John Mattison, CMIO Kaiser Permanente USA, has spoken at the Mobile Healthcare Conference in october 2016. Kaiser Permanente is USA’s largest not-for-profit health plan and health care provider, with annual operating revenue of more than $50 billion, 21 hospitals and 8000 doctors. Kaiser Permanente has been recognized as the national leader for both outpatient and inpatient systems, leading the country for hospitals awarded with the top HIMSS level 7 designation. Before, John practiced internal medicine and critical care at Scripps Clinic and Research Foundation, where he served as director of the Intensive Care Unit. Last year, Kaiser Permanente conducted for example 10.5 million patient-doctor visits via email, phone or video tools. With the KP app patients can access most of their electronic health l records. Kaiser Permanente is a leader in prevention and personalized care.
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Transcript of the interview
What do you see as the most influential trends in mobile healthcare?
I think the most influential trends in mobile healthcare really have to do with dose applications and tools that are focussed on using digital sensing and digital tools to create mindfulness. So instead of someone saying “I need to take 200 more steps today to reach my goal” I like to tell people “stop looking at your monitor, your fitbit or whatever as frequently and become more mindful; if you see an elevator, take the stairs, so that you are actually changing your behaviour unconsciously towards healthier habits, rather than relying on a digital nanny”, because we know that digital nanny’s tend to be subject to habituation and extinction and we lose those things that we are trying to achieve by being too responsive to that digital nanny. There are other tools that help us understand how to have a healthy heart beat, a healthy heart rhythm, that also can help guide us in terms of managing our stress, maintaining our composure and being mindful, that really helps lower stress overall, which is one of the fundamental methods of maintaining a high level of health. The second thing that I think is important is bringing a much more motivational science and motivational economics into the mobile health ecosystem, so that we actually understand that different people are motivated in different ways. There are a lot of studies published that have been underwhelming in terms of the benefits of a lot of the mobile health technology and I think the principal reason for that is that they are being used in relative isolation. What we need to do is create more of a behavioural symphony of wellness that has the goal of creating personalized motivational tools and use a motivational formulary that is different for different people and use motivicons – that could be a video, that could be an in app reward, that could be a text message, that could be an email, that could be a video visit, that could be a humorous video, that motivates you in a way that works for you – but we need to be much more personalized in how we motivate people to achieve their own goals. I think a lot of the reasons that there is some controversy around “why is it taking so long to see the real benefits of digital mobile healthcare?” have to do with the fact that we are taking very simplistic isolated solutions rather than putting them in the context of a behavioural symphony that is relevant to me, motivates me towards my goals, rather than is directed at a population of people who on average respond in a certain way. So I like to think of using modern technology to restore some of the ancient wisdoms of mindfulness and resilience using personalized motivation tools.
Your focus is on patients. How do professionals in healthcare benefit from mobile health?
Well, I would change the premise of that question a little bit, because I think patient-centered care is an oxymoron. I like to think of taking care of people. Because what motivates us in our lives is not just getting a lower blood pressure or getting a better blood sugar. What motivates us in our lives is having more peace in what we do, more gratitude for what we have, more forgiveness for others around us, so that we can actually have a better life experience and lead a longer healthier life. And so we need to look at the whole person, not that subset of our experience as human beings that we call a patient. I believe it is an oxymoron, because patients are what doctors call people. I like to think of person-centered care rather than patient-centered care. Now setting aside the oxymoron of patient-centered care, how do we motivate and how do we manage the physician side of this physician-person relationship. I like to say that most physicians are people too. So they tend to respond to the same kind of motivational tools as non-physicians do. So what we really need to do is help physicians understand that their goal is not just to lower the blood sugar or just to lower the blood pressure, but it is to create more resilience and a higher level of health and wellness in their patients. There is a great book called “Drive” by Daniel Pink, which talks about how you motivate people, whether they are physicians or people that physicians are accountable for helping. In Drive he breaks it down to three levels of motivation. Motivation 1.0, 2.0 and 3.0. Motivation 1.0 is where you use basically food, water, air, shelter, sex, very primitive. Motivation 2.0 is carrots and sticks, where you use money and punitive measures for motivation. Motivation 3.0, which is by far the most powerful and sustainable; almost all of us are born with a sense of wanting to make the world a better place, to feel that we have something to contribute, that we are making a difference in our communities and that we are actually being appreciated for how we apply our skills to improve our community. And that sense of purpose and that sense of dignity is something that applies not only to the people we treat in the healthcare professions, but applies to us as individuals. And so to the extent that we rely on motivation 3.0 in Daniel Pinks book and help physicians and other healthcare professionals realize their aspirations to make the communities better, to make the individual people they are responsible for healthier and more resilient; it gives them the gratification of knowing that they have purpose and dignity in what they do. And I think a lot of that has been displaced by all the distractions of technology and all the demands being placed upon providers today. And we need to more and more use technology, but put it in a background and use a much more human-centered design and restore those very fundamentals of how we as humans help each other out and restore a sense of gratitude, a sense of dignity, a sense of purpose in what we do every day. [That sounds very high lofty, but in fact it’s really the scientific evidence that Daniel Pink characterises is profound that that is most motivating and most sustainable for most people.
You seem to have a very positive outlook on healthcare and maybe even mobile healthcare. Do you see this positivity in this conference that you are attending right now?
I absolutely do. I still think it and I am seeing that here, but I really think that where we need to create a shift in is why we are seeing incredible innovation and incredible entrepreneurial solutions… The entrepreneurs themselves need to be much more deeply embedded, not just with the healthcare professionals but with the patient very early in design, with the people that they are trying to help, with a very much of a human-centered design, so that from the get-go there is much more of a comprehensive view to create that behavioural symphony of wellness that is required to really motivate people, not with just a narrow slice of their live of a narrow slice of [decision 7.39], but more holistically. And we need to think of solutions that are fundamentally based on human values and human aspirations, that are supported by insentive models and organizational structures and then finally by technology. When we are trying to develop the technology as the lead in healthcare I think that we are neglecting some of the more important infrastructure that is necessarily being placed for that technology to be successful. So a more holistic view from the ground up of what it is we are trying to achieve and how we achieve it and how we make the technology reinforce those values and objectives is the important part, that there are still lots of opportunities to improve on.