“We didn’t know we could do it until we did it,” – Jack Cochran, MD, at National Governor’s Association

Atul Gawande, MD and Jack Cochran, MD, CEO of The Permanente Federation

Atul Gawande, MD and Jack Cochran, MD, NGA meeting, Washington, DC

A few weeks ago, Jack Cochran, CEO of The Permanente Federation (the company I work for) mentioned that he would be speaking alongside Atul Gawande, MD, in DC, and that I should try to come. I didn’t realize fully that he was speaking in front of the Governors of the United States of America, and definitely not that he was going right after The First Lady of the United States, Michelle Obama.

In any event, I got to go, so I’m going to share that experience here.

The First Lady

The First Lady was great. She talked about her family’s values with regard to exercise and eating. She’s leading an important conversation about why we need to treat childhood obesity as a societal issue, with multiple causes and solutions. (Disclosure: Kaiser Permanente is a founding partner in The First Lady’s Partnership for a Healthier America)

She spoke of food deserts, which are communities where families do not have convenient access to grocery stores and purchase processed and other less-healthy foods at convenience stores and corner markets.

I do not live in a food desert currently, but I did last week (this photograph explains it all), and I can definitely relate to the feeling of needing to pack high calorie, high sodium, non-perishable foods into the grocery bag, and how unsettling it feels. Great for The First Lady to work on making healthier food choices available to families in communities across the United States.

View from FLOTUS teleprompter - National Governors Association

View from the TelePrompTer

Atul and Jack

Of all the things on our country’s governors agendas, it’s impressive to think that they made health care the lead issue of their winter meeting. And equally impressive that they asked to hear from physician leaders first.

The title of this post is from a comment made by Jack that started with, “Don’t say you can’t do this (high quality, patient-centered care) because you’re not KP. We didn’t know we could do it until we did it.

As Dr. Gawande is very well known (understatement), so here’s a little bit about Jack: He’s a plastic surgeon who delivered care in the fee for service world and became curious about the Kaiser Permanente system in his community in Colorado (“If care was needed, physicians wrote me – ‘please deliver this care’), and became a plastic surgeon in that system. He eventually became the Executive Medical Director of the Colorado Permanente Medical Group where he fostered an environment of physician leadership (of the servant kind), innovation, and personal accountability and responsibility. And, Kaiser Permanente Colorado’s results speak for themselves.

In 2005, I had the good fortune/serendipity to be a student in the national Permanente Medicine and Management course led by Jack, where I and physician peers learned about what we could do to make health care (not just Kaiser Permanente) a better place, starting with us. A lot of the advice I give to others (and to myself) originates from the approach I learned here.

With my excessive interest in patient and family involvement – I picked up on a few significant things said by both leaders:

  1. By Atul, who spoke about “how much faster things went” when the patients were in the room. (This is not a fluke, go with it)
  2. By Jack, who started his remarks with “This is for the patients.” and later “This is about what this does for patients” (We enjoy leaders who never forget this)
  3. By Jack, who, when talking about the deluge of medical information that physicians need to keep abreast of included, “and what our patients find online.” It’s not that he said this, it’s the way he said it – as important as anything else a physician needs to know. (A personal health record leaves an indelible and positive impact on a medical group)

Blast from the Past – “You have the power”

At the event, I happened to sit behind Mary Selecky, The Secretary of Health for the State of Washington, and amazingly, we both remembered a moment, exactly 10 years ago, in a class at the University of Washington School of Public Health where we learned about making change.

My colleague, Abigail Halperin, MD, and I were students in the School of Public Health, working on ending the sale of tobacco products for profit by the University of Washington, and during the class, Abigail asked Secretary Selecky what she could do about ending this practice. Her answer, to us and the class was, “I don’t have the power as the Secretary, you have it as the student.”

It turned out she was right; the decision to end the practice was ultimately made by the Associated Students of the University of Washington, and we got there by working with the student body, not the Administration, who resisted the change.

The value of physician leadership (in addition to the leadership of every other stakeholder)

The not-so-subtle nudge from Secretary Selecky in 2000 made a difference, just like Atul and Jack will, by using their talents to help others lead.

I know that both physicians vastly understate what they know about how to create change in medicine and health care in a venue like this.

That’s okay, one of my tenets is “frequency is better than duration” – I think this experience will come out over time, and it’s going to be helpful to people who wonder if the impossible is possible, a great role for physicians.


Ted Eytan, MD