Jack Cochran ’68 ushered in a new era of information-age medicine as executive director of the Permanente Federation.
This article originally appeared in the College of Natural Sciences’ Elements magazine. Read the full issue here.
The United States spends the most money of any country on health care – a total of $3 trillion, or 18 percent of the total GDP. But, despite all of that spending, neither our health care nor our life expectancy is No. 1 – in fact, both rank 31st globally.
A big part of the problem? Lack of communication – among health care workers but also between people and data.
There is one health system in the country, however, that has pioneered a new path forward, one in which a patient’s data is viewable by the entire care team simultaneously and accessible to the patient. It is a system that challenges its staff to learn from mistakes, look for patterns, and put patients – not docs – at the center of the care model. It is Kaiser Permanente.
Colorado State University biology alumnus Jack Cochran (’68) spent 25 years leading many of these changes – first on a regional level in Colorado, and then as executive director of The Permanente Federation, which supports the consortium’s eight groups around the country, a care network that reaches some 9 million patients. “Jack Cochran’s driving passion to help and his insights into how systems work – from human systems to technological ones – made an incredible impact on the industry,” says Dean of the College of Natural Sciences Jan Nerger. “We cannot be more proud to count him as one of our college’s alumni. He sets an exceptional example as to what is possible with an inquiring and open mind.”
Humanity in healthcare
When Cochran arrived at CSU in 1964, however, he had no inkling he wanted to go into medicine or health care administration. He was a teenager from Wheat Ridge, Colorado, who happened to have an aptitude for science. He settled into a biology major with a minor in political science. This diverse training gave him an important perspective through medical school – and his career – he says. “I am proud of my CSU roots, grateful for what it gave me, and dedicated to be a positive supporter always.” From his time here, he learned of being a good doctor and administrator, “there’s a whole lot more to it than just academic capabilities; you must bring the humanity to it.”
After CSU, he attended dental school for a year, but it became clear he wanted to be a physician, so he enrolled at the University of Colorado School of Medicine, graduating in 1973. He then completed a residency in surgery at Stanford University Medical School and a fellowship in plastic and reconstructive surgery at the University of Wisconsin Medical School. After training at three different leading medical schools, Cochran realized that his CSU education prepared him to succeed in myriad challenges.
He went into private practice of plastic surgery in Denver and, after 10 years, he joined Kaiser Permanente to create their new department. Over the next few years, the organization saw many challenges, which affected the group broadly, including morale. He was encouraged by colleagues to run for their board to see what changes could be impactful. He was perceived as a steady force who listened well before reacting, so he was asked to run for board president and was elected in 1999.
With that position, he knew he would have to make big changes. He just didn’t know what they were yet. So he listened. And listened.
In fact, he sat down with and listened to every doctor in the entire group – a data-gathering mission that took about two months. He called it his “Listening Tour.” And from it, he learned a lot: “Even if you don’t know what all of the answers are, at least you can start to think about it,” he says. And his subsequent thinking built the foundations of his transformative management strategy and vision for the groundbreaking work that Kaiser would do.
One of Cochran’s innovations was to take a big-picture view of the whole system. “We did a turnaround of the whole region and group,” he says. By changing structures and thinking about support staff roles, he was able to empower doctors who had previously complained of being overworked to actually be more productive in terms of patient care.
The other hallmark of his tenure as president in Denver is the implementation of an early digital medical record system. This first version had its drawbacks – and was eventually replaced by the current system when rolled out nationally – but, says Cochran, through the experience, “what we developed over time were physicians who really saw the advantage of computers.”
“If you’re taking care of a patient, and their information is in a paper chart, you better have that paper chart where the patient is,” he says. If that patient was in oncology yesterday, cardiology the day before, and a different specialty today, “that chart could be anywhere,” he says. But once that information is digital, instead of being anywhere, that information can be everywhere – with the specialist treating the patient, with the primary care doctor, and with the system itself, which can now screen for missed tests, unfilled prescriptions, and important follow-ups (likewise, it avoids redundant tests and potentially dangerous drug interactions, and allows patients to e-mail their doctors, cutting down on unnecessary office visits).
“It’s wondrous,” he says. “It’s so powerful. You have the data and the information on the patients, you have the science on the clinical outcomes.”
From there, they can analyze the data to even be proactive. For example, he says, if they know they have 1,000 people in Fort Collins with asthma and learn about a nearby forest fire or dust storm, “you can figure out the risk and reach out to these people – and anticipate problems. That’s the good stuff.”
With all of that data can come uncomfortable truths as well: “The data shows us where we’re good – and where we can improve,” he says. And that meant an additional sea change. “So we developed this culture that embraced measurement, acknowledgment, comparison, and improvement.” From this shift, “you redesign care practices, create different ways of measuring outcomes – and then it gets really exciting,” he says. “That’s a long way from the old model, where everything took place in the doctor’s office and the doctor’s brain.”
Such systemwide data transformed the practice “to the information age: patient-centered and team-based,” he says.
He retired in 2015 and still prizes his own team. Cochran credits his colleagues for the great successes: “I had a tremendous team – I was lucky to be there.”
Jack Cochran is also the co-author of The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care (PublicAffairs, 2014).