Kaiser Permanente organizational structure and operations

Kaiser Permanente Quality Assurance Program

Kaiser Permanente

Facility description. Kaiser Permanente is a healthcare organization that had its origins in the pre-war industrial sector. The program offered health care for workers in the steel mills, the shipyards, and the construction companies in a nation just recovering from the depression and attempting to stand apart from the conflict and volatility evidenced across the globe.

A young surgeon, Sidney Garfield, borrowed money to build Contractors General Hospital with the idea of serving the thousands of contractors building the Los Angeles Aqueduct near Desert Center -- which was in the middle of the Mojave Desert. The 12-bed hospital found it difficult to get insurance companies to pay for the treatment of injured and ill contractors. Some of the workers did not have insurance, but Dr. Garfield treated them anyway and the hospital's debts piled up. With the help of man named Harold Hatch, Dr. Garfield convinced the insurance companies to pre-pay a set daily amount to cover the contractors care and treatment. The prepayment plan rescued the financial situation of the hospital and facilitated a focus on health care and prevention instead of just treatment of injuries and illnesses. The success of the hospital plan and the quality of care established a reputation for Dr. Garfield that brought about replication for workers at the Grand Coulee Dam and the Kaiser Shipyards in Richmond, California, where Liberty Ships were being built for World War II.

Quality assurance Program. The National Committee for Quality Assurance (NCQA) is a private, non-profit organization which has as its mission the improvement of health care quality. The National Committee for Quality Assurance uses a Quality Compass® to measure health care plans. Quality measures used by NCQA are evidence-based and are a manifestation of the most widely used measures applied to clinic quality in the United States ("Kaiser Permanente," 2009). Kaiser Permanente has made the NCQA standards the base for its own scorecard, benchmarking to eight measures from the NCQA Quality Compass® ("Kaiser Permanente," 2009). The attributes of the healthcare teams and the medical facility have resulted in high scores in the measures, which include "health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management" ("Kaiser Permanente," 2009).

Different Kaiser Permanente facilities located across the country received particular mention for top marks. Appropriate use of medications for asthmatics garnered praise for Kaiser Permanente of Colorado, while Kaiser Permanente Hawaii scored top marks for breast cancer screening, and the diabetic nephropathy monitoring ("Quality Compass," 2009). Blood pressure control for diabetics was marked highest for Kaiser Permanente of Northern California ("Quality Compass," 2009). In Georgia, Kaiser Permanente shined in the area of childhood immunization, with the DP/MMR combo, HIB, meningitis, chicken pox, hepatitis B, Chlamydia screening, and LDL screening in coronary artery disease patients ("Quality Compass," 2009). The fact that quality scores are so variable within a single institution is an indicator of the rigor of the NCQA program ("Quality Compass," 2009).

Kaiser Permanente is a strong proponent of third-party clinical quality reporting, and finds that the review process strengthens use of Kaiser Permanente's electronic medical records platform and database, Kaiser Permanente HealthConnect® ("Kaiser Permanente," 2009) All Kaiser Permanente hospital and clinic professionals record treatment and care for patients in the HealthConnect® system, thereby facilitating coordinated and timely care ("Kaiser Permanente," 2009). Research has shown that making the quality improvement process sufficiently salient to practitioners can positively impact patient care. Laiteerapong, et al. (2011) found that hospital staff could significantly impact the routine practices in a hospital setting by using plan-do-study-act cycles to improve screening for obesity by using the Body Mass Index (BMI).

For their part, NCQA has developed and maintains a system called HEDIS® which is the performance tool of choice for health plans in the United States, with more than 90% of the health care organizations using the system ("Kaiser Permanente," 2009).