University of California
Type of paper: Thesis/Dissertation Chapter
A needs assess Gap Analysis on Kaiser Permanente
Kaiser Permanente refers to healthcare consortium that offers prepaid Medicare services. Rising from humble beginnings in 1945, the non profit has flourished from a privately centered medical care to accommodate even the public. It was founded by physician R. Garfied and industrialist Henry Kaiser (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). The hospital has ridden over a hostile environment to become a leading non profit health institution providing services to over 9.1 million members.
The institution has its headquarters in Oakland, California in the United States. Kaiser Permanente constitutes a trio of the Permanente Medical Groups, the Kaiser Foundation Hospitals as well as subsidiaries and the Kaiser Foundation Health Plan Incorporation. Overall, the Kaiser Permanente Health Foundation had 7654 beds as at 31st December 2012 scattered over the District of Columbia and nine states in the U.S.A. The health plan membership totals to over 8.3 million. Still, the hospital maintains a sizeable labor force of about 11,000 physicians scattered in 415 medical offices and 30 medical centers. As at last year, the hospital’s operating revenues grossed $22.5 billion.
The Kaiser Permanente Foundation operates on four major premises, namely:
A physician team practice to realize maximum abilities to nurse and care for patients
Prepaid health plans structured along spreading of costs to ensure affordability across the social classes
Concentration on prevention of illness relative to caring for the patients
A formally structured delivery system to hold as many services as it can hold under one roof (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006).
The following tabulation presents the membership of the foundation by region as at 31st December 2012 (Abelson, 2013).
Southern California 3,594,848
Northern California 3,403,871
Northwest (Oregon /Washington) 484,349
Mid Atlantic States (MD, VA, DC) 481,755
The following tabulation showcases Kaiser Permanente Foundation local markets by each of eight regions (Abelson, 2013).
Northern California Southern
California Georgia Hawaii Mid Atlantic States Oregon/ Washington
Central Valley Coachella Valley Atlanta Oahu Washington D.C Portland
Diablo Kern Valley Athens Kauai Northern Virginia Salem
East Bay Orange Valley Hawaii Suburban Maryland Vancouver, Wash
Fresno Inland Empire Maui Baltimore Longview/ Kelso, Wash
Greater Southern Alameda Metro Los Angeles/
West Los Angeles Marin/ Sonoma San Diego County Napa/ Solano Tri-Central Area Colorado Roseville Denver Sacramento Colorado Springs San Francisco Boulder San Jose Pueblo San Mateo Santa Clara South Sacramento It is evident from the above tabulation that Kaiser Permanente has a stronger presence in the urban areas in each of the nine states as compared to rural presence. Nonetheless, it is commendable on the foundation’s expansion to cover regions outside its core geographic markets (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). However, it is evident that the expansion trajectory seeks to serve the proximate markets.
The Foundation has 38 hospitals, 611 medical offices and outpatient facilities, 16,942 physicians compri9sing of a blend of different specialties and 48,701 differently blended mixes of specialist nurses. Therefore, the foundation employs a total of 174,259 employees comprising of administrative, technical and clerical care givers and laborers as at 31st December 2013 (Abelson, 2013). The hospital maintains an online presence with a platform in which clients and employers manage their accounts. Online customer account services are offered freely meaning that the foundation does not charge. Member terminations as well as demographic changes are updated immediately. This gives the institution a competitive advantage over its rivals.
Part II Needs Assessment/ Gap Analysis on Kaiser Permanente
At present, Kaiser Permanente is criticized for failing to have facilities, resources or policies to conduct a number of services. Additionally, where critical services are offered, the facility features as lazy to act exposing the patients to delay in diagnosis. The hospital is often accused of prolonged diagnosis period preferring available formal diagnosis rather than recommending specialized and expensive diagnosis so as to contain costs. Furthermore, the institution prefers cheaper dispute resolution mechanism such as arbitration. This process may take prolonged time and has often sparkled criticism. For instance, Wilfredo Engalla succumbed to lung cancer five months after submitting an arbitration demand. Consequently, the Supreme Court of California awarded his spouse $500,000 as damages from Kaiser Permanente (Abelson, 2013).
Still, The Huffington Post accuses the institution of overburdening its staff resulting to sloppy work (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). This occurs even when the company rackets billions of dollars in profits. Sadly, mental health patients contend with a prolonged wait for appointment at the institution’s California facility. Upon meeting the doctor, the meeting lasts briefly, therefore, receiving brief consultations. Finally, the patient ends up in a group therapy set up comprising of 20 members under the astute of a single clinician, in spite of a one on one clinician session (Eichler, 2011). The report concluded by showing the cuts in mental health funding. California led the pack by cutting the mental health budget by $177.4 million out of the $1.7 billion mental health budget cuts.
Moreover, Kaiser is accused of understaffing its various departments in spite of an inflationary membership. For instance, mental health patients are sloppily rushed through the treatment and rehabilitation process resulting to dire implications. Rushing is necessary in order to serve the over 6.6 million members (Eichler, 2011). Cases of misdiagnosis as well as wrong diagnosis and treatment cases have been reported in which some were catastrophic resulting to deaths.
Kaiser’s violations of rules and regulations in kidney transplant regulations led to closure of the program (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). An investigative report by the Los Angeles Times revealed Kaiser Permanente’s mismanagement across the board on 3rd May 2006 (Eichler, 2011). Apparently, the facility had operated 56 transplants the previous with an alarming death of 112 patients while waiting for the operation. Kaiser Permanente realized financial savings through the delays in transplants. Consequently, the institution announced discontinuation of the practice on 13th May 2006 (Eichler, 2011).
Most of the employees at Kaiser Permanente are members of various labor unions although the Medicine Doctors as well as the Osteopathic Medicine Doctors share in the for profit profits of the institution (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). Surprisingly, the California facilities witnessed 4 major strikes between 2011 and 2012. There were over 20,000 participants drawn from the institution’s mental health providers, nurses and other specialists (Eichler, 2011). Labor Unions constantly accused Kaiser Permanente for stalling negations deliberately in spite of the huge profits and a hefty pay to the C.E.O. The workers grievances included delayed care, poor staffing, and loss of medical insurance, pensions as well as other benefits.
Based on the above criticism, it is indeed true that a gap subsists between Kaiser’s current performance and the projected. This part addresses solutions to the criticism based on social, legal and culture. Firstly, the modern world is fast paced and Kaiser must accommodate fast pacing in service delivery (Lawler, Boudreau, Mohrman, Mark, Neilson, & Osganian, 2006). Employee staffing, training, recruitment, retention, job function redesign will help address friction with labor unions (Kochan, 2009). Besides, competitive and equitably pegged remuneration will motivate employees to offer quality services. Recruiting more employees will help address the ballooning membership. Besides, training of employees on cultural accommodations of different patients will enhance positive reviews to Kaiser Permanente. Finally, Kaiser must embrace a law abiding organizational culture. This will reduce arbitrative litigations. Moreover, taking up a less materialistic approach to delivering services is a crucial social factor that will enhance closing of the performance gap.
Implementation of these policies involves three pertinent stakeholders in Kaiser Permanente. These include the patient, the caregiver and the ownership of Kaiser. The patient is the key stakeholder as s/he identifies helps identifies areas of improvement. For instance, the patient directs services to be offered based on the common illnesses and ailments. The caregiver professional is a crucial link in implementing the services and building on a solid reputation of Kaiser Permanente. The motivation and remuneration of caregivers determine their delivery of medical services to the client. Adequate staffing ensures that clients do not feel rushed, delayed or misdiagnosed (Kochan, 2009). Finally, the ownership of the institution is crucial because it will spearhead implementation of the policies. It is pivotal because it will approve, reject or hold implementation of these recommendations. Besides, the ownership will provide resources to steer through the implementation process. Communication will be crucial to achieving the set objectives. Besides, it will fine tune synergy and course of direction. Communication to the stakeholders will involve internal and external communication channels. Periodic meetings will appraise the owners and caregivers on the progress of the implementation. Brochures will be distributed from time to time to the patients sensitizing and informing them of the progress.
An evaluation process will then follow to assess the effectiveness of the intervention. Questionnaires will be administered to each of the three groups of stakeholders. The questionnaires will be structured to assess and evaluate the effectiveness of the intervention as well as requesting proposal for achieving further progresses. The intervention will deemed successful through satisfied and happy patient positive reviews from happily served, satisfied and recovered patients (Kochan, 2009). Besides, motivated, inspired and friendly caregiver labor force will signify a successful intervention. Higher earnings, more trophies and recognition of the institution in the public glare will foster a successful intervention to the owners.
Abelson, R. (2013, March 20). The Face of Future Health Care. Kaiser Permanente is seen as the future of healthcare. Retrieved November 23, 2013, from http://www.nytimes.com/2013/03/21/business/kaiser-permanente-is-seen-as-face-of-future-health-care.html?_r=0
Eichler, A. (2011, November 14). Kaiser Permanente Makes Billions In Profits While Overburdening Staff: Report. The Huffington Post. Retrieved November 23, 2013, from http://www.huffingtonpost.com/2011/11/14/kaiser-permanente-overburden_n_1092694.html
Kochan, T. A. (2009). Healing together the labor-management partnership at Kaiser Permanente. Ithaca: ILR Press/Cornell University Press.
Lawler, E. E., Boudreau, J. W., Mohrman, S. A., Mark, A. Y., Neilson, B., & Osganian, N. (2006). Achieving strategic excellence: an assessment of human resource organizations. Stanford, Calif.: Stanford Business Books, an imprint of Stanford University Press.