Fellow and Faculty Bios

Sanjana Vig

I attended St. Louis University for both undergrad and medical school. After my third year of medical school, I took a year off to obtain my MBA. I've always had an interest in the administrative aspects of medicine, and now specifically OR management.  I'm looking forward to gaining some practical experience and putting my skills to use!

On a personal note: I was born in India and moved here with my parents when I was about 4- months old. While growing up, my family moved around a lot, so we lived in several states and cities before finally settling down in southern Illinois. (Or as I like to refer to it as So. ILL). In my spare time I love traveling and doing as much around NYC as possible. Fun fact: if you were to eat at a different NYC restaurant everyday (without repeating any of them) it would take you 56 years to visit them all!

Roya Saffary

I trained at Boston Medical Center. I took a slightly unconventional route and completed 2 years of general surgery followed by 3 years of neurosurgery before I joined the anesthesiology department. I am very interested in the concept of surgical home and a more comprehensive and team-approach to surgical patients. I am also excited to learn more about the aspects of OR management that we as residents are generally not exposed to, such as OR efficiency and cost-effectiveness, as well as staffing and scheduling. 

On a more personal level, I enjoy traveling. I was born in Kabul and grew up in Poland and Germany before moving to the States, so exploring new places is always exciting to me.

Joseph Sanford

I did my bachelor’s in Computer Science at the University of Arkansas and medical school and residency at UAMS. My recent non-clinical time has been geared towards OR suite efficiency analysis for the department, as well as work in network analysis and fat-tail risk. I’ve lately been very busy doing MPOG/AQI mapping, building reports and doing general superuser support, as we just went live with Epic. I am looking forward to getting physician and anesthesia builder training in the near future to expand that skillset.  Outside of work my interests include reading, gaming, playing music, and SCUBA diving.

Rahul Modi

 I went to USC for residency and medical school and Cal Berkeley for undergrad (so I am looking forward to all of your boos and mockery during the battle for the axe!) I grew up in Texas and have been living the Cali dream since college.

I am interested in collaborating on projects related to OR management. I am particularly interested in learning about the ins and outs of ambulatory surgery centers (how to manage, staff, supply, operate...), how to implement new technologies in our daily operations, OR ergonomics, and how anesthesiology is practiced in other countries. 

On a personal note, I l enjoy surfing, standup paddleboarding, beach bumming, skiing, camping, football (watching and playing), bargain hunting and trying new foods.

Brandi Sinkfield

 I finished residency at Cleveland Clinic in 2011 and have been in private practice in Indiana since. I am married with one daughter who is 3 years old.  During my short time in private practice, I began to read about the ongoing changes in Anesthesiology, particularly the development of the Perioperative Surgical Home. I began to wonder if there were any new tools that could be built to meet the changing and overwhelming needs of the Perioperativist to improve OR efficiency. I have always been interested in technology and its role in medicine. Last year I attended the Medicine X conference at Stanford, attended various sessions, and met with many health professionals who had developed creative tools to improve patient and/or provider experience. I decided to apply to the Physician Entrepreneur fellowship through the AIMS lab with an interest in developing a tool that will be useful in the Surgical Home.

Long-term goals include:

  • Continued Clinical Practice in Anesthesiology, 
  • Creating a startup company that will allow for ownership of a tool to improve Surgical Home experience
  • Improve postoperative outcomes through further examination of the surgical patient’s experience
  • Assist with data integration to improve OR workflow (i.e. smooth the rough edges of the EMR platform used for Preoperative, intraoperative, and Post operative data.

On a personal note, I’m originally from Ohio, attended college at Xavier University of Louisiana (in New Orleans) and went to Case Western School of Medicine. My husband is an Agile methodology coach (project and portfolio management) who owns a small consulting firm. He is currently consulting at Cisco in San Jose. My hobbies include cooking, reading, fitness and nutrition. 

Loren Riskin

I did my undergraduate at Wellesley, medical school at Duke and residency here at Stanford. I spent some time exploring other fields before deciding on anesthesia, (veterinary medicine, biochemical bench research, tech work), and absolutely love the work here. Outside of the OR, my focus is on patient safety and quality improvement, particularly the design of safe workflows and healthcare IT policy.

On a personal note, I've been in the Bay Area for 6 years now, and don't miss the New England winters at all. I love traveling, just spent some time in Ecuador and am looking forward to an upcoming medical trip to Guatemala. Once I find the time to sit the exam, I'm working towards my certification as a sommelier. I also do a fair amount of outdoor sports—rock climbing, hiking, backpacking. If anyone wants to brave the cold water of Monterey Bay and go diving with me, let me know!

Thuan Le

I completed my residency at Henry Ford Hospital in Detroit and practiced at a community hospital in Lansing, Michigan.

I was born in Vietnam in 1969 and emigrated to the US with my immediate family when I was 6 years old. We left Saigon April 23, 1975, one week before the end of the war, and headed to Kalamazoo, Michigan, where my dad had a job with Upjohn Pharmaceuticals. After undergrad, I joined JPMorgan, where I worked for nine years in the investment banking division in NYC, Singapore and Hong Kong. I quit my job in 2002 after making the decision to pursue a career in medicine. I took a year off to detox from the business world, to travel and volunteer with Operation Smile in China. I completed my post-bacc premedical training at Hopkins, then U of Maryland for medical school.

Our practice in Michigan consists of 8 partners, 14 CRNAs, and 12 Michigan State University anesthesia residents. We cover on average of 21–23 ORs, including OB and special studies. I am the co-chair of the Quality Committee. We have been integrating our practice into the hospital’s daily management by actively participating in quality improvement initiatives, data gathering and analysis, surgical block time management, etc. I hope to use this year to learn more about all aspects of OR management and hospital administration so that I can strengthen our practice's negotiating position when our contract comes due. Our goal is to remain independent as long as possible and keep away the competitive forces that compete solely on the basis of price.

Specifically, I am in the process of, or hope to accomplish, the following tasks during this upcoming academic year:

  • work with hospital administration to implement a hospital-wide safety alert reporting system to improve our record on patient safety;
  • work with our orthopedic surgeons to develop protocols for knee, shoulder and hip replacements with the goal of reducing hospital stay and complication rates while improving patient satisfaction; and, where applicable, implement the surgical home concept;
  • expand our data gathering and analysis capabilities with AQI;
  • develop an outlook for our industry for the next 10 - 15 years, i.e., where will this consolidation lead us and what is the model going forward, and determine how to best position our group for the challenges of the future.

On a personal level I am married to my fantastic wife Kim; we are “DINKs.”  My activities include tennis, soccer, golf, scuba diving, classical piano (but would love to start learning how to play the cello), road and mountain biking, skiing, travel and volunteering with NGOs.

Mitchell Tsai

I am an attending anesthesiologist in the Department of Anesthesiology at the University of Vermont College of Medicine.  I must clarify that I was an eFellow because I never spent time on the most beautiful college campus on earth (aka The Farm), but I have enjoyed working with Alex and I continue to work with Bassam.  Following Alex's tutelage, I earned a Master's of Medical Management from the University of Southern California.  I strongly believe that Alex's perspective about networks is important.  Gawande commented that we need pit crews, not cowboys, to change the health care delivery system.  A network, not local, but diffuse, provides the diversity and bandwidth necessary to foster and promote new collaborations (or as David Kelley puts it, building better ideas on top of ideas).

Aside from a busy clinical practice, I manage a reading elective entitled Medical Management and Leadership (you are all welcome to the curriculum courtesy of the Dean) for fourth-year medical students and I co-direct the Perioperative Bridge Week for third-year students.  I direct an OR Management mandatory rotation for all of our CA3s and I just finished a web module for the ASA on OR Management (it's the dumbed-down version, but still qualifies for CME credit of OR Management). I also created and manage Multi-Disciplinary Grand Rounds (Perioperative Nursing, Anesthesiology, and Surgery) at this institution in an effort to change the culture, and I am working with Bassam Kadry to implement WiseOR across a network (Fletcher Allen Partners).  Again, it is amazing the amount of psychology involved with organizational change.  The inside joke about OR Management is that you don't need an administrative degree, just a PhD in behavioral psychology (for those interested, check out Ariely's Predictably Irrational).  I am working with ePreop and our expanding anesthesiology group to standardize, streamline, and reduce variability during the preoperative process for our surgical patients.  Finally, I continue to spread the gospel about OpenTempo; yet, I am still waiting for a seat on the Board of Directors.

Outside of work, I have a wonderful, amazing partner who manages the PACU and somehow, we manage to find a little for ourselves with our own son and our blended, Brady Brunch family of 7 total (yes, we own a mini-van).  I do miss the California weather, and the New England winters do take their toll, but there is no perfect place, and Vermont does remind me of the quiet, "rural" Orange County, California, where I grew up.

We try to gather each year at the ASA Conference on Practice Management only because Alex makes it a point to get the current/in-coming fellows to the conference.  If we want to make it official, we can use this e-mail distribution list to get the word out.  Past Fellows have had the opportunity to enjoy belly-dancing, Moroccan food, and restaurants frequented by Guy Fieri.  We even called a CODE RED for Santiago.  And if it weren't for the conference in Las Vegas, we wouldn't have Bassam's WiseOR here at our institution.  Alas, what happens in Vegas, stays in Vegas.

One last comment about the network. One of our former Chief Resident's husband completed his PhD in Mechanical Engineering at M.I.T.  She took a year off so that he could complete a fellowship in Switzerland.  The department extended his fellowship and she decided to look around at the possibility of working as an anesthesiologist in Swizterland.  She checked out the local hospitals and looked up the CEO, who was none other than Christopher Egger, former fellow.  Small world.

Jaume Balust

I am currently Division Head of Anaesthesia for Abdominal Surgery and Liver Transplant at the Hospital Clinic University of Barcelona, Spain. My family and I spent a wonderful year in Palo Alto. I was with Alex and also with Chris, who was still there as a faculty member. My wife Graciela was in an experimental lab in UCSF, my sons Jaume and Clara were studying at Gunn High School and my little son Aleix was in kindergarten at Duveneck School. Currently Jaume is working in Louxembourg as an electrical engineer and Clara is applying to a Master’s Degree in biomedical engineering at ETH Zurich. We owe Alex a debt of gratitude to allow us to go to the US. More than a fellowship, it was a vital experience for the whole family. Until then, I had always lived in Barcelona. I obtained my Medical Degree at Universitat Autonoma of Barcelona, then moved to my Residence Program in Hospital Clinic and worked there until now. Outside of work, I love to go running in the hills around Barcelona, climbing mountains in the summer, and skiing in the winter in the Pyrenees or Alps, each year less than before due to global warming.

As a group, we work in a Digestive Institute with close contact with general surgeons, gastroenterologists, and endoscopists trying to get involved in the entirety of the patient’s process. That means that we participate in the pre-, intra- and postoperative period, also working in committees deciding what is best for our patients. We are involved in fastrack colon surgery, bariatric surgery, NOTES surgery and liver transplant. Nowadays we are conducting a research study granted by the Spanish government aimed at trying to demonstrate that preop personalized training in high-risk surgical patients could improve patient’s outcomes (NCT 02024776).

One of the things that I learned with Alex was how close business and entrepreneurship are to University. When I was there, I went to multiple journal clubs with people trying to make start ups from ideas. Right now we are developing a project trying to improve the operating room workflow and efficiency supported by smartphones and tablets. How difficult it is to develop something in Spain!! And how easy it seemed in PA!!

Harshu Chaobal

 I was a fellow in 2005-06 and spent 6 years afterwards in academic medicine at Mount Sinai Medical Center in NYC.  I am currently the head of Anesthesia Services and Business Development for a moderate-sized group of anesthesia and pain physicians.  We are in a rapid-growth phase in an exciting and dynamic environmental that is seeing, amongst other big changes, consolidation of anesthesia groups into large private corporations.

The Fellowship was invaluable to me on several levels and I am most grateful to Alex and Stanford University for the opportunity to have studied there.  I had the honor of having Chris Egger as a co-fellow.

In addition to the MPS studies, I spent time in the BioX and Business School programs, taking classes in each, completing projects, and even attempting to launch a company.  The friends I made in those programs have remained good friends since, and continue to be a source of inspiration and guidance.

In addition to pursuing a management role in my organization, I have pursued a few medical device projects and even more new business adventures.  All have been great fun, and some of it has gained meaningful traction.

It would be great to hear from any of you, and should you be in the NYC area, I would love to meet, discuss projects, and exchange ideas.

Christoph [Chris] Egger

I am the CEO of Hirslanden Klinik Beau-Site in Bern, Switzerland, a 137-bed acute-care specialty hospital focusing on cardiac, thoracic, abdominal surgery, urology and interventional cardiology. In 1995, I received my MD from the University of Basel School of Medicine in Switzerland and completed a residency in anaesthesia at the University Hospital of Basel, Switzerland. Because I have always been interested in both clinical work and management, I decided to get a formal training in business administration and in 2004, I earned an MBA from the Simon Business School, University of Rochester (NY). Frank Dexter, who I met in the same year, strongly recommended Alex’ fellowship as a rewarding, intellectual pursuit of both “worlds” and so I joined Stanford a year later. I completed the one-year OR management program but stayed as clinical faculty for another two years, during which time I continued to both do anesthesia and accomplish admin duties as part of the huge EPIC implementation project.

For family reasons, my wife Regula and I decided to relocate back to Switzerland with our two LPCH-born sons, where I decided to focus on management. Prior to becoming hospital CEO, I spent some years working in hospital consultancy, business development, and as director of medical affairs/chief quality officer.

I owe Alex a debt of gratitude for being a great mentor. Specifically, he always made clear that success should be reached through a continuous self-reflection and strong focus on the right customer. Peter Drucker once pointed out that “even small healthcare institutions are complex, barely manageable places—large healthcare institutions may be the most complex organisations in human history.” He might have been right. Independent of whether we work bedside or as a hospital manager, I believe we should always keep in mind the following:

  • What we do is always about the patient
  • We can only achieve great goals if we engage physicians and executives—and through both leading and empowering employees
  • We can only get sustainable results if we focus on quality. Money follows outstanding medicine—not vice versa.

Tom Archer

 I worked with Alex starting rather late in my career, at age 50, after 21 years in private practice and after getting an MBA degree. Both Alex's Fellowship and the MBA have served me very well, both as purely intellectual experiences and as preparation for medical leadership and administration. I am currently finishing my sixth year as Director of Obstetric Anesthesia at UCSD (San Diego) and am trying to practice the key principle of listening to all the customers (patients, nurses, other docs, midwives and others). As we all know (at least in theory!) good communication is a key to good medicine (as well as a good life) and we try to have good communication between all of the "players" on Labor & Delivery. We have interdisciplinary conferences and I think as a group we try to practice respect and good listening to one another. I know this sounds very touchy feely, but it is really true—and it was true of course in private practice as well. I love working with the residents and I am really very happy focusing in one small area (Labor & Delivery). We are also doing research on non-invasive measurement of cardiac output with a new type of impedance cardiography combined with hand held TTE, which I am very excited about.

I am very glad I spent my time at Stanford and I learned a great deal from Alex and from everyone else there.

Matt Weinger

 I have been teaching and conducting research in patient safety, human factors engineering, healthcare simulation, medical device development, and clinical decision making for more than two decades. In 2014, I received the Laufman-Greatbach Award from the Association for the Advancement in Medical Instrumentation (AAMI) for my contributions to patient safety and medical technology. I have received more than $7 million in direct research support from federal agencies and major non-profit foundations. I have over 150 publications that cover a range of topics including human factors, simulation, use error, technology design and evaluation, measures of clinician performance, workload, alarms and vigilance, clinical expertise, automation, clinician fatigue, and clinical decision support. In 2011, The Handbook of Human Factors in Medical Device Design, the seminal 850-page textbook on which I was lead editor, was published by CRC Press/Taylor & Francis. I have mentored 18 post-doctoral fellows, 80 pre-doctoral students, and numerous junior faculty.

I currently hold the Norman Ty Smith Chair in Patient Safety and Medical Simulation and am a Professor of Anesthesiology, Biomedical Informatics, and Medical Education at the Vanderbilt University School of Medicine. I also serve as Vice Chair for Academic Affairs in the Department of Anesthesiology. For the Medical Center, I am the Director of the Vanderbilt Center for Research and Innovation in Systems Safety (CRISS) and the Director of Research for the Center for Experiential Learning and Assessment (CELA), our institutional simulation center. I have also been a Department of Veterans Affairs (VA) physician for 27 years and currently serve as a senior staff physician at the Geriatric Education Research and Clinical Care (GRECC) Center at the Middle Tennessee VA Healthcare System.

I am the Associate Editor for Health and Health Systems for the journal Human Factors and am on the Editorial Board of Simulation in Healthcare. I serve on the AAMI Board of Directors and was, for 13 years, the Co-Chair of its Human Factors National Standards Committee. I am also the Secretary and a member of the Executive Committee of the Board of Directors of the Anesthesia Patient Safety Foundation as well as a Senior Associate Examiner for the American Board of Anesthesiologists. I am the first physician elected to be a Fellow of the Human Factors and Ergonomics Society.

I live in Nashville with my teenage daughter and Zippy, a 90-pound golden retriever, where I play golf, tennis, run, travel and snowboard whenever possible.

William Fritz

I am currently the Chairman of Anesthesia at Memorial Medical Center in Johnstown, Pennsylvania.  We are a 545-Beds, level-1 trauma center with 10 Anesthesiologists and 30+ CRNAs, 16 ORs, a 4-OR off-site ASU, and a very busy dedicated acute pain service. Statistically, we have one the oldest and sickest patient populations in the US. How many other institutions have a Geriatric Trauma Institute? We are currently profitable, but we are being acquired by Duke-Lifepoint in a $550M acquisition.  The change from non-profit to for-profit will undoubtedly be a culture shock.  But this is the first of many more that are coming in the “new world of medicine”.

I trained at Hahnemann and St Christopher’s in Philadelphia and received my MBA from Pitt. Feeling very old, I must say that exactly 18 years ago this month I was a visiting fellow at Stanford. In the short time I was there, I learned a lot of things, and have gone on to accomplish numerous things. I’ve had the fortune (or misfortune?) to be Chair three times, or exactly half of my career. This has forced me to deal with a great number of problems over the years. Now I am planning on stepping down 5 years hence, and it is my goal to have mentored and actively prepared my replacement.

Over the years, even as a “community” anesthesiologist, I have had multiple roles, ranging from department chair to leading the health system’s medical management program (the chief cost and quality curmudgeon or the chair of the land of NO, do you know your outcomes and what the #$? are you doing?), to even being the interim director of surgical research for the surgery residency. I’ve had the opportunity to work on a great number of exciting projects, including benchmarking a then-$220M health system, redesigning surgical services along with 14 clinical DRG’s, 2 national quality demonstration projects, establishing a recognized collaborative acute pain service, and now we are currently working the safety aspects of patient preoperative preparation and decreasing resource utilization.  I’ve also had the privilege of teaching medical students, of whom about 3 got into anesthesia residencies a year, ranging from UCSF to Hopkins and many in between. Last year, the 3 went to Pitt, Syracuse and UT-Galveston. No Stanfords yet.

Things in our field are constantly changing.  Right now the projects that we are working on are:

  • Decreasing the number of preoperative anesthesia clinic visits at our institution by 20% using risk stratification, IT etc….Sounds like a great idea, but what if the patients are sick, elderly and technologically inept? Add to that that the current rate of case cancellation is measured in a per thousand rate and you have a tough problem.
  • Limiting/ decreasing the use of IV acetaminophen. Our aged population and the drive for low complications and shortened stays have driven us to being a $250K/year consumer of IV acetaminophen. Now the bill is going up to $600K. What are the options? Are there any in our patient population? What really is the “value” of the drug? Additionally, this really is becoming a study of the perception of the problem by each departmental silo.  Pharmacy wants the use down, nursing says that’s a bad idea and the ASU and PACU say we’re screwed here…. This is a true “clinical value” problem.

All of Alex’s fellows will be adept with analytic skills, but as you go on you are surely going to find that the less credit you take and the better you are at the proverbial “soft” interpersonal leadership skills the more you can accomplish. My suggestion would be to consider a reading list starting with these books:

  •  Influence Without Authority by Allan R. Cohen and David L. Bradford (Bradford is a Stanford GSB Organizational Behavior Guy)
  • Nudge: Improving Decisions About Health, Wealth, and Happiness Paperback by Richard H. Thaler
  • Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher, William L. Ury and Bruce Patton
  • First Among Equals: How to Manage a Group of Professionals by Patrick J. McKenna and David H. Maister

On a personal note, I have now had 2 members of my family diagnosed with cancer, and being on the other side of the physician-patient relationship is quite humbling. And I would suggest if you only do one thing today, watch the Cleveland Clinic YouTube on empathy http://www.youtube.com/watch?v=1e1JxPCDme4 Because everything that we do, clinically or otherwise, is, as a wise anesthesiologist said, “always about the patient.”

Alex Macario

I was born in Argentina and at age 4 moved to Sweden and spent the first decade of my life in Europe, as my parents are scientists and held different positions in Sweden, Italy, and France. We immigrated to US when I was 10 and I finished high school in Albany, NY, and completed my undergraduate, medical school and business school at the University of Rochester. I then did the anesthesiology residency at Stanford, finishing in 1994, including as Chief Resident, and then completed a postgraduate fellowship in health services research. That means that I have been at Stanford since 1991!

I have two kids in college and in my free time enjoy rooting for Stanford sports, biking up the local hills with my wife, Susan, and playing tennis.