Kaiser Permanente Kaiser Permanente is a titan of the managed health care industry. Established in 1945, it has grown to enormous proportions, serving approximately 9 million members through the efforts of 180,600 employees. Such gigantic proportions and wide arrays of services necessitate complex management. The organization has succeeded in establishing management that works "from the top down" with mixed results. A giant in the managed health care industry, Kaiser Permanente has dealt with its huge membership, extensive geographic expanse and wide array of services by establishing an administrative system in which national management and regional management work with each medical facility's upper management, middle management, middle frontline management and frontline workers. In doing so, the organization has met external and internal forces with mixed results. While its developed "top-to-bottom" management style and "performance improvement process" have resulted in award-winning results, its employees anonymously complain of a bureaucracy that is burdensome, slow and rife with red tape.
Kaiser Permanente is a titan of the managed health care industry. Established in 1945, it has grown to enormous proportions, serving approximately 9 million members through the efforts of 180,600 employees. Such gigantic proportions and wide arrays of services necessitate complex management. The organization has succeeded in establishing management that works "from the top down" with mixed results.
Assessment of the Various Management Levels and Their Role in Kaiser Permanente
Kaiser Permanente is a managed care conglomerate initially developed in the 1930's and 1940's for construction, shipyard and steel mill employees, then opened to the public in October 1945 (Kaiser Permanente, 2012). Today Kaiser Permanente works as two partner organizations: Kaiser Foundation Health Plan, which is not-for-profit, and Permanente Medical Groups, which is for-profit (Kaiser Permanente, 2012). Based in Oakland, California, Kaiser boasts approximately 9 million members (Kaiser Permanente, 2012) and 180,600 employees (Kaiser Permanente, 2012).
Kaiser Permanente operates in 8 regions, including Northern California, Southern California, Colorado, Georgia, Hawaii, an area embracing Maryland, Virginia and Washington, DC, Ohio, and an area comprised of Oregon and Washington (Kaiser Permanente, 2012). In addition, Kaiser Permanente acts as "the caregiver, the hospital, the laboratory, and the pharmacy" (Kaiser Permanente, 2012). These extensive geographical and service categories require far-reaching corporate structures, topped by George C. Halvorson, its Chairman and CEO (Kaiser Permanente, 2012). In addition to its CEO, Kaiser Permanente's management structure includes: "Human Resources; Information Technology; Clinical Systems Support; Compliance; Health Plan Operations; Finance, Audit, Procurement; Communications; Community Benefit; Research and Health Policy; Legal; and Hospital Operations" (Kaiser Permanente, 2012). Those many areas are governed by a laundry list of executives, including: Bernard J. Tyson, President and chief operating officer; Jack Cochran, MD, FACS, Executive director, The Permanente Federation; Philip Fasano, Executive vice president and chief information officer; Kathy Lancaster, Chief financial officer and executive vice president of strategy; Arthur M. Southam, MD, Executive vice president, Health Plan Operations; Anthony A. Barrueta, Senior vice president, Government Relations; Raymond J. Baxter, PhD, Senior vice president, Community Benefit, Research and Health Policy; Chuck Columbus, Senior vice president and chief Human Resources officer; Amy Compton-Phillips, MD, Associate executive director, Quality, The Permanente Federation, LLC; Daniel P. Garcia, Senior vice president and chief compliance officer; Chris Grant, Senior vice president and managing director, Kaiser Permanente Venture Capital and Corporate Development Group; Diane Gage Lofgren, Senior vice president, Brand Strategy, Communications and Public Relations; Cynthia Powers Overmyer, CPA, CIA, Senior vice president, Internal Audit Services; Jed Weissberg, MD, Senior vice president, Hospital, Quality and Care Delivery; Harold F. (Hal) Wolf III, Senior vice president, chief operating officer, The Permanente Federation, LLCl; Scott Young, MD, Associate executive director, Clinical Care and Innovation, The Permanente Federation, LLC; Mark S. Zemelman
Senior vice president and general counsel (Kaiser Permanente, 2012).
Operating in a "top-to-bottom" management style, Kaiser Permanente also uses regional and medical facility management. In addition to its national corporate leadership team, the organization has a regional leadership team comprised of 8 regional presidents from all regions and 8 executive medical directors covering all regions (Kaiser Permanente, 2012). Kaiser's medical facilities also have their own management structures, consisting of a medical director, "middle management" and "frontline management" and "frontline staff" (Kaiser Permanente, 2011). Clearly, the organization employs an extensive, complex management system from the top down.
Description and Explanation of the External and Internal Environment of Kaiser Permanente
Kaiser Permanente's external environment certainly includes National Health Care Reform. Kaiser's official response is: "Universal access to high-quality, affordable health care coverage is imperative, and we are fully committed to working with policymakers to make that goal a reality" (Kaiser Permanente, 2012). In addition, a 1999 article that is admittedly too old yet outlines still significant external forces, states that the organization must deal with such external forces as: the power of large purchasers to force reductions in premiums; competition from HMOs; the aging of the population, rising costs of pharmaceutical agents and new technology; anti-HMO sentiment; and a significant increase in the number of individual consumers with limited dollars for purchasing health plans (Crosson, 1999).
The internal environment of Kaiser Permanente consists of the management systems and services mentioned above, as well as a corporate culture about which employees give mixed reviews. One anonymous employee stated, "At Kaiser Permanente, you job title is what you imagine it to be. Given the experience, education, and passion, there is room for growth for each individual. The union provides members with ample support to perform their job, seek funding for additional learning opportunities, or handle management complaints." However, that same employee in that same review complained about the bureaucracy that "prevents changes from occurring at a bearable pace. If a large fixture is needed in a department, paperwork and numbers of doors to break down will seem endless" (Anonymous, 2012). Yet another anonymous current employee stated that the organization has "Good benefits. Good morale and work ethics. Very diverse environment." However, he/she also stated that Kaiser is "Very Beaucratic [sic] and lots of red tape" (Anonymous, 2012).
Explanation of how Management Contributes to Kaiser Permanente's Effective and/or Non-Effective Performance
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