After more than 20 years, Gary Kaplan is stepping down from his role as CEO at Virginia Mason Franciscan Health as of January 2022, but will continue to advise the new sole CEO Ketul Patel for a year. Kaplan will assume the role of senior vice president focusing on quality, safety and patient experience during 2022 at parent company CommonSpirit Health's 21-state network of health systems.
Kaplan got his start at Virginia Mason as a physician and is renowned for implementing best practices in safety and quality from automotive manufacturing into healthcare, eventually forming the Virginia Mason Management System. He will also continue to be active with the Virginia Mason Institute, which trains providers internationally in the system and other process improvements.
Modern Healthcare's Safety & Quality Reporter Lisa Gillespie spoke with Kaplan about his career and what he hopes to achieve with CommonSpirit Health.
MH: Why are you leaving your post?
This is something I've thought about for a long time and Ketul and I've talked about for a long time. I'm now past 70 and I have a lot of things I'd like to do both personally and professionally. I'm very excited and pleased with the progress we've made since our merger, and the trajectory of Virginia Mason Franciscan Health is on. I feel very, very confident in Ketul's leadership, his passion, and energy around quality, safety and patient experience—the things that I've been very passionate about from my several decades in senior leadership.
The merged Virginia Mason Franciscan Health system will soon celebrate one year. What are highlights of the work that's gone on?
We have been clear that the Virginia Mason production system will be the management system for the organization going forward. And we have already begun the training required to make that happen across all Virginia Mason Franciscan Health. We have an ambitious plan to deploy this over the next couple of years. Integration takes time, but the foundation is in place. I have tremendous confidence in the structure and the people to lead this work.
What will your role at CommonSpirit be?
I'll help divisions across the country realize the power of engineering approaches to improve quality, safety and patient experience. And what's exciting for me is that there are already numerous requests for the Virginia Mason Institute from team members. I understand where there are opportunities to take waste out of processes. The chance to formally do that, across 21 states with 140 hospitals is, I think, an exciting way to spend the last year of my career.
And how will you operationalize this work?
Marvin O'Quinn, the president of CommonSpirit, and I are in conversations about what's going to be the best approach and I can be most effective. Some of those details are yet to be determined. I expect that this work will really allow us to make some substantive improvements, promote that kind of dialogue and conversation within CommonSpirit, but also in the industry.
What role is the Virginia Mason Production System playing during the pandemic?
The management system allowed us to quickly understand our processes on Day One. We've had very close relationships with our suppliers, and we established mass vaccination programs such as the one between the Virginia Mason Medical Center and Amazon. We've distributed over 380,000 vaccines. These things were made much easier and more possible because of the management system.
What were your greatest achievements at Virginia Mason?
Some of the things I'm most proud of was changing the conversation from healthcare designed around physicians and those working in the industry, to a new way of working designed around our patients. We convened teams with equal numbers of healthcare providers, patients and family members to redesign processes. Another thing that I'm very proud of was the willingness to look outside of healthcare for answers. Early on, I personally looked all throughout healthcare for a management system, and back in 2001 nobody had it. And that's when we heard from Boeing about what they were doing, ironically, with the Toyota Production System. And we were willing to explore that.
How can we increase evidence- and value-based care?
My hope is that we will increasingly move upstream so that in medical school, and certainly in residency, students will gain exposure to opportunities to reduce the total cost of care—particularly around appropriateness.
Back in 2004, Virginia Mason patient Mary McClinton died from a preventable medical mistake and the organization went public with what happened and apologized. That was a bold move, and one that we don't see often in the industry. What led you to publicize this error? And what can leaders today can learn from that decision?
One of the critical forces, whether we like it or not, is transparency. Here we were two years into the Virginia Mason production system work, learning that we needed to deeply understand our processes even if we didn't like what we saw all the time. And Mary McClinton came to us and died from a preventable medical error.
I said, "How can we not tell this story? Because if we don't, we are allowing the lessons learned to go unlearned by others, and potentially, other patients will be harmed." And so we almost instantly made the decision to go public. And we got fried in the media. One of our team members said the same thing happened in another hospital in this community and it was swept under the rug. Mary might have lived if there'd been transparency. And so it was groundbreaking in that respect. Even the trial lawyers will tell you that if you're transparent with apology, disclosure and communication programs, you can actually reduce professional liability costs.
Over the course of your career, you've taken a lot of risks. What is it about you that made you a different kind of leader?
Sometimes we choose to ignore things that make us uncomfortable. As a clinician I took an oath to above all do no harm. And as a leader I've seen that, as well intended as we are as a profession, we don't always act in the best interests of patients. Once you shine a bright light on the way things are, you can't help but say that the status quo is inadequate. I've also been fortunate to have board members over the years that have both held me accountable as a leader, and encouraged me and our team to innovate and not be fearful. Part of the making a good CEO is having a board that that is also driven.
Seattle is known as being a fairly forward-thinking place. If a hospital CEO is somewhere less so, how can you find board members who encourage risks?
All too often, we as leaders have felt like we need to protect the people we lead, or we can't be as transparent as some because the consequences of that transparency. What I've learned is that by telling the truth and by shining a bright light, at a minimum, you create a sense of urgency. And once you have a sense of urgency, then you have the beginnings of change. Without a sense of urgency, the status quo is like gravity.