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Kaiser Permanente Reaped 136 Percent ROI with Performance Improvement System


Process outlined in The Joint Commission Journal article

OAKLAND, Calif. — Kaiser Permanente reaped a 136 percent return on investment based on its successful performance improvement system that enhanced quality, safety, service and efficiency, according to an article published this month in The Joint Commission Journal on Quality and Patient Safety. The article, entitled “Kaiser Permanente’s Performance Improvement System, Part 2: The Value Framework” looks at how the organization has measured early success and learned from early failure. This is the second article in a series that chronicles Kaiser Permanente’s journey toward developing an enhanced PI system that has contributed to continued progress across the health care organization on all key quality metrics.

The PI system was developed in response to quality variations across facilities and regions to ensure consistent, first-rate care. Kaiser Permanente implemented the PI system nationwide to transform care delivery by engaging the entire workforce and providing uniform quality measurement, increasing PI skills in staff at all levels, developing organizational capabilities, and providing on the ground support for making improvements in medical centers and across regions. The results outline that for each dollar invested there was an average return of $2.36.

“Recognizing multiple levels of processes within a health care organization, we focused on designing a systemwide performance improvement approach that cascades from national to regional to facility levels,” said Lisa Schilling, RN, MPH, vice president of Kaiser Permanente Care and Service Quality in Oakland, Calif. “Our system demonstrates the value of investing in developing capability to improve capacity in operations, supporting its application in the delivery setting and its impact on overall medical center performance. These elements can be adapted to smaller systems and single hospitals.”

The first article in the November issue of the journal highlighted an approach to designing and initiating a system of improvement for health care organizations seeking to enhance quality outcomes. Kaiser Permanente leaders benchmarked five high-performing external organizations to identify the capabilities that led to consistent best-in-class organizational performance.

In the medical centers where the PI system was implemented, the organization found improvement of more than 60 percent in the six key capabilities: leadership priority setting, a systems-based approach to improvement, measurement capability, a learning organization, improvement capacity, and a culture of improvement. After initial evaluation of the system, improvement advisers successfully led and completed 81 percent of initial projects in conjunction with front-line teams, organizational capabilities increased, and the investment in PI infrastructure and staff was realized.

The next article in the series will provide a close-up look at the system in action, using the example of how a whole systems approach to performance improvement helped 20 medical centers in one region reduce mortality in sepsis patients. The final article will present what was discovered about becoming a learning organization, and how an organization can leverage the power of people and systems to more rapidly share and adapt practices to continually transform the way the business of health care is conducted. The articles will be published in The Joint Commission Journal on Quality and Patient Safety over the coming months.

Authors of the papers include: Lisa Schilling, RN, MPH; Alide Chase; Sommer Kehrli, PhD; Amy Y. Liu, PhD; Matt Stiefel, MPA; Ruth Brentari, MHA; Dennis Deas, MBA; Maile Jedlinsky, MBA; Deborah Aronoff, MS, MBA; Juliette Fershtman, MHA; and Abdul Wali, MD.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to:


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