Launched in December 2004, Kaiser's collaboration includes scholarships -- funded through an $8 million endowment to the IHI -- for Kaiser employees and workers at other organizations that partner with Kaiser to attend IHI education and training programs over the next 15 years. Topics include clinical outcomes; patient safety and satisfaction; office and hospital redesign; and healthcare access and disparities.
There's also a $2 million contract for IHI to provide "strategic guidance" on patient safety, organizational metrics and management; assistance with innovation pilot tests that use IHI methodology; guidance in leveraging results to positively affect more patients; and help with organizational structure improvements such as staff training and skills development.
"Kaiser Permanente is excellent at everything somewhere," Bonacum says. "We want to be excellent everywhere, and we think we can do that with IHI's help."
Berwick, IHI's president and chief executive officer echoed a similar sentiment during a Sept. 27 Kaiser Family Foundation symposium on healthcare improvement. Berwick mentioned how several hospitals working with IHI have gone months without a central-line infection and asked "If there, why not everywhere?"
Berwick, who was not available for comment on this story, was involved in hammering out the collaboration with Kaiser and is active in managing its progress, an IHI spokeswoman says.
Bonacum adds that the collaborative effort was "brokered" in a large part by the longtime working relationship between Berwick and Louise Liang, a past chairwoman of the IHI board of directors and Kaiser's senior vice president of quality and clinical systems support. In the early '80s, Berwick was vice president for quality-of-care measurement at the Harvard Community Health Plan while Liang served as associate medical director.
In addition to Kaiser, Massoud says IHI has similar but smaller-scale relationships with HHS, Allina Hospitals & Clinics, national alliance Premier and Ascension Health, as well as partnerships in Sweden and the U.K.
"We partner with organizations that can leverage IHI's work to thousands of patients," Massoud says. "One of the things (Kaiser) brought to the table is that they have made the single-largest investment in electronic medical records outside of the military."
Considering that Kaiser is spending some $3.2 billion on its HealthConnect EMR system, Massoud says the goal is to squeeze every last benefit out of that massive expenditure and to answer the question of "How can we make this the best investment they've ever made in the area of improving quality of care?"
"We have an expensive IT system," he says. "You can show up in any part of the Kaiser Permanente system -- from Hawaii to Washington, D.C. -- and we will know you."
The key, however, is to make use of this resource beyond the random emergency department visit by a tourist visiting another state. Bonacum says Kaiser is working to automate IHI's "trigger tool" strategy that calls for some 20 random chart reviews a month to check if any unnoticed adverse events or patient harm may have occurred. The practice is now done manually at Kaiser, and Bonacum says the goal is to have it done electronically, which would be more efficient in terms of staff time.
Schilling adds that this is also important because programs can flag incidents that are considered adverse events from the eyes of a patient. For example, a patient may be nauseated for several days and this might not have been officially registered as an adverse event or patient harm, but that individual patient would hold a different opinion.
Massoud says he was particularly excited about a Kaiser project now being tested where physicians have a telephone consultation with patients whose chronic care they are managing. Both doctor and patient view the patient's medical record on a computer during the discussion.
"Imagine the difference in having a 15-minute phone conversation at home without the driving, waiting and driving back of a typical office visit," Massoud says. "We realize the future of medicine is in that type of interaction."
Early indications are that such a method for managing chronic conditions "increases patient satisfaction dramatically," Massoud says.
Observers agree and say they are glad Kaiser is pushing programs like this forward.
"We think it's the future as well, but the reason we haven't seen a lot of uptake is twofold," says Steven Waldren, director of the American Academy of Family Physician's Center for Health Information Technology. He explains that there are medical-legal issues attached to concerns that the introduction of new technology may introduce some new way of harming patients, but the driving issue is reimbursement. "I think the fact Kaiser Permanente is doing this will help the market understand that the benefits (of IT) outweigh the risks, and it will help with reimbursement issues as well," Waldren says.