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Indeed, perceived control over the practice environment is one of 10 evidence-based practices for successful organizational retention of physicians. The philosophy of OPS is to be physician-focused in addressing several areas: relaying messages between patients and their physicians; ensuring consistent availability of support staff; and preparing examination rooms ie, setting up for each patient visit and maintaining sufficient inventory of supplies.
The goal of OPS is to create an environment in which all physicians at the Los Angeles Medical Center achieve a sense of professionalism by using practice methods that support optimal patient care delivery. OPS was originally intended to support primary care physicians in an ambulatory care setting.
OPS was implemented by a steering committee in conjunction with three specific workgroups, each of which respectively set standards for auditing message handling, consistent availability of staff, and preparation of examination rooms ie, setting up for each patient visit and ensuring that examination rooms remained well stocked with appropriate supplies.
Needs and standards of the workgroups—named Exam Room Stocking and Setup; Message Handling; and Staffing Consistency —were determined by office personnel, whose expertise in these areas was thus relied upon. Members of the steering committee served on the workgroups as liaison to the steering committee. The audit consisted of inspections, review of documents, and interviews with physicians and staff. Special attention was given to methods for evaluating clinician satisfaction with OPS at the departmental level.
Use of the audit tool presented various challenges and led us to reach several conclusions:. Twenty-five departments, including outlying medical office buildings and several specific modules, were audited. Audits were conducted in February, July, and November of Other successful practices included use of a message log, advance preparation of medical charts before appointments, and attaching to these charts copies of relevant laboratory and radiology reports as well as recent consultation notes.
OPS was identified as a process useful for increasing the quality of professional life for physicians. Departments that achieved OPS goals were recognized by the medical center at a meeting of chiefs of service and department administrators.
For , the OPS process was revised to be more inclusive of nonoffice and hospital-based departments. All departments were asked to address an aspect of Quality of Professional Life that would lead to increased physician satisfaction. Departments were required to submit an OPS proposal, an implementation plan with status update, and a report of final outcomes.
For each department, the committee evaluates final outcomes scoring responses to three core survey items:. All departments submitted a proposal, and only three departments were deficient in submitting an implementation plan with status update.
Data regarding final outcomes from individual department projects are pending, and further revisions to the OPS process for are underway.
Perm J. Nancy A Cohen , MD. Copyright and License information Disclaimer. Abstract Control over the practice environment is one determinant of the quality of professional life for physicians. The workgroups had the following membership: The Exam Room Stocking and Setup workgroup consisted of a registered nurse from the pediatrics department; clinic assistants from the family practice and obstetrics and gynecology departments; department administrators from the dermatology and internal medicine departments; and physicians from the orthopedics and family practice departments.
Lawrence served as chairman and CEO until his retirement in On November 5, , the board of directors announced that Bernard J.
Tyson , Kaiser's president and chief operating officer for the last two years, would replace Halvorson,  marking the first time an African American was appointed as chairman. Adams assumed the role of chairman and CEO in December As of , Kaiser Permanente had In addition, Kaiser Foundation Hospitals despite the plural name, a single legal entity operates medical centers in California, Oregon,  and Hawaii, and outpatient facilities in the remaining Kaiser Permanente regions.
The hospital foundation entity is not-for-profit and relies on the Kaiser Foundation Health Plans for funding. It also provides infrastructure and facilities that benefit the for-profit medical groups. Kaiser Permanente is administered through eight regions, including one parent and six subordinate health plan entities, one hospital entity, and nine separate, affiliated medical groups:.
In addition to the regional entities, in , the then-twelve Permanente Medical Groups created The Permanente Federation LLC , a separate entity, which focuses on standardizing patient care and performance under one name and system of policies. A mutual benefit corporation named "Kaiser Foundation for the Advancement of Integrated Health Care" was established on December 27, The specific purpose of the corporation is "to advocate for and promote the integrated models of health care".
The history of Kaiser Permanente dates to and a tiny hospital in the town of Desert Center, California. At that time, Henry J. Kaiser and several other large construction contractors had formed an insurance consortium called Industrial Indemnity to meet their workers' compensation obligations.
Soon enough, Garfield's new hospital was in a precarious financial state with mounting debt and the staff of three going unpaid , due in part to Garfield's desire to treat all patients regardless of ability to pay, as well as his insistence on equipping the hospital adequately so that critically injured patients could be stabilized for the long journey to full-service hospitals in Los Angeles.
It was Hatch who proposed to Garfield the specific solution that would lead to the creation of Kaiser Permanente: Industrial Indemnity would prepay Later, Garfield also credited Ordway with coming up with the general idea of prepayment for industrial health care and explained that he did not know much at the time about other similar health plans except for the Ross-Loos Medical Group.
Hatch's solution enabled Garfield to bring his budget back into the positive, and to experiment with providing a broader range of services to the workers besides pure emergency care. However, in March , Consolidated Industries a consortium led by the Kaiser Company initiated work on a contract for the upper half of the Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who had worked for a different construction consortium on the first half of the dam.
Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers who had been treated poorly by their earlier employer , Hatch and Ordway persuaded Edgar to meet with Garfield, and in turn Edgar persuaded Garfield to tour the Grand Coulee site.
Garfield subsequently agreed to reproduce at Grand Coulee Dam what he had done on the Colorado River Aqueduct project. Unlike the workers on Garfield's first project, many workers at Grand Coulee Dam had brought dependents with them.
The unions soon forced the Kaiser Company to expand its plan to cover dependents, which resulted in a dramatic shift from industrial medicine into family practice and enabled Garfield to formulate some of the basic principles of Kaiser Permanente. It was also during this time that Henry Kaiser personally became acquainted with Garfield and forged a friendship which lasted until Kaiser's death.
In , the Kaiser Company began work on several huge shipbuilding contracts in Oakland, and by the end of would control four major shipyards on the West Coast. During , the expansion of the American defense-industrial complex in preparation for entrance into World War II resulted in a massive increase in the number of employees at the Richmond shipyard.
On March 1, , Sidney R. In July, the Permanente Foundation formed to operate Northern California hospitals that would be linked to the outpatient health plans , followed shortly thereafter by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for California. Kaiser's first wife, Bess Fosburgh, liked the name. An abandoned Oakland facility was modernized as the bed Permanente Hospital opened on August 1, this facility evolved over the decades into today's flagship Kaiser Oakland Medical Center.
Three weeks later, the bed Richmond Field Hospital opened. Six first aid stations were set up in the shipyards to treat industrial accidents and minor illness.
Each first aid station had an ambulance ready to rush patients to the surgical field hospital if required. Stabilized patients could be moved to the larger hospital for recuperative care. These physicians established California Physicians Service to offer similar health coverage to the families of shipyard workers.
Meanwhile, during the war years, the American Medical Association AMA which opposed managed care organizations from their very beginning tried to defuse demand for managed care by promoting the rapid expansion of the Blue Cross and Blue Shield preferred provider organization networks. In , Henry J. Kaiser and Dr. Sidney R. In , the Kaiser Permanente health plan was opened to the public.
In , Kaiser established the Henry J. Membership bottomed out at 17, for the entire system but then surged back to 26, within six months as Garfield aggressively marketed his plan to the public.
During this period, a substantial amount of growth came from union members; the unions saw Kaiser Permanente care as more affordable and comprehensive than what was available at the time from private physicians under the fee-for-service system. Kaiser Permanente membership soared to , in , , in , , in , , in , and , in From onward, both Kaiser Permanente and Garfield fought numerous attacks from the AMA and various state and local medical societies.
Henry Kaiser came to the defense of both Garfield and the health plans he had created. In , the organization acquired its current name when Henry Kaiser unilaterally directed the trustees of the health plans, hospital foundations, and medical groups to add his name before Permanente.
That same year, Kaiser Permanente also began experiments with large-scale multiphasic screening to identify unknown conditions and to facilitate treatment of known ones. Henry Kaiser became fascinated with the health care system created for him by Garfield and began to directly manage Kaiser Permanente and Garfield.
This resulted in a financial disaster when Kaiser splurged on the new Walnut Creek hospital; his constant intermeddling led to significant friction at every level of the organization.
The situation was not helped by Kaiser's marriage to Garfield's head administrative nurse who had helped care for Kaiser's first wife on her deathbed , convincing Garfield to marry the sister of that nurse, and then having Garfield move in next door to him. Clifford Keene who would eventually serve as president of Kaiser Permanente later recalled that this arrangement resulted in a rather dysfunctional and combative family in charge of Kaiser Permanente.
Keene was an experienced Permanente physician whom Garfield had personally hired in During he had been trying to get a job at U. Steel , but on the morning of December 5, , with internal tensions worsening day by day, Garfield met with Keene at the Mark Hopkins Hotel in San Francisco and asked him to turn around the organization.
It took Keene 15 years to realize that Kaiser had forced Garfield to ask Keene to become his replacement. Due to the chaos on the board, Keene at first took control with the vague title of Executive Associate, but it soon became clear to everyone that he was actually in charge and Garfield was to become a lobbyist and "ambassador" for the HMO concept.
However, even with Garfield relieved of day-to-day management duties, the underlying problem of Henry Kaiser's authoritarian management style continued to persist. After several tense confrontations between Kaiser and Permanente Medical Group physicians, the doctors met with Kaiser's top adviser, Eugene Trefethen, at Kaiser's personal estate near Lake Tahoe on July 12, Trefethen came up with the idea of a contract between the medical groups and the health plans and hospital foundations that would set out roles, responsibilities, and financial distribution.
While Keene and Trefethen struggled to fix the damage from Kaiser's micromanagement and Garfield's ineffectual management, Henry Kaiser moved to Oahu in and insisted on expanding Kaiser Permanente into Hawaii in He quickly ruined what should have been a simple project, and only a last-minute intervention by Keene and Trefethen in August prevented the total disintegration of the Hawaii organization.
Having overseen Kaiser Permanente's successful transformation from Henry Kaiser's health care experiment into a large-scale self-sustaining enterprise, Keene retired in In , all six of Kaiser Permanente's regions had become federally qualified health maintenance organizations.
In , Kaiser acquired a nonprofit group practice to create its Mid-Atlantic region, encompassing the District of Columbia, Maryland, and Virginia.
In , Kaiser Permanente expanded to Georgia. By , Kaiser Permanente provided coverage for about a third of the population of the cities of San Francisco and Oakland; total Northern California membership was over 2. Elsewhere, Kaiser Permanente did not do as well, and its geographic footprint changed significantly in the s. The organization spun off or closed outposts in Texas , North Carolina , and the Northeast. In , Kaiser Permanente sold its Texas operations, where reported problems had become so severe that the organization directed its lawyers to attempt to block the release of a Texas Department of Insurance report.
This prompted the state attorney general to threaten to revoke the organization's license. The organization also sold its unprofitable Northeast division in The Ohio division was sold to Catholic Health Partners in In , Kaiser Permanente celebrated its fiftieth anniversary as a public health plan. Two years later, national membership reached nine million. In , the organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and labor , known as the Labor Management Partnership.
Going into the new millennium, competition in the managed care market increased dramatically, raising new concerns. The Southern California Permanente Medical Group saw declining rates of new members as other managed care groups flourished. This information technology failure led to major changes in the organization's approach to digital records. Under George Halvorson's direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems , ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect.
Although Kaiser's approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Early in the 21st century, the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation and initiated a series of studies involving several health care organizations in England.
The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK.
In , a controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Service , finding Kaiser to be superior in several respects.
Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics.
This practice results in lower costs per member, cost savings for KP and greater doctor attention to patients. Alleged violations of California's timely access laws included failures to accurately track wait times and track doctor availability amid evidence of inconsistent electronic and paper records. It was also found by the DMHC that patients received written materials circulated by Kaiser dissuading them from seeking care, a violation of state and federal laws.
DMHC also issued a cease and desist order for Kaiser to end the practices. The report found Kaiser had put systems in place to better track how patients were being cared for but still had not addressed problems with actually providing mental health care that complied with state and federal laws.
It also issued a statement which denied much of the wrongdoing. In Kaiser settled five cases for alleged patient dumping —the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical care—between and Los Angeles city officials had filed civil and criminal legal action against Kaiser Permanente for patient dumping, which was the first action of its kind that the city had taken. At the time that the complaint was filed, city officials said that 10 other hospitals were under investigation for similar issues.
In , Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services exclusively through its internal KP-owned transplant center. However, patients who needed a kidney were less likely to be offered one. At other California transplant centers, more than twice as many people received kidneys than died during the same period.
Unlike other centers, the Kaiser program did not perform riskier transplants or use donated organs from elderly or other higher-risk people, which have worse outcomes.
Northern California Kaiser closed the kidney transplant program in May As before, Northern California Kaiser now pays for pre-transplant care and transplants at other hospitals. This change affected approximately 2, patients. Kaiser operates a Division of Research, which annually conducts between and studies, and the Center for Health Research, which in had more than active studies. Kaiser's bias toward prevention is reflected in the areas of interest—vaccine and genetic studies are prominent.
The work is funded primarily by federal, state, and other outside non-Kaiser institutions. Kaiser has created and operates a voluntary biobank of donated blood samples from members along with their medical record and the responses to a lifestyle and health survey. De-identified data is shared with both Kaiser researchers and researchers from other institutions. Kaiser Permanente announced its plan to start a medical school in December, , and the school welcomed its inaugural class in June, The Kaiser Permanente Bernard J.
The school will waive all tuition for the full four years of medical school for its first five classes. In order to contain costs, Kaiser requires an agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system.
This has triggered some opposition. Wilfredo Engalla is a notable case. In , Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. Watchdogs have accused Kaiser of abusing the power imbalance inherent in the arbitration system.
Kaiser engages in many cases whereas a customer will usually engage in just one and Kaiser can reject any arbitrator unilaterally, thus they can select company-friendly arbitrators over those that rule in favor of customers.
As a large organization, Kaiser can also afford to spend much more on lawyers and orators than the customer, giving them more advantages. The degree to which this office is actually independent has been questioned.
Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford's attempt to use proof of a physician lie to overturn an arbitration decision. In one case, Kaiser attempted to significantly expand the scope of its arbitration agreements by arguing it should be able to force nonsignatories to its member contracts into arbitration, merely because those third parties had allegedly caused an injury to a Kaiser member which Kaiser had then allegedly exacerbated through its medical malpractice.
The California Court of Appeal for the First District did not accept that argument: "Absent a written agreement—or a preexisting relationship or authority to contract for another that might substitute for an arbitration agreement—courts sitting in equity may not compel third party nonsignatories to arbitrate their disputes.
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Kaiser Los Angeles Medical Center, located on more than 15 acres of East Hollywood property near the intersection of Vermont Avenue and Sunset Boulevard, i s expected to be redeveloped in three phases over a roughly year period. Plans call for razing a series of small commercial buildings, surface parking lots, and a residential duplex to make way for new construction at six different sites across the campus.
If completed , the project would add upwards of , square feet of hospital expansion and medical office space, as well as more than , square feet of new parking.
The initial phase of the project, which is expected to be built over an approximately four-year period, would include the redevelopment of several small commercial buildings at N.
Vermont Avenue Site 1 with a nine-story, foot-tall structure featuring approximately , square feet of medical office space above a car parking garage with five podium levels and four below-grade levels.
Demolition of the existing structures and construction of the new building is expected to occur over a roughly month period. One block northwest at Sunset Boulevard Site 2 , the phase one plan calls for expanding an existing three-story, 60,square-foot medical office building through the addition of a four-story, 50,square-foot procedure center at the intersection of Sunset Boulevard and L Ron Hubbard Way. Work on Site 2 would occur over roughly 15 months, with the work period overlapping with construction at Site 1.
Phase one plans also call for the demolition of two existing office buildings, located at and N. Edgemont Street, which Kaiser would replace in later phases of the project. Existing services in the buildings would be located elsewhere at the Kaiser hospital campus prior to the start of demolition.
The full phase one program is expected to be carried out over a roughly four-year period. Commencing immediately afterward, the phase two plan would begin with the redevelopment of Site 4 at Edgemont Street. Commencing immediately afterward, the phase two plan would begin with the redevelopment of Site 4 at Edgemont Street.
Kaiser is weighing two alternatives for the property:. Either option would be built over a roughly three-year period. Site 5 at Vermont Avenue, currently a parking garage, would be razed and replaced with a larger garage featuring eight above-grade levels and two subterranean floors, offering parking for vehicles and 2, square feet of ground-floor commercial space.
Construction at Site 5 is expected to take roughly two years. The final phase of the redevelopment plan, expected to occur over a two-year period, would comments with the redevelopment of a six-story, car parking structure at Sunset Boulevard Site 6.
Plans call for appending a new nine-story structure to the garage, adding a total of stalls. Simultaneously, plans call for adding a new medical office building on Site 3 Edgemont , which could move forward under two different alternatives depending on the option chosen option for Site 4.
If Kaiser were to build a medical office building on Site 4, then Site 3 would be redeveloped with a 41,square-foot medical office building. However, if the hospital expansion is chosen, Kaiser would instead build a larger five-story, 73,square-foot medical office building at Site 3. Kaiser's plans for the East Hollywood campus comes at a time when many hospital chains operating in California are scrambling to comply with the Alfred E. Alquist Hospital Facilities Seismic Safety Act, which requires that all acute care hospitals statewide should be able to withstand a major earthquake by the year Some facilities have opted for retrofits of existing buildings, while others such as Cedars-Sinai, have used the deadline as an opportunity to expand or rebuild.