Kaiser Permanente Continues to Be Recognized as a Leader in Quality
Kaiser Permanente's Performance Improvement System, Part 1: From Benchmarking to Executing on Strategic Priorities
Article-at-a-Glance
Background
By 2004, senior leaders at Kaiser Permanente, the largest not-for-profit health plan in the United States, recognizing variations across service areas in quality, safety, service, and efficiency, began developing a performance improvement (PI) system to realizing best-in-class quality performance across all 35 medical centers.
Measuring Systemwide Performance
In 2005, a Web-based data dashboard, "Big Q," which tracks the performance of each medical center and service area against external benchmarks and internal goals, was created.
Planning for PI and Benchmarking Performance
In 2006, Kaiser Permanente national and regional continued planning the PI system, and in 2007, quality, medical group, operations, and information technology leaders benchmarked five high-performing organizations to identify capabilities required to achieve consistent best-in-class organizational performance.
The PI System
The PI system addresses the six capabilities: leadership priority setting, a systems approach to improvement, measurement capability, a learning organization, improvement capacity, and a culture of improvement. PI "deep experts" (mentors) consult with national, regional, and local leaders, and more than 500 improvement advisors are trained to manage portfolios of 90–120 day improvement initiatives at medical centers.
Impact
Between the second quarter of 2008 and the first quarter of 2009, performance across all Kaiser Permanente medical centers improved on the Big Q metrics.
Conclusions
The lessons learned in implementing and sustaining PI as it becomes fully integrated into all levels of Kaiser Permanente can be generalized to other health care systems, hospitals, and other health care organizations.
Section snippets
Measuring Systemwide Performance
In 2005, the national quality committee created a data dashboard known as "Big Q," which distilled hundreds of performance measures into a vital few, high-level measures to allow leaders to answer the question, "As a system, are we improving?" Dashboard measures were selected in consultation with organizational clinical, operational, and financial leaders and in collaboration with the Institute for Healthcare Improvement (IHI),6 creating a view of systemwide performance (Table 1, above).
Planning for PI
In April 2006, a small work group of Kaiser Permanente national and regional stakeholders convened to develop an approach to assessing needs, identifying gaps in skills, and planning a PI system to drive enhanced performance in the Big Q measures. In July 2006, national and regional quality leaders agreed to pursue a uniform methodology to create a common organizational language and approach to improving quality, safety, service, and efficiency. In late 2006, the chief executive officer and
Developing the Performance Improvement System
We focused on designing a whole-system PI approach that cascades from national to regional to facility levels as staff focus on a collaborative effort to improve performance. With autonomy and innovation as enduring organizational values, the PI system allows regions and medical centers to independently set goals to close performance gaps on dashboard measures and national and regional leadership to create vision, set direction, and establish accountability to reduce variation across sites.
Impact
Between the second quarter of 2008 and the first quarter of 2009, performance across all 35 Kaiser Permanente medical centers improved on the Big Q metrics. The Healthcare Effectiveness Data and Information Set (HEDIS) composite measure (Table 1) improved from approximately the 80th percentile to exceed the 90th percentile. The overall HSMR (observed-to-expected deaths) improved by 0.15 (Figure 4, page 494). The prevalence of hospital-acquired pressure ulcers decreased by more than 50% (Figure 5
Discussion
In 2006, Kaiser Permanente aligned system-level measures and leadership goals for PI. In 2008, we began implementing an organizationwide PI system entailing six capabilities to move all Kaiser Permanente medical centers to top-decile performance. Lessons learned from three years of experience in implementation pertain to what was effective in implementing and sustaining PI, hurdles we identified along the way, and challenges we continue to face as PI becomes fully integrated into all levels of
Conclusion
Kaiser Permanente embedded PI into operations by making performance data transparent, benchmarking external organizations, and designing a PI system to develop six capabilities of high-performing organizations. Improvement has occurred in systemwide composite measures of care. Although we have accomplished a great deal, much remains to be done.
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Copyright © 2011 The Joint Commission. Published by Elsevier Inc. All rights reserved.
Source: https://www.sciencedirect.com/science/article/abs/pii/S1553725010360727
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