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Creating a Culture of Continuous Improvement, Patient Focus, and Commitment to Excellence
Institute of Medicine Evidence Communication Innovation Collaborative December 6, 2013
George C. Halvorson Chairman Kaiser Permanente
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Cultures create a context
for organizational
functioning.
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Cultures are, at their core,
paradigms --
belief systems.
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Cultures tell us in any given
setting what we should do,
what we should not do,
and why we should do
or don’t do what we do --
“what” “should” and “why”
anchor cultures.
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Like all paradigms, cultures
are anchored by their core
beliefs. To create or change
a culture, you need to
address the core beliefs.
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Cultures need to be designed
with clear goals for what you
want the culture to do.
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To install a culture, you
need to both enforce and
reinforce it.
Cultural Steps
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1) Delineation
2) Articulation
3) Codification
4) Explanation
5) Enforcement
6) Reinforcement
7) Celebration
8) Iconization
9) Personification
10) Rejuvenation
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Cultures, when well rooted,
perpetrate and
enforce and reinforce
themselves.
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Begin by both knowing
what the current culture is
and what you want the new
culture to be.
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Uprooting old paradigms
requires uprooting their core
beliefs and explicitly replacing
them with new core beliefs.
The old core beliefs can
cripple the new ones if you
leave them in place.
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It is often useful to
delineate, explicate, and
show respect for the old
paradigm -- explaining
why it worked when it
was the driving thought
factor.
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Data-Based Culture
Culture of Excellence
Culture of Collaboration
Culture of Continuous Improvement
Culture of Service
Teaching Culture
Culture of Trust
Patient Focus at the Core
KP Culture Points
Our Value Compass: Negotiated Explicitly Into the Labor Management Partnership Agreement
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Big Q
220 electronically available monthly quality and service measures on site-specific
performance -- shared with the Board Quality Committee and with leadership teams at
each site.
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Research is also part of the culture, with the number of research papers growing from 300 per year to more
than 1,200 per year
over ten years
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The culture of excellence results in solid
performance, with number one ratings for Medicare, J.D. Power & Associates, Satmetrix Consumer Survey, and 29 top HEDIS scores
Hospital-Acquired Pressure Ulcers (HAPU)
Stage 2 Plus
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0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q210 Q310 Q410 Q111 Q211 Q311 Q411
CalNOC (2008) Average – projected forward – top local performers
KP Average – to under one percent
CalNOC consists of a coalition of California hospitals who are working together on patient safety issues.
National Average for Pressure Ulcers – non-KP care sites
Several Kaiser Permanente hospitals have not had one single
pressure ulcer in over a year.
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It took continuous improvement, data-based decision making,
patient focus, and a commitment to excellence as a culture to get
to zero pressure ulcers.
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Be well.
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