Learn, Apply, Share: Kaiser Permanente's 3-Step Strategy for Healthcare Quality Improvement

Many hospitals and health systems are turning their attention to quality to improve patient care and avoid financial penalties for issues such as preventable readmissions and infections. While the Patient Protection and Affordable Care Act has brought the issue to the forefront with the creation of Partnership for Patients and other initiatives, many organizations have been pursuing high quality for several years.

In 2005, Oakland, Calif.-based Kaiser Permanente partnered with the Institute for Healthcare Improvement to become a top performer in quality. Kaiser Permanente studied high-quality organizations and devised a multi-pronged strategy for improvement, which it will present in May at the 2012 Quality Institute for Healthcare in Anaheim, Calif. Lisa Schilling, RN, MPH, vice president of healthcare performance improvement at Kaiser Permanente, explains how the organization followed three steps to improve quality.

After studying various organizations, Kaiser Permanente identified six common capabilities among high-quality institutions:

• Leadership alignment
• Knowledge of the system
• Measurement of improvement
• Sharing best practices
• Training
• Involvement of the entire organization

The three underlying strategies to achieving these capabilities were learning, applying and sharing. The organization needed to learn new skills in process improvement, apply them to real care delivery systems and then share the results and effective practices with others across the organization for rapid adoption. In addition, part of the share strategy is to share and learn with outside organizations to develop new practices and models of care as well as adapt those to their organizations.

1. Learn. "We learned from other industries that the development of expertise requires developing skills in everyone from leadership to frontline staff and needs to be a multi-year strategy," Ms. Schilling says. When applying improvement techniques, Kaiser Permanente used a variety of tools instead of adopting one single approach that includes a model for improvement and Lean Six Sigma. This broader philosophy allows staff and leaders to use the tools that are most appropriate for a given situation. "After our benchmarking visits, we found that it's far more important that culturally we want to focus on performance [rather] than the methodology and tools used," Ms. Schilling says. "We don't want to teach people a new language around improvement; we want to teach [them] how to focus on designing care around the person so they can bring the tools [they need] to make that care better."

2. Apply. In order to achieve the desired results through training, Kaiser Permanente established a system that supported the learner's application of knowledge directly in the care delivery setting. "We also adapted the master black belt approach to our system and teamed the individual with each medical center to assist our students in applying their learning to improve care delivery and service," Ms. Schilling says. Kaiser Permanente hired experts with 20 to 30 years of experience in improvement to mentor staff and leaders on improvement strategies. Building knowledge through expert mentors helped embed quality improvement in the culture of the organization and accelerate the rate of learning and change in strategic implementation.

3. Share. After applying quality improvement strategies, Kaiser Permanente shared the results and effective practices with others in the organization so they could learn from each other and avoid needing to reinvent solutions that had already been tested in other areas of the organization. Particularly for an organization the size of Kaiser Permanente, which has 37 hospitals and more than 500 medical offices, communicating quality improvement experiences across the organization can save a significant amount of time and resources by reusing a successful technique for multiple areas. In addition, Kaiser Permanente has engaged in strategic partnerships and networks to continue learning with others around the world.

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