How do leaders help healthcare change? From electronic health record systems to tracking outcomes to incorporating MX encounter notifications, physicians are facing a lot of transformation in a short amount of time.
Bob Jako knows what it takes to get people in healthcare organizations to work together to achieve great things. Before joining Manifest MedEx as director of people, Bob spent two decades in human resources in large and complex healthcare environments. His organizational psychology skills were especially put to the test during 10 years of The Permanente Medical Group’s massive technology and process transformations. We sat down with Bob to get his best advice for healthcare leaders implementing new technology and supporting the shift to value-based care:
MX: Tell us more about your human resources role at Kaiser Permanente.
Bob: Most of my career has been working with physicians through organizational matters involving adaptation to change. At Kaiser Permanente, I started out on the insurance side with the Health Plan and quickly moved over to the Permanente Medical Group. Eventually, I was responsible for all aspects of physician employment in the medical group, including recruiting, managing retirement, policies, feedback, bonuses, compensation — all the difficult parts of employment, as well as all the great parts. Really A to Z with physicians. It was a real privilege to work with such a great group of people.
MX: Kaiser Permanente went through a lot of big changes when you were working there. What was that like from the human side?
Bob: The medical group was starting to embark on some very dramatic organizational change work when I first joined. There was a three-year very painful process of redistributing compensation, implementing a variety of performance measures at the group level and at the individual level as a basis for compensation decisions. Personally, it was a very difficult time of change because the HMO environment in healthcare had suddenly become very competitive and was priced at levels that threatened our existence. We needed to go in and stir things up and redefine the rationale for distributing income. And so that was a very tough change.
MX: What were the lessons you took away from helping navigate those years?
Bob: One thing was just a general empathy and respect for physicians given the work they are doing.
I respect physicians for playing a role that I don’t think I have the guts to play, which is taking responsibility for a large number of patients and their well-being.
Ultimately, if someone falls ill or dies, having to take that home is hard for many if not all physicians. I always gave physicians space to be rude, to be unresponsive. It just never offended me. “Well, of course you’re going to be. You’ve got more important things than me to worry about.”
They’ve always really warmed up to that, and I’ve always just made friends with physicians because I think there’s just this shared understanding that they’re trying their hardest to do something you can’t do perfectly, and when it goes wrong, it’s going to be their fault.
MX: How did you develop that physician empathy?
Bob: I did all sorts of things that didn’t work. Over time, I learned that what worked best was respecting their time. For a physician, spending time hearing about or thinking about an EHR or performance measure means he or she is not spending that time with a patient. Be practical; avoid lip service and lofty ideas. They want to go do their more important work. I learned to be very explicit about our shared value, which was that “This needs to get done. I’m here to help you get this done as quickly as possible.” So given that … “We need to meet. What’s going to work for you?” And just keep really repeating that “your work is so much more important than this thing that we need to get done, that I just want to focus on how to get you through it as painlessly as possible.”
MX: When you’ve built these trusting relationships, what’s the best way to bring physicians in as change drivers?
Bob: Bringing the right approach to the right physicians can be very impactful. Be sensitive to the physician’s medical specialty when you’re working on an organization issue. It sounds like prejudgement, but it is true that internists and pediatricians have an instinct to use time to let problems heal. Surgeons are interventionists; they are more prone to want to intervene and fix it. Physicians are also changing a lot. Newer, younger physicians are a lot more systems-oriented, and they can be more interested in creating workflows. They are also not feeling the loss of status that was experienced by those of the baby boom generation who started their careers as the owners, in effect, of medical records, expertise, and knowledge. Now it is distributed broadly.
Another key is to play to each individual’s strengths. You might have a brilliant physician on staff who is a great colleague but also an introvert and who gets lousy feedback from patients. With population-based medicine, there’s a ton of work that person could to do in terms of follow-ups, and interpretation of lab results, and referring in for other orders. That sort of “informologist” role can be an untapped resource.
MX: Where have you picked up inspiration and advice on change in healthcare from others?
Bob: Atul Gawande’s writing on transforming healthcare is something that both executives and physicians can agree on. The Checklist Manifesto had a lot of influence on actions within Kaiser Permanente. I think he’s a wonderful writer and a very pragmatic communicator as a physician, and as a leader, for patient interests. John Smillie’s book Can Physicians Manage the Quality and Cost of Healthcare? is an old one but so relevant to the changes in healthcare today.
MX: What’s the one lesson you want to pass on to healthcare leaders today?
Bob: It’s a key learning that came from implementing Epic within Kaiser Permanente. Physicians complained and complained because implementing Epic truly did negatively affect their lives in many ways. It caused many to quit or retire early and added hours to the day for a lot of them. For the physician, as a person with a life, it was not a good thing. But every time we heard a growl about having to spend three hours after the clinic closed to update all the records, our CEO would say, “…but it’s good for the patient.” And that is the hook — anything that undeniably helps his/her patients will usually be adopted by a physician.
These changes aren’t easy. There will be frustration. Keep everyone focused on how it is helping the patient get the care needed. Everyone is aligned around that focus. Kaiser Permanente showed that the outcomes are real.
It’s a powerful mantra. “It’s good for the patient, it’s good for the patient, it’s good for the patient.”