How Kaiser Permanente Became a Continuous Learning Organization

OAKLAND, Calif., Nov. 17, 2011 /PRNewswire/ -- Five years ago, Kaiser Permanente set a goal to deliver best-in-class, high-quality performance. To support this, experts developed a performance improvement process to reduce variations in quality, safety, service and efficiency across its medical centers.

Five years later, the performance improvement process is clearly working as evidenced by high marks in recent quality rankings. In 2011, Kaiser Permanente received No. 1 rankings in 11 effectiveness-of-care measures, more than any other health plan in the nation. Kaiser Permanente's Medicare health plans received a 5-star rating from the Centers for Medicare & Medicaid Services, the highest ranking possible, in five of its regions. And, according to the National Committee for Quality Assurance, Kaiser Permanente has the four highest-ranked Medicare health plans in the nation and four of the top 25 Private (Commercial) health plans.

In an article published in the December 2011 issue of The Joint Commission Journal on Quality and Patient Safety, Kaiser Permanente shares the continuous improvement process used to attain these industry-leading results. "Kaiser Permanente's Performance Improvement System, Part 4: Creating a Learning Organization" discusses how a health care organization can sustain best-in-class quality performance in a rapidly changing environment.

"Creating structures and systems for learning from tests of change at all levels are foundational to creating a high-performing health care organization and that's what we've put in place at Kaiser Permanente," said Lisa Schilling, RN, vice president of national performance improvement for Kaiser Permanente. "We've created structures and developed capabilities that facilitate learning from improvement efforts and speed sharing of effective practices."

To achieve the goal of best-in-class and high-quality performance, Kaiser Permanente implemented a strategy for creating a systematic capacity for whole system and continuous improvement. Six "building blocks" enabled Kaiser Permanente to make the transition to become a learning organization:

  • Real-time sharing of meaningful performance data
  • Formal training in problem-solving methodology
  • Workforce engagement and informal knowledge sharing
  • Leadership structures, beliefs and behaviors
  • Internal and external benchmarking
  • Technical knowledge sharing

Unit-based teams — Kaiser Permanente's strategy for frontline performance improvement and engagement, established through its Labor Management Partnership — were key to implementing this strategy.

Putting each building block into place requires multiple complex strategies — all of which combine top-down and bottom-up approaches. Leaders understand improvement priorities in relation to organizational goals, and middle and frontline managers work with staff to focus on the value of making improvements for the patients. The dynamic interplay between leadership, middle management and frontline staff facilitates learning throughout Kaiser Permanente.

"Our Labor Management Partnership — the largest and most comprehensive such partnership in the country — built a foundation for Kaiser Permanente and the Coalition of Kaiser Permanente Unions to do something unique in health care," said Paul Staley, vice president, Operational Initiatives and Performance Improvement. "We are creating an environment for learning at the front lines of care and giving frontline workers, managers and physicians ways to test and implement ideas that improve service, quality and affordability for our members and patients."

With the proper knowledge, skills, systems supports and technologies, all learning organizations have the capability to improve, and develop structures and processes that facilitate the acquisition and sharing of knowledge. Kaiser Permanente's future development as a learning organization is now focused on four areas: application of knowledge and sharing effective practices; organizational assessment of progress; knowledge management; and operational sustainability of improvement efforts and sharing learning and practices.

"The transformation to become a learning organization requires the alignment of people, processes and technology; which enables organizations the have the capability to improve health outcomes for populations," Schilling said.

For more information on the previous articles in this series, please see the following:

Authors of this article are: Lisa Schilling, RN, MPH; James W. Dearing, PhD; Paul Staley; Patti Harvey, RN, MPH; Linda Fahey, RN, MSN, and Francesca Kuruppu.

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 serve approximately 8.9 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:

Mark Camps
Office: 510-625-5624;  Mobile: 510-529-1854
[email protected]

SOURCE Kaiser Permanente