Kaiser CEO Bernard Tyson on Balancing Technology and Human Touch

Editor's Note: In this One-on-One with Medscape Editor-in-Chief Eric Topol, Bernard Tyson outlines his remarkable career at Kaiser Permanente, where he advanced from a position in the medical records department to become CEO of the $60 billion-a-year company. He also talks about why the human touch will always be at the center of healthcare, even as technology revolutionizes patient care.

Ten Million Patients and Counting

Eric J. Topol, MD: Hello. I am Eric Topol, editor-in-chief of Medscape. Today I have with me Bernard Tyson, who is the chairman and chief executive officer (CEO) of Kaiser Permanente. Mr Tyson is going to tell us about some of Kaiser's magic and secrets, and about his upbringing and how he got to this very important leadership position in healthcare.

You grew up not so far from where you work today, right here in California.

Bernard J. Tyson: That's right—Vallejo, California. The mayor of Vallejo reminds me all the time to make sure I say "Vallejo, California" and not "The Bay Area."

Dr Topol: Now you work in Oakland. How far away is Vallejo?

Mr Tyson: It's about 25 miles.

Dr Topol: You now look over 10-plus million members who have Kaiser healthcare. That is a pretty good subset of the 310 million Americans. You have about 18,000 doctors and 180,000 employees. But the buck stops here with you. You have a lot of responsibility and are doing many innovative things. What is it like to be in your position?

Mr Tyson: It's not all on my shoulders, but at the end of the day, the buck has to stop somewhere, and that is clearly with me. However, the leadership is distributed across the entire organization. We need to make sure that everyone is playing their roles, and we all are being driven through the lens of the mission of the organization. That is the common denominator. We are here to provide high-quality, affordable care to millions of people and to take care of our communities.

Dr Topol: You have been with the Kaiser organization for 3 decades. You moved up all the way through the ranks and were promoted to chief operating officer. You have now been the CEO for 3 years.

Bernard Tyson working as an assistant administrator at Kaiser Permanente Medical Center San Francisco in 1987.

Mr Tyson: I started in the outpatient medical records department at Kaiser, as a resident. I was finishing my residency program at Golden Gate University here in San Francisco. My first job in Kaiser Permanente was doing a project at the San Francisco facility in the Outpatient Medical Records Department. I played a role in the opening of our open-heart unit in San Francisco. From there I moved on to other jobs. I have changed roles, on average, about every 2-2.5 years during the past 32 years. It has been a great experience.

Dr Topol: It is pretty remarkable, this rise to such an important position, particularly because it is in the vanguard of American healthcare. There is hardly a time when people talk about innovative institutions or healthcare systems without mentioning Kaiser.

Lessons From the Other End of the Stethoscope

Dr Topol: I want to get to the things that you are doing that are progressive and unique, but before I do that, let's go back to 2006, when you were a patient, following a bypass operation. What was it like to be a patient?

Mr Tyson: Nowhere on my calendar would you have found an entry that evening saying I would almost die. The first takeaway is how traumatic something like that can be. It becomes very personal when it is your health, when something goes dramatically wrong.

Dr Topol: It was sudden?

Mr Tyson: Yes, it was very sudden. The symptoms had been present for a while, but it was presenting more like asthma as opposed to something going on with my heart. I ended up in heart failure and had a massive heart attack. They got me to the hospital in time to put me in a coma. They kept me in a coma for a couple of days. When they brought me out, the conversation started with the damage to my heart. They suspected that it was a heart valve, and more than likely they would need to surgically repair—and possibly replace—the valve to see how much damage actually had occurred.

I requested a transfer to Kaiser Permanente in San Francisco for the open-heart surgery. They went in and my heart valves were fine, but they did a double-bypass surgery while they were in there. The care was superb. It is all about the personal touch. It is all about the trust and the confidence in the people who are caring for you. One big takeaway is how vulnerable you feel. Here I am, at the time the executive vice president, running large parts of the company, and as a patient, none of that mattered. What mattered was my confidence in the physician and in the care teams—how they talked to me, how they treated me, and how they handled me.

I have often told the story about how, in my most vulnerable moment, a nurse came in and saw me in the condition I was in, and she did not say a word. She just simply touched my hand. I knew she knew what was going on. I have thought many times about that from two standpoints: First, in my role as CEO, what am I doing to make sure that the nurses have what they need to do their jobs?

Dr Topol: You anticipated what I was going to ask. Did being a patient in those circumstances help in your role as CEO of a healthcare system?

Mr Tyson: Absolutely. I really mean this about touching my hand, because touching a hand is not a procedure you can plan. You cannot write an order for the nurse, at 2:05, to touch the patient's hand. It is an emotional attachment. It is a human touching a human. We are heavy into technology. We are heavy into how technology will enable us to do a better job in taking care of each individual and millions of people, but not at the expense of the human touch. The human touch will always be the deciding factor of how people feel about the care that they are getting.

Dr Topol: I could not agree with you more. A lot of people think that technology is going to take us away from that central, critical aspect of human touch. It is important to emphasize that.

Technology and Trust

Dr Topol: I want to get into the technology, however, with that proviso. Kaiser is doing some unique things. For example, I know that as a member, through a mobile app you can access a lot of your medical information. Is that across the board for all members?

Mr Tyson: Absolutely. We have a road map. It is all based on a theory that we are working from, which is that if you look at the whole healthcare industry, we have designed it such that everybody comes to us for whatever they need. It has, generally, historically been through a physical location—a medical office building, a physician office, a hospital—those settings. What we are demonstrating is that you can provide care [outside of those settings]. We have been working on tools, starting with the telephone. We get 60-plus million calls between our members, providers, and nurses.

We also have televisits and secure e-visits. Last year we did almost 30 million of those. The patient does not have to go in; he or she has a relationship with the doctor. Patients can email into the secure email system.

Dr Topol: That is a key point, because many doctors throughout America do not want to email with their patients. You actually encourage that. Patients and doctors are mutually happy with it?

Mr Tyson: Absolutely. The challenge in our environment, and in every industry, is that email has become a way of doing business, a way of transacting. There is always the challenge because the use of technology has invaded so much of our space. We deal with this all the time. Our physicians now are dealing with the fact that they are virtually on call 24/7. A member can access that physician directly through a secure messaging system.

Our physicians have come to terms with that. It is interesting, though, that physicians are asking a different set of questions, such as, what should I be doing versus someone else? Some of the regulations have not caught up with our use of technology. Physicians do some things, such as signing orders, that we require from a regulatory standpoint but which now serve no purpose because the technology tells us who is doing what, and it is foolproof with fingerprint and passcode technology.

The ongoing challenge for physicians is how to balance the multiple demands that are being placed on them. A day no longer means seeing 20-25 patients in the office. They might see 20 patients physically but are seeing another 10-20 patients virtually. The life of a physician is changing dramatically with technology.

Virtual Visits and Open Records

Dr Topol: Do you think most visits will be virtual over the years ahead?

Mr Tyson: Yes.

Dr Topol: Is Kaiser supporting that move?

Mr Tyson: I fully support it. What I am hoping for is that it comes in a very positive way, because we are all about how to keep people healthy and productive. We started with my story. I could not run a $60 billion company if I did not have both my own responsibility for how I maintain my health and the assistance of my medical team to make sure I am doing things right. They keep a check on me to make sure that I exercise, not gain too much weight, and eat the right foods—coaching to keep me healthy as opposed to waiting until something happens, and then I'd need high-level interventions.

There is no way that I can go all over the world if every time I need something I have to physically be at a location. I have a relationship with my doctor and with her medical care team. I can be anywhere around the world. I can simply send an email to my doctor, say I am wondering if this is okay, and get a message back within a day. That is a convenience for me; it's a different relationship with my doctor. She knows me very well and the trust is there. In our view, the technology cannot substitute for trust. When I have a relationship, everything else is built on that.

Dr Topol: If you are in another country, you can just look at your smartphone and look at your labs, your notes, and your scans?

Mr Tyson: Yes. Not only that, but I can go in as I did about a month ago, do some lab tests, and within a couple of hours I am getting the results at the same time that my doctor is getting the results. I can graph them; I can make bar graphs. I can pull up old history. I can push a button and go into the medical library. Any member can do these things.

Mr Topol: This is part of the app?

Mr Tyson: Exactly. I could be looking at the results of the B-type natriuretic peptide tests that they do on me, which I love to monitor. I think they order it for me because I love to see it. I can go in, hit a button that says "About this test." I can go from there and study the test. I can study the different medications. It is engaging me in my health, which is what we are trying to do. How do I better understand my body? What is your role in the future as my provider in how you help me to help myself to be responsible for my health?

Cars, Yes—Bodies, No

Dr Topol: Does this reflect the philosophy that we tend to underrate humans, that we need to give them more information, and more charge, if they so desire? Is that part of this story?

Mr Tyson: Yes. Humans have shown that if they are interested in something, they are engaged in it. We use our phones now for everything. Sometimes, when your mind is wandering, you are wandering on your phone, going to what interests you. We need to make our human bodies interesting. Just like how we get into our cars and technology allows us to know how much air is in our tires. Some people know more about the air in their tires than about their blood pressure or sugar levels.

Dr Topol: It's crazy.

Mr Tyson: It is crazy. The question is, how do we make that inviting? The wearable technology started to evolve to medical devices that monitor the body in a 21st-century way. We might be on to something. People might start paying attention to what sugar does to their energy levels, for example. How am I sleeping? What does it mean if I feel a certain way because I slept only 4 hours, 6 hours, or 8 hours? What can I do about it?

I see it as evolving over time. In my case, the American people are behaving in healthcare more and more like consumers. They are asking different questions of us. That is giving us a real opportunity in how we make health and taking care of ourselves cooler, if you will, for the 21st century.

A Kaiser Medical School With a Unique Philosophy

Dr Topol: A lot of interest was expressed when you announced that you are going to start a Kaiser medical school in Pasadena. It is going to open with its first class within the next couple of years. What was the thought behind going into undergraduate medical education?

Mr Tyson: It is another concrete action in our continuum. We are already in medical education. We train thousands of residents every year. Many come in to the Kaiser Permanente program and then we have to reorient them to how we do things. We have yet to find a class leaving Kaiser Permanente saying, "What are they doing? This is crazy." They leave jazzed. They leave with a different appreciation for how we take care of individuals and populations, how we use technology, and how it is integrated into everything that we do.

We give them a real good lesson on how to take care of the whole person and how the person fits into the environment, because at the end of the day, I view Kaiser Permanente as a health system. It is not just a medical care program. It looks at your environment. It gets involved in how you eat, how you exercise, and what is in the community. We approach it from a holistic health system standpoint. Many of the behavioral factors outside of the medical care system are what determine your health. That is our line of sight.

The medical school, for us, is a logical next piece to the puzzle of how to train physicians for the future. That is what this is about—taking our collective wisdom and putting it into the classroom setting as we go forward.

Dr Topol: The skeptics—traditional, academic universities—are saying, how is Kaiser going to do this? They do not have anatomy professors. They do not have a basic science program or a university. Obviously, you can do it. What are your thoughts about how your curriculum will be different and unique compared with the 140 or so medical schools in the country?

Mr Tyson: There is some basic information that would be generic to any medical school. That is not the sweet spot that we are after. We are after how to train physicians in the future to be team leaders and team players, and to be oriented to total health as the framework for the provision of medical care, to think about evidence-based medicine of the future and how research will fit into the training programs of the future. What does it mean to be a part of a medical team in a medical environment that provides care? What are the practices that we have implemented over the years at Kaiser Permanente that produce the health outcomes and results that we have been able to achieve?

It is about bringing a unique value to medical education, not just copying another medical program. By the way, I have been very clear that our desire is to contribute a medical school to the greater society; we're not trying to bash 100 or 200 years of medical schools. God bless them. We are saying that we have something to offer here, and we are energized to offer it.

Finally, we believe that we still lack diversity in our medical profession. Our target is to be very inviting and enticing, and to figure out the formula to get more minority students into medicine. This is going to be an area of focus.

Dr Topol: That is terrific. It is something that you have worked hard on throughout your career, and I think it is laudable. Hopefully the medical school will also help. What you have been doing, and the way you have been expressing it, is just extraordinary. When I was training here at UCSF in 1980, Kaiser wasn't the pinnacle it is today.

Charting a New Path

Dr Topol: Over time, and especially in these recent years with George [Halvorson, former Kaiser CEO] and now you, the leadership and the movement of progressive nature, and all the things that you have been expressing—embracing human touch, technology, and other aspects—are setting a new model.

Mr Tyson: In the center of that we have 18,000 physicians. I do not want to minimize how critically important they are or the leadership that they provide. We have some of the best of the best. They are pushing the envelope about how to provide care in the 21st century. Having a mega health system the size of Kaiser Permanente, we have $60-plus billion in revenue and we invest $3-$5 billion annually in innovation and technology. There are resources that allow us to continuously redesign and innovate how best to provide care and coverage for the American people, and how to do it around a centerpiece of affordability. We want to improve quality, access, and service and make it affordable.

Dr Topol: I spoke at the Kaiser Division of Research 50th anniversary; you are doing some great research in genomics and other things.

It was just wonderful to have you at Medscape for this One-on-One, because what you are doing is charting a whole different path. Many will consider it a better, futuristic approach to progressive healthcare. Thank you so much for all that you do and stand for, and thanks to all of the folks at Kaiser Permanente.

Thank you also to everyone at Medscape for tuning in to this One-on-One with Bernard Tyson. We are lucky to have him. He is certainly one of the most interesting people in medicine and healthcare today.