Lessons from the longtime CEO of a 100-year-old health system on staying relevant in healthcare

When Gary S. Kaplan, MD, started working at Seattle-based Virginia Mason Health System in 1978 as an internal medicine intern, he saw an opportunity to train for his physician career.  

He said he knew he didn't want to be a university professor but still wanted to learn in an academic-oriented and challenging environment. That led him to Virginia Mason.

"My wife and I came to Seattle, and we fell in love with the community, the environment and the training opportunity. So, I came here in 1978 to Virginia Mason as an internal medicine intern," said Dr. Kaplan.

He's now been at the organization for 42 years, the last 20 of which as chairman and CEO. Outside of his executive responsibilities, Dr. Kaplan also practices internal medicine at Virginia Mason, which today consists of a multispecialty group practice of more than 500 physicians as well as two hospitals and a network of clinics.

With 2020 being Virginia Mason's centennial year, Dr. Kaplan recently spoke with Becker's Hospital Review about his career path, his greatest achievements at Virginia Mason and the lessons he's learned about staying relevant in an ever-changing industry.

Editor's note: Responses were lightly edited for length and clarity.

Question: How did you become interested in healthcare?

Dr. Gary S. Kaplan: Thinking back to my youth, I was intrigued when a family friend invited me to spend some time rounding with him. He was an old-style family physician. I was 15 years old and had a chance to spend a couple days with him in the hospital. I found it intriguing, particularly around the relationships he had built over so many years. I have always been a relationship-driven kind of person, and I was intrigued with the opportunity to help people in a meaningful way and began to explore a career in medicine. The more I learned, the more excited I got. As an undergrad at the University of Michigan, I knew I wanted to go into medicine, and I needed to take on the necessary prerequisites, so I used that opportunity to not just take the science prerequisites as part of the premed curriculum, but also think about how do I take full advantage of the college undergraduate opportunities and branched out in a variety of areas — philosophy, Russian history, psychology — all of which have influenced me as a physician and as a leader.

Q: What was the healthcare industry like when you came to Virginia Mason?

GP: The industry was obviously much different, and in some ways very much the same. At Virginia Mason, I found an organization that was team-oriented from its beginnings, and that was different than what I had experienced in academia. I found a commitment to excellence in this organization.

I feel we've made progress [in healthcare], even though some might say it's not the way it used to be. One of my great joys is seeing how we've learned about quality improvement and about how to keep patients safe, and how to focus on a more rewarding patient experience. These things were on our minds back then, but those aspects of medicine were much less developed. And likewise, of course the science and technology. We had handwritten notes and charts, spent more time talking about great cases and building relationships. Obviously today the science has brought us to exciting changes, with its own challenges but also great opportunities.

Q: What would you consider the greatest achievements at Virginia Mason during your tenure?

GK: Over 20 years ago, we had the courage to change our minds, change our thinking about a variety of things. Challenge the dynamic of being a physician-driven organization to one that was truly patient-driven. Then being able to look outside our industry that led us to adapt the principles of the Toyota Production System to healthcare — what we call the Virginia Mason Production System. That's just an example of attributes I'm particularly proud of. The spirit of learning and innovation; relentless curiosity; and a belief that what we say here is 'better never stops,' which means we know we are making great progress, but we need to relentlessly pursue improvement.

Q: What has your tenure taught you about healthcare?

GK: One of the things I've learned to appreciate is the critical importance of culture. Culture is so important to our ability to continue to improve and get better for our patients and team members. Being at one organization over a long period of time, I've had the privilege of watching the evolution of our culture but also to lead it.

What I've learned is the behavior of our leaders and the power of leadership through their behaviors to set and evolve the culture — leveling the hierarchy, eliminating fear in the workplace. These create a fertile field for improvement, for people being the best they can be, to be thinking and becoming aware of all the waste there is in our [healthcare] environment. That isn't something that is embraced but requires the cultural elements to make the most of the opportunities we have to better care for our patients and communities.

Q: What advice would you give other hospital leaders about staying relevant in healthcare today?

GK: Healthcare leaders at all levels stay relevant by staying curious. That curiosity manifests itself in their visibility, their questioning and humble inquiries, their being out of their offices with teams, coaching, facilitating, tearing down barriers. Many of us as leaders cut our teeth or became leaders by solving problems. But I think what we've learned — and where I think we can have the most value as leaders — is in building capability and helping through facilitation and empowerment, helping frontline team members to redesign their care, to come up with the solutions that are most meaningful to those teams and the people they serve.

Another thing I would say to my fellow leaders is we should not shy away from creating a sense of urgency. There are many reasons to feel a tremendous sense of urgency today in healthcare, and one of the things we've always tried to do as leaders is to help our teams feel good. And the result has been protecting the people we lead as opposed to shining a bright light on telling the truth about our opportunities, about the things that need to be made better. We need to create that sense of urgency, and the result will be accelerating the pace of positive change. The status quo is like gravity, and unless we have a reason or feel that compelling rationale for improvement, we're not going to do the hard work I think is required in today's healthcare environment.


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