Project Themes—Kaiser Permanente "Core Values"
As KP developed from a prepaid health plan for Kaiser Industry employees to a program available to the broader community, six values defined the practices and culture of the organization:
- group practice
- integration of facilities
- preventive medicine
- voluntary enrollment or “dual choice”
- physician responsibility
These values appeared over and over again in the interviews with KP pioneers. For the founding generation, the values grew directly from the process of developing an innovative health care system that satisfied membership needs for affordable quality medical care. External studies of KP in the 1960s affirmed the practical and financial utility of KP values. KP representatives participated in drafting both the Medicare Act of 1965 and the Health Maintenance Organization (HMO) Act of 1973. In the latter bill, Congress mandated four of KP’s core values (1, 3, 4, and 5) as necessary components of HMOs.
Ironically, even though KP provided the single most important model for legislation designed to cure the growing inadequacies of America’s fee-for-service-based medical system, it, like every other organization, had a difficult time adjusting to a new, more complex environment. Efforts to adapt to the new situation inevitably involved questioning the continued utility of KP’s “genetic code.”
National expansion posed a particularly important set of challenges. The results of national expansion were varied and often traumatic. The ability to transfer KP core values proved an important factor in the relative success or failure of new regions, thus confirming the functional centrality of core values to KP operations. To abandon them altogether seemed a recipe for failure.
Another set of conflicts developed as continuing changes in law as well as intense competition from new HMOs affected the relationship between Health Plan and Medical Group. As the national organization responded with what many viewed as radical departures from the core values that had guided KP for decades, the cumulative experience of KP leaders around the country suggested that however compelling new approaches might seem in light of the new situation, problem-solving strategies had to respect KP’s long-established culture or they would fail.
The story of how KP came to reaffirm its core values is not one of heroes and villains. Radical change swept through American medical care, and no one had a clear vision of what to do. The apparent decision in the late 1990s to reaffirm KP’s “genetic code” was based on its continuing utilitarian value as well as the strong attachment many within the organization had to KP’s heritage.
Francis Jay Crosson
Bob Erickson (interview I)
Bob Erickson (interview II)
Al Weiland (interview I)
Al Weiland (interview II)