we're very deliberate actually about not trying to do too much also at once.
So in my role, I support our clinical affairs team, which is led by Dr. Ron Dalman, Dr. Joe Forrester. So they set a lot of strategic direction, and I work closely with them, uh, as well as, uh, our other key leaders. So Dr. Cindy Kin, for example, our wellness director, Dr. Andy Shelton, our newly appointed patient safety director, and especially one of my favorite ones, Dr. Shipra Arya, our newly appointed accountable care champion, who leads our nationwide CMS team initiative in surgery, particularly around major bowels. So that's actually where a huge portion actually of my work is focused. So we also operate within a broader structure, I would say, through ICDP, so our bridge to SHC is [00:09:00] very important.
So ICDP stands for Improvement Capability Development Program. And so we report out to them quarterly across all those different pillars that I mentioned. So I guess one thing we've been really proud of as a department, and that I've been really proud of personally since I've been here, so we've consistently met our ICDP operational goals and secured the funds flows for the department.
So we haven't missed a cycle. Knock on wood, we won't miss any cycles. So that consistency comes from being very intentional about what exactly we choose to focus time. And then very quickly in terms of timing, so usually around this time, April, May, that's when we start discussing priorities for the upcoming fiscal year, so for '27.
And so those are shaped usually by clinical affairs and mostly based on what we're seeing in the data or across divisions. And so you can just imagine the behind-the-scenes work there. And then we get to [00:10:00] finalize it all with ICDP, usually over the summer, like end of June, July. So that's when we have a clean start in September when we fire up our engines.
Rachel Baker: This is all very exciting. I get those text messages that say, "We wanna hear about your patient experience. Take this survey." And I'm like, "Do you really care? Does anyone ever look at this data?" And clearly you are. So I guess the next time you guys send me a text message about my recent patient experience, I should actually take that survey.
Amin Etemad: Thank you. That gonna help our outcomes a lot, so yeah.
Rachel Baker: Well, when you identify a priority like- Reducing readmissions for liver transplant patients - how do you go from identifying a problem or a goal and then turning it into real actionable change?
Amin Etemad: When we identify that priority, whether it's something like you said, like readmissions or length of stay, or I [00:11:00] don't know, complications, or just, just a simple documentation gap the approach is actually pretty consistent because the initial intent is to define the problem first. So what exactly is happening and where is the breakdown? So because if you don't get that part right, everything that follows is off. So I'm the type of person who, you know, usually tries to engage the people doing the work early.
So surgeons, APPs, residents, you know, because if that solution isn't grounded in the reality, it's really not going to stick. So from there, try to get very specific, so not broad ideas, so to say, but where are the real friction points? Where are the speed bumps in the process? That's where QI gets interesting, and honestly, a big part of my role and how I think about quality is exactly that.
So it's about identifying the speed bumps and the headaches in the [00:12:00] system, and then helping turn those into smoother roads. Sometimes I joke that, you know, a big part of our job is to be the Advil for those headaches. And, you know, a good quality leader isn't just there to implement or reinforce. They're there to understand, you know, where things hurt and help fix it in a way that, you know, actually works for the people.
And so that usually means building simple, practical solutions, baby steps sometimes, you know, whether it's a simple form on Smartsheet or a new workflow, or setting up a cadence to communicate a simple message or a process change with efficient communication behind it. So to sum it all up, I guess the work is less about big, complex ideas.
It's more about consistency and consistently kind of removing that friction and making things work better over time
Rachel Baker: You're like the hospital's life coach.
Amin Etemad: Yep. I try to be. So, yeah.
Rachel Baker: Well, so this [00:13:00] past September, you launched a program actually for our residents called SurgIQ. Can you tell us what it is and how it fits into your broader approach to quality improvement?
Amin Etemad: Absolutely. SurgIQ is very dear to my heart. So Surg standing for surgery, IQ stands for improvement quality, so not IQ- ... but improvement quality. So, SurgIQ is really, simply said, I guess it's about bringing residents into quality improvement earlier in their training. So we completed our first pilot with a PGY1 resident, Dr. Dong Hur, who was our first official graduate actually. He did a really strong project on resident RN communication. It was a great example of what this can become.
So the idea, Rachel, for SurgIQ did not come out of nowhere. So I, I just wanna be clear here. So it's really an evolution of a program I led, in my previous life in radiology called 52 in 52.
So 52 in 52 is [00:14:00] an ESPN term, by the way, for people scratching their heads saying, "What is that?" So that started, as I said, in radiology at Stanford, uh, by the great David Larson and Jake Mickelsen and Ali Faust. And so over about three years when I was with them, we ran 10 cohorts and graduated around 30 teams, and they were resident-led or ops-led teams, uh, working together on improving projects.
So it ended up becoming something I'm really proud of because I had the opportunity to present it at RSNA in '23 in Chicago, which was honestly one of the highlights of my career. So SurgIQ is essentially a reimagined version of that model adapted for surgery. So same philosophy, bring frontline trainees into real improvement work, make it practical, not like theoretical, you know- and connect it to the system, and they're already working in it.
So the goal is simple. If we want long-term [00:15:00] change in how care is delivered, I strongly believe that it has to start during training and not after. And, you know, at the same time, it helps build a culture where improvement is just part of how we practice and not you know, something separate from it.
Rachel Baker: Awesome. Well, I'm glad you explained SurgIQ. I always thought that the, IQ was about making surgery smarter.
Amin Etemad: Yeah, the IQ part, sometimes you gotta explain what that means. But, you know, I think it's a catchy name.
Rachel Baker: Well, so that sound means that it is time for our lightning round. All right. On each episode of Scrubcast, we ask each of our guests the same three questions, which we're going to finagle a bit because you are not our typical guest.
So who is a person in QI that you admire, and why?
Amin Etemad: You know, I love the lightning round piece. So I'll give you a few because it's hard to pick [00:16:00] just one, and I'm gonna stay kind of in the professional network of Stanford. So in my professional life, I definitely say Dr. David Larson, who was my mentor and my former boss in radiology.
So he really shaped how I think about quality leadership, and the person who brought me to Stanford, actually, from Minnesota during COVID. So he is probably also one of my biggest advocates for launching SurgIQ because 52 in 52 was his baby. So just imagine that when you clone a baby- ... uh, imagine the, the original creator must be really happy, right?
So Dr. Larson is amazing. I also really admire Dr. Cindy Kin. I think her international background, her journey, everything she's accomplished is just amazing, and she's such a kind person, such a great leader. So she actually reminds me a lot of my sister, Roya, who's a radiologist and associate professor in Canada, and I've always told her that. So there's always a personal connection there.
And I would say I also mention Matt Bucher. I think Matt, our fiscal affairs director, [00:17:00] so really forward-looking vision, especially around AI. So the partnership, I think, that he built and developed with CoPilot and growing CoPilot is just amazing. And thanks to Matt's vision.
So Matt's an incredible team player and a kind, uh, helping person, especially with me as a newcomer when I came on board. I can't tell you the number of times he helped me get settled, and I think he cares about his team, and we're really lucky to have him.
And honestly, you know, more broadly, I admire our entire surgery clinical affairs team, and Dr. Forrester in particular, who is our rock star, you know, both in the OR and at the conference table. So we've come a long way together, and I think the work we're doing is, you know, starting to turn heads in meaningful ways.
Rachel Baker: Awesome. Well, the second question is, what is the best advice you have received in 10 words or fewer?
Amin Etemad: Best advice. You know, Dr. Dalman is the, the expert in advices under 10 words. So I need to keep them in a, some sort of a archive booklet. Some of them are [00:18:00] gold. Uh, I would say there's a German saying that says, "Jedem das Seine," Jedem das Seine, which means to each their own. And I truly believe to each their own is a great advice because sometimes in life we have expectations and high expectations of people and things, and so you need to know what sticks to whom.
My late mom used to always tell me, "If you spill milk, you can't drink it." "So carry, so carry on." And that's, I think that's about 10 words. If you spill milk- ... you can't drink it. Carry- So I love that about mom. It's because you're right, you know, half of my milk is spilled, at least keep the other half or just carry on, and that's just put it behind you.
Rachel Baker: That's adorable. I love that.
Amin Etemad: Yeah,
Rachel Baker: This might go on the wall here.
Amin Etemad: There you go.
Rachel Baker: Third and final question of the lightning round: What is your preferred work music?
Amin Etemad: Oh, wow. Wow. Well, I'm a musician myself. I play guitar, I play santur, which is a Persian traditional music, a tiny bit of piano. My wife is a great [00:19:00] pianist.
So first and foremost, I would say bossa nova, so bossa nova beats especially, you know, Antonio Carlos Jobim, especially on guitar patterns. Those are a must in my playlist always, in particular, the pieces that, uh, he, he had with Sinatra, who- ... is probably my all-time favorite singer. Uh, and also, as you know, Sinatra songs can also be played with a bossa nova beat, a lot of them, especially like "Fly Me To The Moon", so I love practicing those.
I also love Cuban jazz, especially the piano rhythms, so like Buena Vista Social Club, love those. And then my immortal trio, I would say, that shaped my childhood and made me fall in love with rock and with guitar especially, so The Police, Dire Straits, and Zeppelin, those are, those are my all-time three favorites.
Rachel Baker: Yes. I am loving this. Fantastic options.
Amin Etemad: Yeah. Yeah.
Rachel Baker: I might need to go listen to some Frank with a bossa nova beat-
Amin Etemad: Oh, yeah ...
Rachel Baker: after this. We're recording this on a Friday, by the way, and I'm-
Amin Etemad: There's a video, [00:20:00] he made with Antonio Carlos Jobim where they're sitting on stage, and both of them are actually smoking and singing, so that's a- You have to watch that one.
Rachel Baker: I'll find it.
Amin Etemad: In this day and age, that doesn't fly anymore, but back then- Yeah ... in the '70s, you could do that.
Rachel Baker: Absolutely. Well, it has been a pleasure chatting to you. Before we go, one final question.
Amin Etemad: Yes.
Rachel Baker: What is next for Amin Etemad?
Amin Etemad: Well, what is next for Amin Etemad?
Well, one thing I would have loved to kind of discuss a little bit further is I had this opportunity to present our work in, on patient experience in French at HEC Montreal, so at my alma mater. As you know, I am a graduate of there. So I've, I've had this ongoing conversation and growing partnership with the CHUM, which stands for the Centre Hospitalier de l'Université de Montréal, so that includes their chair of surgery, Dr. Fred Saad, who graciously hosted Dr. Lisa Knowlton and I back in November, and Rachel, I know you wrote a nice article about that. Thank you for that, and it's, you know, something that continues to evolve. And so that has been a [00:21:00] huge surprise, I think. You know, Stanford and, you know, HEC signing a summer program pact together.
And so what's next is growing on those partnerships, but at the same time not forgetting where our priorities are. So those ICDP priorities, you know- aligning again with, you know, what clinical affairs does, not missing a beat, getting all of our funds flow, keeping our faculty pleased with the services that are, you know, at their disposition, networking strongly with other service lines, and just enjoying work.
I love what I do. I love my team, and I couldn't be happier, and I'm so grateful that you had me on today.
Rachel Baker: Well, I will put a link for everyone to that HEC presentation for all of our Francophiles.
Amin Etemad: You're gonna have to brush up a little bit on your Quebecois We don't speak Parisian French in Quebec-so definitely put the subtitles there, highly recommend.
Rachel Baker: They were very helpful, let me tell you. Well, I look forward to seeing your [00:22:00] next list of priorities for the 2026-27 fiscal year. Yes. Thank you so much for coming on the show.
Amin Etemad: Thank you so much.
Rachel Baker: And that brings us to the end of another episode.
If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker. The music is by Midnight Rounds, and our chair is Dr. Mary Hawn.