This is part of an ongoing series of audio profiles of front-line improvers.
Senior Vice President for Quality and Service
My name is Alide Chase. I am the Senior Vice President for Quality and Service with the program office, which is the national arm of Kaiser Permanente, the health care organization. I’ve been in my current position for four years now, and I have been with Kaiser since 1980, so I have had a long career in Kaiser Permanente.
Until I took my national job, all of my career in Kaiser has been in operations. So I started my career in nursing in a head nurse position, and then sort of moved from there up to being the director of nursing of one our hospitals in the Northwest region; was offered the opportunity to be the administrator of the two hospitals that we have there, and finally was the chief of operations for the delivery side with another gentleman who did the ancillary services.
I love operations. I like working right in the delivery system and fairly close actually to where the care is being delivered. So it wasn’t until I was offered the opportunity to come into the national office, doing this work in quality and patient safety across organization, that I really thought seriously about doing something other than operations.
Our organization has been working very hard for many, many years on our quality agenda and [we] have a great deal of effort and performance and pride in how we deliver quality. The work that we’re doing right now is how to take practices from one geographic area or one setting to another and speed things up and to learn more quickly. And the challenge as I see it, and my role, is to identify where those practices exist — and there’s lots of ways that our organization does that — and bring them up in visibility and suggest adoption in other locations in a way that is seen as supportive of the work that the other location is doing as well.
Kaiser has never lacked for innovation and innovative thinkers, and so actually harnessing and making sure we know about it, and figuring out how to conduct evaluations of those innovations and then spread it, is more the challenge. You can pretty much go in to any of our regions and find amazing innovations and/or past innovation where they are now starting to really get it into the delivery system.
I know we’re getting better, but we’re not there yet, so there is at the belly of the organization still an awareness and dissatisfaction in terms of our own reflection on ourselves that we could spread faster and harness our ability to use the whole organization even more effectively than we are already doing. Now that being said, we had history, maybe I am going to say five to six years ago, and then it went a long time before that, we had what I called “lots of innovation, but if it is not invented here” syndrome, “then it doesn’t count.” And we have now gone after the culture, realizing that it does create an inefficiency at a minimum, and a slowness, or a sluggishness to not have speed in some of these things. And in our industry, that’s one our problems, this number of years from research to practice, and then from one place to another. So I would paint a picture that we are in the middle of this journey, but we are learning quickly.
We have a very unique labor/management relationship. It’s like the only one we know of, a partnership with our labor partners, the most unionized labor force in the health care industry in the United States. Working both with historical sort of roles of labor, but also having our staff in all of our decision-making groups — from the quality to budget meetings to our facility designs to our service committees. So that’s been a big culture shift for us and one that we’re pretty proud of, and I think if you look at our employee surveys you can see sort of this steady progress, but we’re not in the stratosphere yet.
Even with our pretty successful labor partnership in terms of viewing our staff as having a voice and a place at the table as we make decisions about work redesign, and building design, and flow, it would be fair to say and we would acknowledge that fear in the safety area around error is going to take years and years to just keep working on. We espouse and believe in a blame-free environment and run courses in it. But when you still get out and talk to people about [how] they feel when they’ve made errors and their worry about how they are handled, that is a cultural issue that we are still working on.