I believe it’s important to have physician leadership in healthcare organizations, because the focus will be on care delivery. —Richard Isaacs, MD
Explore This IssueApril 2020
Operational excellence creates the capacity for you to have systems that help support the work that you’re doing. For the head and neck surgeon, for example, there’s nothing more frustrating than having a patient who has neck cancer and needs to get to the operating room—but not having the appropriate process in place to get him to the operating room.
It’s really about having systems that support the practice and having leadership that engages the surgeons and the people doing the work so they can help drive changes to make their practice better. And then ultimately there’s a culture of leadership that drives this work. We talk about the pebbles in your shoes: What are the issues you struggle with every single day, and how can we remove those and make it easier for you?
Dr. Chiu: We did an article on gender equity benefits and the lack of them as one of the causes of burnout, especially in our female physicians. We talk about the lack of maternal leave in most academic organizations, a lack of day care. How does Kaiser Permanente address those issues?
Dr. Isaacs: Our board of directors has a comprehensive compensation committee process which recognizes tenure, independent of gender. We recently studied our physician compensation, and there’s no difference between male and female compensation across the program. My executive team is over 50% women. We have both robust maternity and paternity leave benefit packages. We are working to develop on-site day care, which is the vision. I’d love to be able to do that. The logistics are hard. A major focus is on equity and also ensuring the support of physicians for life.
Dr. Chiu: Tell us about the new Kaiser Medical School [in Pasadena, California] as well. Have you had any input or direction in that, and what’s the thought behind that?
Dr. Isaacs: The goal of the medical school is to expand on what makes our program so successful. Kaiser Permanente is very much like a Mayo Clinic or a Cleveland Clinic in that it’s a non-university-based program where the care is highly academic. It was a natural step for us to establish a medical school, and the first class will matriculate in the summer of 2020. Dr. Mark Schuster, who was on the faculty at Harvard, is the dean, and he has an exceptional team working with him.
I should also mention that our Permanente Medical Groups have been actively engaged in undergraduate and graduate medical education for many years. KP Northern California, for example, has 16 residency programs, including family medicine, head and neck surgery, internal medicine, ob-gyn, pediatrics, and podiatric surgery, and 12 fellowship programs—and we have plans to add more of both.
TPMG physicians also train another 1,300 residents from affiliated programs, such as Stanford University and University of California, San Francisco. Plus, we train more than 800 medical students annually from nearly 90 medical schools from around the nation.
Dr. Chiu: Tell me the hardest part of your job and a lesson from a misstep or small failure that you may have had in your career.
Dr. Isaacs: I’ve had a lot of experience with change management. I touched on this a bit earlier, but in 2005, when I first became the physician leader of KP’s South Sacramento Medical Center, our organization decided to bring [the medical record system] Epic into Kaiser Permanente. The most important lesson that I learned then is that people need to understand exactly why it is we’re doing what we’re doing. If people understand the why, they are far more likely to rally around the project than if you’re just forcing something on them.
We had a very nice community hospital in South Sacramento that was doing good tertiary work, and we had an opportunity to be the first trauma center within the Kaiser Permanente national system. Trauma’s difficult, because you’re opening your door to some complexity—high-speed motor vehicle crashes, gunshot wounds, etc. It was important to inspire our physicians and help them understand that this was the right thing to do because it was in the best interest of our patients. Now we have a very strong ACS-accredited level 2 trauma center.
Dr. Chiu: What is your leadership style?
Dr. Isaacs: I lead with clear vision and encourage people to think about what’s possible. I believe my job as CEO is to encourage creative thinking by cultivating an environment in which our physicians and staff feel safe to push the envelope and continually think about new and better ways to advance the delivery of healthcare. I believe good leaders accept risk and trust their people. Our job is to clear a path.