Kaiser Permanente and the NHS have much in common

The NHS should become more like Kaiser Permanente. It is a regularly debated topic. But it is also an adage that understates the challenge of developing a fully integrated care system, says Hal Wolf, senior vice president and chief operating officer of the Permanente Federation.

“There’s a tendency for people to say, ‘They can do that, because they’re Kaiser.’ However, when you introduce change to physicians, there is scrutiny of the evidence base and entirely appropriate resistance. These challenges exist in every single healthcare system. Kaiser is ahead of the learning curve.”

‘There is outstanding leadership in the NHS, it’s about identifying those few who are ready to lead and to pilot change’

How so − and how much further ahead than the NHS? An advantage that Kaiser may have, says Mr Wolf, is it allocates significant resources to developing physician leadership and a wider culture of innovation. “There is outstanding physician leadership throughout the NHS, and within any organisation it’s about identifying those few who are ready to lead and to pilot change.”

Underpinning the Kaiser model is not just an integrated model of care, he says, but “a critical cultural change − the physicians lead in population care”.

“When you take a look at the silver tsunami, which will hit every single healthcare system, continuing to improve care quality and affordability in a world of limited resources will not be magic. It will take systems, communication and sharing of best practices.”

Patient care drives innovation

The NHS now joins Kaiser in the drive for clinician-led commissioning and there are, he says, more parallels between the two than differences. But direct comparison is made more difficult given the differences between the NHS and the wider US healthcare system. Aren’t market forces the main driver for innovation in the latter?

Not so, says Mr Wolf. “The development of Kaiser’s toolsets came from our quality leaders considering how to do a better job of taking care of their patients, not from considering how to do a better job than their competitors. When we think of access to services we do, of course, look at the market. But the focus has always been on − and tremendous efficiencies stem from − becoming the best at delivering quality personalised care in our market.”

‘One of the great lessons for Kaiser has been the terrific way in which the NHS looks at the full social environment’

Pivotal to the organisation’s integrated care system has been the development of IT. Mr Wolf’s career arguably embodies the rhetoric of technology as an enabler. With a business management background in cable television and telecommunications, he joined Kaiser’s Colorado operation as regional information officer in late 2003. There he oversaw the expansion of the IT organisation.

Today, the electronic health record for Kaiser’s nine million patients, KP HealthConnect, is accessible in all primary and secondary care settings. It also provides facilities for patients to view lab test results (state laws permitting) and for secure patient-physician emailing.

First steps

Mr Wolf says technology not only engages patients in healthcare, it also drives efficiency. “Take, for example, our operation in Hawaii, where video consultations maximise the resources available, as specialists are not available on every island.

“Our primary care physicians in California can contact a list of specialists who are on call for exam room-type questions, rather than setting up an appointment for the patient to see the specialist to answer those questions in a few months’ time. Moreover, that appointment would be 10-20 minutes of the physician’s time; for the patient, it’s three hours of childcare [or] missing work − why? The more we can do virtually and on an outreach basis, the better.”

‘“How are we going to do things differently?” What a fantastic question. That’s the key to innovation and making things work’

He recalls the teething problems faced by his own organisation. “You don’t have to build everything at once. The first step is the adoption of the electronic health record. The NHS already has methodologies for collecting and sorting critical data. The journey requires building on this, but that’s certainly happening here.”

Much like at the NHS, he says, the challenge remains setting up a system that enables communication between different care settings.

Asking the right questions

Kaiser has benefited from international systems, communication and sharing of best practice. “One of the great lessons for Kaiser has been the terrific way in which the NHS looks at the full social environment,” Mr Wolf says. “For example, many components of our Total Health initiative were direct lessons learned from interfacing with the NHS.”

And ultimately his experience of the NHS leaves a positive lasting impression.

“I’ve had the opportunity to hear the conversations in the NHS as reforms take place about ensuring the continuity of care for patients. ‘How are we going to do things differently?’ What a fantastic question. That’s where I see the journey that the NHS has been on, and that’s the key to innovation and making things work.”