The secret of their success

Much has been written about the integrated health care system that the Kaiser Permanente health group makes possible in the eight states and nine regions which it serves in America. But what did the participants who ventured to Kaiser in our recent study tour learn from the experience? And what is the value of taking NHS leaders out of their own system to learn from another?

On the tour, UK leaders joined equivalent representatives from 15 other countries and health systems. Participants wanted to hear first-hand about clinical engagement and physician leadership and this expectation was met at every level. The leaders of the system made clear the ingredients of the ‘secret sauce’ – that is Kaiser Permanente’s key to success – without giving away the recipe.

First: integration. Kaiser provides a one-stop health campus, which caters for primary and secondary care, and incorporates diagnostics and a wellness centre all in the same location. Doctors work across boundaries to provide health plans, and one of the many spin-off benefits is the appropriate utilisation of A&E. The same leaders work together to negotiate with suppliers, such as drug companies, to achieve the benefits of clinically led procurement, which they manage and are held accountable for. Delegates on The King’s Fund tour of Kaiser Permanente reflected on the strong lead and visibility of doctors throughout the system and the culture of primary and secondary care doctors working together.

Second: information. The work at Kaiser is underpinned by significant investment in a world-class IT system, which took seven years to fully implement. At the Fremont Kaiser Permanente site the world’s first fully integrated electronic patient record (Connected for Health) was championed by a doctor from the emergency room. Christopher Wan MD explained that he was passionate about IT and knew that he could engage other doctors in the drive to use information technology better than an IT specialist. Kaiser also invests in an IT support team, who work with clinicians to make the electronic patient record a success for staff and patients.

Third: innovation. During the study tour, delegates saw the work advanced at The Garfield Centre, where clinicians and multidisciplinary team members have access to expertise and ‘a living laboratory’ in which they can consider the issues they need to solve in order to deliver high-quality care. Teams are supported to build solutions and to test and then apply innovations, ensuring more successful implementation in their clinical environments. Projects include safer medication dispensing, optimising the home environment and the use of technological gadgets, such as smartphones and Ipads.

Learning from study tours is a chance to learn through direct exposure; in this case NHS leaders were exposed to Kaiser’s system of pre-paid, private health care with strong links between health insurance and care delivery as opposed to their own government-funded system. Participants’ reaction to exploring systems that are so different to what they are used to can initially be a dismissal of much of the learning – ‘it is not like this in the NHS!’ This does, however, give way to an appreciation both of what they already have – for example, with regards to annual leave and sickness leave entitlements compared to their US counterparts – and of what they can learn – for example, Kaiser Permanente invests heavily in developing quality leadership matrices for each service line and physician leaders are responsible for maintaining and managing the performance of their colleagues. It also helps participants to reflect on what we do well in the NHS and therefore what others could learn from us.

The enforced ‘thinking time’ that occurs when leaders are removed from their day jobs allows them to take a step back and consider critical decisions. This was an opportunity that some enlightened participants took full advantage of on the programme – a medical director and clinical commissioning group GP leader attending in a pair in one case.

The chance to learn from different systems, ask critical questions and connect with global leaders in health care is priceless. England is not California, but we can still use lessons from abroad to make a difference to health care and patient experience in the NHS.

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#1167 HB

A very insightful and thought provoking blog. It is far too easy for us in the UK to be dismissive of the USA healthcare system per say. However, the Kaiser model as portrayed by Vijaya is a classic example of a system with essential effective components that could be adopted by the NHS in this era of reformation. Clearly consisting of elements far superior and better long term returns than some of our own proposed reforms. Way to go Vijaya! Well done King's Fund!

#1168 Dr Aston Villa

KP looks more like the vision of the 2004(?) NHS Plan than the 2012 Health Act. The UK currently encourages division: primary vs secondary and competition between providers. We are witnessing the end of any hope that the NHS can be an integrated health care service. It could be more efficient than KP as it doesn't have to chase its clients for money.

#1169 Dr Vicky Vidalaki
Consultant clinical Psychologist/ Clinical Lead

I really enjoyed Vijaya's fair and succinct account of what OUR health care system could be: Clinician led, with strong leadership pipeline, embracing innovation and truly appreciative of the dialectic dynamic of the three "I"s: Integration, innovation & information. Maybe the secret recipe is a fourth "I" Investment in building relationships, reaching out and not be inward looking

#1170 AM

People have been going on organised study tours to KP for years, I remember when all the top tier of the NHS in Birmingham went a few years ago and came back enthused (nothing changed as result). It reminds me very much of the tours of the USSR which used to be run by the Communist Parties of various countries where those with receptive hearts and minds would be taken round showcase factories and workers housing units. A conversation with ordinary members of the public in the US or Canada lucky enough to have health insurance will give a balanced picture of a system biased in favour of denying treatment, inflating costs and making money rather than providing health care. HMO's epitomised by KP have a reputation in the USA roughly on a par with estate agents and fund managers, what we need is the full picture not some Stalinist, airbrushed glossy presentation designed to woo the gullible. Send NHS leaders to speak to genuine users of the disfunctional system in the USA, better still go to developing countries where financial necessity encourages efficiency and innovation because there is no other option.

#1171 Dr Alfa Sa'adu
Medical director & Deputy Chief Executive
Ealing Hospital NHS Trust

I went on the Seatle Study Tour in September 2011. The experience was truely amazing!

I learnt as much as from the other delegates (from the UK, Australia and New Zealand) as from the institutions we visited in the US.

Our US hosts were anxious to learn from us and to exchange idea about our system as they were to teach us about theirs.

The value of leaving these shores to visit other healthcare institutions abroad should not be underestimated. I have attend some very valuable teaching experiences in the UK, but these overseas exposure coarse offer a very different experience that is hard to replicate in the UK

#1172 Vijaya Nath
Assistant Director, Leadership
The King's Fund

Hi AM,

Thank you for your comments above, blogs as you will appreciate have limited word count and so one aspect not included is the point of view expressed by over 15 KP members (patients) who were randomly selected by me from the San Francisco Bay area and interviewed with regards to their experience of the plan. Their unprompted responses were unanimous in their positive feedback with regards to multiple aspects of Kaiser Permanente’s plan, happy to explore other positives with you if interested.

With regards to selection of location for future learning, there is much to learn from the innovation being undertaken in other global economies (we are exploring these) and some of the main differences between some of these health systems and the UK are the expectations of our patient population/political ideology. It is for this reason that learning from countries (Eg USA, Canada,Sweden, Denmark, Netherlands) with more demanding and vocal patient populations and work force, continues to provide learning opportunities for us in the UK.

#1173 Vijaya Nath
Assistant Director, Leadership
The King's Fund

Hi Vicky, agree that your fourth 'I' was critical to KP's success. Building relationships at all levels, creating exciting partnerships with other agencies such as The Farmer 's markets and making use of their volunteer population as assets in staffing Wellness centre on campus just a few examples of how the 'thrive ' vision is spread.All applicable in promoting engagement in health and wellness!

#1174 Nick Gallegos
Medical Director

Whatever one may think about KP health care it seems undeniable to me that they have developed a very defined strategic vision with a clear plan for its operational delivery and which is suscribed to by both primary and secondary care sectors and connected by an electronic care record (that works)accessible to all and providing all sectors with a 360 degree of what is happening to the patient. Integrated it certainly is. Can the NHS pull off a similar trick - possibly and only if there is much greater risk sharing between primary and secondary care sectors and a more cohesive approach as seen from the patient's perspective of how they can be supported by community and social services.

#1175 Lesley Coles
Head of Nursing
Portsmouth Hospitals NHS Trust

I know 2 people who have recently been to KP via the Kings Fund programme and all have come back inspired. We certainly can learn a lot from visiting other countries and sharing experiences like these, it certainly gets you thinking differently and laterally.

This fully integrated model of care sounds perfect and the direction set out in the recent Health Bill aims to move us in that direction. In the UK we have a legacy of disparate components bolted together over time rather than carefully constructed purpose built KP model, and that is the challenge for the UK.

Other interesting feedback has been that some of the clinical outcome data is not necessarily better than the UK, so we need to celebrate this practice and share widely.

Breaking down organisational boundaries has got to be the way forward and for the NHS to become one organisation that promotes health and wellness. A health service that works seamlessly (one stop shop) for patients and their families is a very attractive model and surely cost effective.

#1176 Ruth Taylor
Associate Head of School

Thanks for an interesting blog Vijaha. As a nurse educator I have been fortunate to undertake two recent study tours (Seattle and Sydney) and found both experiences to be inspiring for a number of reasons. Firstly, the interaction with part of a global community of educators provided me with insights into challenges, opportunities and potential solutions to the issues that we all face. Secondly, the act of undertaking a study tour gave me the physical time-out to truly reflect on my own practice in light of my experiences with colleagues, as well as an opportunity to critically relate to others within my profession. From these experiences I am now better connected to nursing education than I was when I set out. I am a great supporter of opportunities like these as, rather obviously, they open our eyes to different ways of being in the world.

#1177 Gerry Horner
Psychiatric Social Worker [retired]

Study of organisations run for profit like Kaiser Permanente need to note,that they are designed to cater for a relatively well off population only. The poor and those in insecure or poorly -paid work are not in the business plan. The N.H.S. caters for all -or used to. It makes a difference to how you organise a service.

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