Consistent Care: Spreading Best Practices for Total Joint Replacement

Kate Koplan, MD, Leads National Initiative to Improve Quality of Patient Care

When you grow up in a home with two physicians – a father who works at the Centers for Disease Control and Prevention and a mother who works in psychiatry – dinner time conversation naturally consists of topics like the epidemiology of outbreaks and social determinants of mental health.

With medicine in her genes plus a passion for animals, Kate Koplan, MD, initially thought she might become a veterinarian. With a passion for reading, she majored in history while in college at Yale, but as she completed her education it became apparent she was best suited to pursue a joint medical and masters of public health degrees, which she earned at Emory University in Atlanta.

What happened during her residency in Boston primed her for a subsequent leadership role at Kaiser Permanente. Dr. Koplan did her clinical rotation at a large multi-specialty group practice, where she led quality improvement and medical management work. She learned how to navigate in a large and diverse organization, working with leaders within an organization and at outside groups such as insurers and hospitals to measure performance and improve quality.

When she decided to return to the Atlanta area a few years later to start a family, she was excited to be offered a position as associate medical director of Quality and Patient Safety at Kaiser Permanente Georgia, “the most well-organized, integrated, highest-quality organization in Atlanta,” Dr. Koplan says, and the only place she was looking to work.

National Quality Leader

Just two years after starting her job, she was offered a fascinating opportunity: the chance to lead a national Kaiser Permanente clinical quality initiative as a national Permanente Quality leader. The goal of Kaiser Permanente’s six national quality initiatives is to ensure patients have a consistent care experience across the organization, to identify and promote the spread of evidence-based medicine, and to ultimately enhance value for members and care teams. Each initiative is led by a physician leader who has accountability for advancing Kaiser Permanente’s clinical quality strategy at the national level, in addition to their regional responsibilities.

I am very concrete, pretty black and white, and I like to keep things well-defined and moving forward in the context of the team.

Despite being an internist, Dr. Koplan was asked to lead the roll out of the Kaiser Permanente National Total Joint Replacement Initiative. But she didn’t let her lack of orthopedic subject-matter expertise or the fact that this was a fledgling initiative deter her. She agreed to take on the role in addition to her job as a practicing physician and regional quality lead for The Southeast Permanente Medical Group. The new role offered her the opportunity to learn more about a specialty that was new to her as well as new approaches within that specialty. It was also an opportunity to support the national quality work and the great work of the Orthopedic chiefs and care teams.

“I’m happy to jump into something even if it’s not perfectly defined,” Dr. Koplan says. “I knew that this was a learning experiment and that there was room for failure. I didn’t mind being a guinea pig.”

The National Total Joint Replacement Initiative was established to improve efficiency while maintaining and improving effectiveness, safety, and care experience for Kaiser Permanente patients undergoing elective knee and hip joint replacement procedures. It includes a suite of spreadable successful practices for joint replacement surgery harnessed from across Kaiser Permanente and bundled together in an implementation guide.

The spreadable practices range from pre-operative care (including patient and family health education), to perioperative care (such as blood management protocols), all the way to post-operative care, such as home physical therapy visits. One of the key tenets of the initiative is the opportunity to allow patients to recover at home following surgery and reduce any unnecessary lengthy hospital stay. Recovering at home can cut down on complications like surgical infection and allow patients to heal in a familiar environment. The key is planning in advance for the support patients will need following surgery.

Collecting these best practices meant pulling together a diverse clinical team – from perioperative nursing leaders, to anesthesiologists, to orthopedic surgeons – along with the data scientists who study surgical outcomes. Along the patient journey, experts look at what’s working from the patient and clinician experience and safety standpoints. Performance improvement experts help identify ways to spread the practices across Kaiser Permanente’s diverse regions.

Moving Forward

Bringing these great minds together and putting pen to paper was no easy task. But Dr. Koplan makes it look easy. Her background in quality and performance improvement efforts is critical to her success; she understands how to collect and analyze data. Her strong background in project management also comes into play.

“I am very concrete, pretty black and white,” she says, “and I like to keep things well-defined and moving forward in the context of the team.”

It is so important to recognize the innovation and contributions of individual physician leaders.

Key to project management is figuring out how to do shared learnings and interact with teams in different regions, communicating with the right frequency, and creating a community for learning. Dr. Koplan also has the essential people skills required to bring diverse sets of leaders together and keep key leaders involved. Part of this involves staying in frequent contact with the Orthopedic chiefs to keep them engaged in the project, and giving them recognition for their ongoing clinical and operational leadership.

“It is so important to recognize the innovation and contributions of individual physician leaders,” she says. “From there, we can kickstart engagement and identify successful practices to spread.”

Blueprint for Future Initiatives

Dr. Koplan believes the work her team and other national Permanente Quality leaders are doing could ultimately become the blueprint for many more initiatives across Kaiser Permanente. In 2017, she shared the practices and results at Kaiser Permanente’s National Quality Conference, inspiring other physicians, operational leaders, and care team members to take a more holistic approach to joint replacement surgery.

“This is about looking at internal success, outcome data, picking up what works and spreading it,” she says. “At the end of the day, our guide is the quadruple aim, and we care about all four elements:  improving population health, increasing patient satisfaction and provider satisfaction, and reducing per-capita health care spending.” This all supports the organization’s collective framework for quality: safe, timely, effective, efficient, equitable, and person-centered.

Even with Dr. Koplan’s early success, leading the National Total Joint Replacement Initiative continues to be a learning experience for her. “I love learning on the job every day and working with a diverse, multi-specialty, cross-regional team,” she says. And Dr. Koplan continues to love animals, especially her 7-year-old golden retriever, Cooper. He’s been joined in the household by Maxwell, her 3-year-old son, with her husband, Gregg. The family stays busy taking Cooper for walks, listening to music and going to concerts, traveling, and spending time with friends and family.