New Stanford professor to establish clinical excellence research center

Arnold Milstein, MD, has been appointed a professor of medicine at Stanford University and will lead a new Stanford research center. The Clinical Excellence Research Center will be dedicated to accelerating the discovery of clinical service innovations that will improve the societal value of health care in the United States and globally.

The center is being launched amid intense debate over how to rein in health-care spending responsibly. Milstein is a national figure in the design and deployment of clinical service innovations that both improve quality of care and help offset the costs associated with population aging and valuable biomedical technologies.

Milstein will start in July. He will coordinate transdisciplinary research collaboratives initially composed of faculty from Stanford’s business, engineering and medical schools. The collaboratives will focus on the discovery and refinement of new clinical service designs that improve health and patients’ experience of their care, while lowering annual per capita health-care spending.

The new center will contribute to teaching at Stanford, with an initial focus on advancing graduate medical education in clinical service engineering.

While the center’s scope is national, its work could provide a particular boost to health care at Stanford by actively involving clinicians at Stanford Hospital & Clinics in its design and refinement process. “Beyond broadly benefiting society, by establishing Stanford’s research center in the science of clinical performance improvement, Dr. Milstein will generate tangible dividends for Stanford Hospital and our patients,” said SHC president and CEO Martha Marsh.

Milstein is unfazed by current pessimism about bending the health-care cost curve. “Stanford is the perfect place to advance the management science of clinical performance improvement,” he said. “No other institution offers globally distinguished business, engineering, medical and social science faculties that are next door to one another and already collaborate to meet global challenges in energy, the environment, bioengineering and multiple other domains.”

Philip Pizzo, MD, dean of the School of Medicine, concurred. “This is the right time, the right place and the right leader to accelerate the nascent science of clinical performance management,” he said.

Milstein’s recent research led to the formulation and current multistate implementation of “ambulatory care ICUs.” An A-ICU is a new form of ambulatory care expressly designed to prevent costly and dangerous health crises among patients with severe, chronic illness.

Milstein also brings a remarkable record in national policy-making to foster health-system improvement. As a congressional MEDPAC commissioner, he originated a recently enacted Medicare provision that ceases extra payment to hospitals for the cost of treating preventable hospital complications, such as some types of infections and patient injuries due to falls.

Milstein was the founding staff member and will remain the medical director of the Pacific Business Group on Health, the largest and most nationally influential regional health-care purchasers coalition in the United States. Stanford University is a long-standing member of PBGH.

Representing PBGH, he co-founded both the Leapfrog Group and the Consumer-Purchaser Disclosure Project. Initially sponsored by U.S. Fortune 500 companies, the Leapfrog Group is credited with substantially improving patient safety in U.S. hospitals, including Stanford Hospital, which now ranks in Leapfrog’s top performing 10 percent of hospitals nationally. The Consumer-Purchaser Disclosure Project is an alliance of the nation’s largest employers and consumer organizations. It proved highly effective in assuring that the recently enacted federal health-reform legislation expanded the public’s ability to compare the quality and total cost of care at U.S. hospitals and at physician offices.

“I think Arnie has, over decades, been one of the really critical forces in health care, not just representing the employers’ perspective but trying to really drive a remodeling of the health-care system,” said Thomas Lee, MD, network president of Partners HealthCare, the integrated health-care delivery system established by Brigham and Women’s Hospital and Massachusetts General Hospital. Peggy O’Kane, president of the National Committee for Quality Assurance, an independent nonprofit organization, added: “It would be difficult to name anyone who has done more to promote value purchasing of health care among Fortune 500 employers than Arnie, with his passion for improving the quality and effectiveness of care.”

The author of scholarly work that spans quality improvement policy and clinical process redesign, he has since 2004 received the highest annual award of four national health-care improvement organizations, including the American College of Medical Quality. He is an elected member of the Institute of Medicine of the National Academy of Sciences. Previously, he practiced adult psychiatry, headed western operations of federal programs to improve clinical performance, and founded National Medical Audit, a clinical performance assessment firm that was acquired by Mercer, a company that provides consulting, outsourcing and investment services. At Mercer, he headed clinical performance improvement consulting in the United States. He was educated at Harvard College, Tufts Medical School and the UC-Berkeley School of Public Health.

Milstein welcomes his new challenge. “Collaborative research among Stanford's globally distinguished business, engineering and medical school faculties will help clinicians to deliver more health with less money,” he said. “This, in turn, will enable expanded investment in upstream health interventions such as early childhood education, broad technology development and other powerful sources of human benefit.”