Cati Brown-Johnson PhD (she/her) loves to bring unexpected ideas together. At Stanford, she puts her PhD-linguist love of language to use in quality improvement, implementation science, and evaluation. In response to COVID’s isolating impact on patients, Dr. Brown-Johnson fused art and medicine to enable the US launch of PPE Portraits – small self-portraits worn by masked clinicians – featured on the Rachel Maddow Show. Dr. Brown-Johnson provides scientific direction and qualitative expertise for health services research projects as a founding member of the Stanford Evaluation Sciences Unit. In this role, she developed a new rapid assessment tool (the Stanford Lightning Report) based on implementation science principles. The structured Lightning Report feedback has in one case saved ~$1.2mil in averted expenses for an unnecessary implementation (primary care, 2016), and is being used across the US. Cati lives in on a tiny Oakland, California farm (<.1 acre) with her tiny dog, tiny chicken coop, not-so-tiny farmer-partner, and their two ever-larger children.
A rapidly evolving healthcare implementation requires methods and tools to facilitate prompt communication with stakeholders while maintaining methodological rigor. The Stanford Lightning Report addresses these gaps with a methodological approach and flexible framework that innovates on debriefing techniques from manufacturing, enabling rapid feedback to healthcare partners.
The Lightning Report method includes:
1. Pre-planning with evaluation partners to integrate emerging areas of interest into pre- existing collection tools.
2. Rapid synthesis. Structured research notes surface themes and unexpected findings. Researchers discuss notes/memos, and synthesize findings using Plus/Delta debriefing, adapted from Lean pedagogies.
3. Lightning Report creation. Components include executive summary, status of data collection, and findings that reflect Plus/Delta: what is going well with implementation, improvement opportunities and what needs to change, and suggested actions (“Insights”).
We assessed stakeholder perceptions of the value of the Lightning Report with a confidential feedback survey.
Results: We have used the Lightning Report in 20+ studies and quality improvement projects, in academic medicine, government health, and community. Stakeholders they are valuable, easy to understand, shared with colleagues, addressing important issues, and often influencing initiative implementation. Suggestions include wanting “larger number of completed interviews” and validation against systematic coding of transcripts. One healthcare partner reported that before Lightning Reports, they “got so little information during the first 3 to 4 years that we were unable to take corrective action that would help….”
The Stanford Lightning Report approach bridges the chasm between data collection and full data analysis/results publication. It can be rapidly developed from data to deliverable, is highly valued by partners, and generates stakeholder trust.