title: Kaiser Permanente's performance improvement system, part 2: developing a value framework.
abstract: BACKGROUND
  In 2008, Kaiser Permanente began phased implementation of a nationwide performance improvement (PI) system. The aim was to improve performance by providing consistent, highly meaningful performance measurement, increase PI skills in staff at all levels, develop organizational capabilities, and provide support for making improvements in medical centers and across regions. Evaluating the PI System: The intermediate results of the PI system were assessed in the 22 medical centers in four of the eight Kaiser Permanente regions. Implementation for 3 of these medical centers occurred in January 2008 through November 2008, with implementation for the remaining 19 medical centers occurring from September 2008 through September 2009.
  
  
  RESULTS
  The 22 medical centers that were evaluated achieved a 61% improvement in selected capabilities, and improvement advisors (IAs) successfully completed 84% of initial PI projects. For each dollar invested, estimates suggested an average return on investment of $2.36.
  
  
  CONCLUSIONS
  Critical factors include adequate dedicated time for PI activities by staff with necessary expertise, expert support to operations, alignment of projects with regional and national strategic priorities, and close working relationships between PI staff and operational management. Involving finance leaders in improvement planning, prioritization, and oversight is important. These elements can be adapted to smaller systems and single hospitals.
  
  
  CONCLUSIONS
  The initial evaluation of the Kaiser Permanente PI system indicated that (1) IAs successfully led projects in conjunction with frontline teams, (2) organizational capabilities increased, and (3) the investment in PI infrastructure and staff was sound. Expansion throughout the entire Kaiser Permanente system is under way.
authors.affiliation: National Health Care Performance Improvement and Exection Strategy, Kaiser Foundation Health Plan, Inc., Oakland, California, USA. lisa.schilling@kp.org
authors.forename: Lisa
authors.initials: L
authors.lastname: Schilling
authors.forename: Dennis
authors.initials: D
authors.lastname: Deas
authors.forename: Maile
authors.initials: M
authors.lastname: Jedlinsky
authors.forename: Deborah
authors.initials: D
authors.lastname: Aronoff
authors.forename: Juliette
authors.initials: J
authors.lastname: Fershtman
authors.forename: Abdul
authors.initials: A
authors.lastname: Wali
mesh_terms: D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006801:Humans; D017064:Process Assessment, Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*