From San Francisco Business Times:
Communication and administrative errors that doomed Kaiser Permanente’s San Francisco kidney-transplant unit have raised fears among health-care observers about broader management problems at the health-care giant and questions about the role its affiliated medical group played in the fiasco.
Kaiser said May 12 that it would shutter the program in response to pressure from the state Department of Managed Health Care and federal regulators to fix flaws outlined in a May series of articles in the Los Angeles Times. Those included botching the transfer of patients from other waiting lists and creating delays in providing transplants. Kaiser transplant patients will be transferred to programs at UC San Francisco and UC Davis medical centers.
Kaiser officials initially declined to answer additional questions.
“The decision, for now, is to go into no further detail than last Friday’s announcement and news release,” Kaiser Northern California spokesman Rick Malaspina said May 15. “(Our) first concern is to work directly with patients, answer (their) questions and get them transferred.”
But simply closing the door on the failed program isn’t enough, say some health-care insiders, who believe the episode illustrates deeper rifts within Kaiser, and serious oversight issues that management must address.
Raising questions
The transplant fiasco “is particularly troubling,” said Peter Lee, CEO of the Pacific Business Group on Health, which represents many of the region’s largest employers. “Employers expect an integrated system to fix problems faster.”
Also, Lee said, “it flies in the face of Kaiser’s generally high performance” across the broad spectrum of patient care, including high-end specialty care. “What makes it such an important issue,” he added, “is that it’s an apparent systems flaw that raises the question if there are other areas where there are quality-control systems that are not in place.”
Observers say doctors in the 6,000-doctor Permanente Medical Group, the Kaiser Northern California for-profit medical group affiliate also known as TPMG, should be held more accountable for problems in the kidney unit.
“The fault lies with the dysfunctional nature of TPMG, which has so far escaped scrutiny,” said Ruth Given, a former Kaiser and California Medical Association executive. She also previously worked as director of health-care research at Deloitte Consulting, which does extensive work with Kaiser. “They should have done a better job of monitoring quality, not only of this program but of all medical programs,” Given said. “But my experience is that the M.D.s discourage that (kind of oversight) — and Kaiser typically backs off.”
“Rather than just picking on Mary Ann Thode,” she said of Kaiser’s Northern California president, “somebody needs to get (Permanente CEO) Robbie Pearl on the hot seat and have him explain and apologize and describe why this will never happen again.”
Although Kaiser didn’t make a medical group executive available, when given a second chance Kaiser spokesman Malaspina agreed to respond to comments made by Lee, Given and others. “The medical group at the highest levels is involved in addressing this issue,” he said.
Malaspina downplayed concerns that the kidney unit’s woes may portend broader quality and management problems. “These issues and these concerns are confined to the kidney transplant program,” he said, “and we have reviews under way to address those issues and concerns.”
The failure of Kaiser’s vaunted information technology infrastructure to bring the kidney unit’s problems to the attention of top management in a timely manner was another significant lapse, said a former TPMG executive who still works in Bay Area health care. “It sounds to me like somebody dropped the ball,” he said, noting that transferring information from one health-care provider to another is often problematic. “They may not have had enough programmers, or even enough clerks” to handle the IT load.
Further, the “internalization” of clinical areas that were formerly farmed out to others has always been tricky for Kaiser, he said. The decision to do so “was probably not entirely financially driven, but it was probably a big selling point.”
Similar questions are rippling through Kaiser’s Oakland headquarters.
“There’s a story — the whole issue of physician culture,” said a high-ranking Kaiser source. “Physicians don’t seem capable of policing their own, much like cops, firemen or the CIA.”
Public relations headache
As a result of the disclosures about the kidney unit, Kaiser also has severe challenges on the public relations front.
Said Sam Singer, president of San Francisco’s Singer Associates and a crisis-communications specialist with health-care industry experience: “What makes this so difficult is that it flies in the face of people’s perceptions,” both about Kaiser’s reputation and the strengths highlighted in its “amazingly good” Thrive advertising campaign, which touts Kaiser’s focus on preventive care and on putting doctors in charge, rather than bean counters.
To recover, Singer said, Kaiser needs to fix the administrative malfunctions — “the first foray into the battle of recovery” — and then publicly share the results of its internal investigation.
“They have to show people that they’ve solved this problem,” he said. “They need to show their cards, however ugly they may be, and correct them, so they never occur again.”
It was so gratifying to see the mainstream media FINALLY acknowledge Kaiser may have serious administrative problems. It was even more surprising that the SF Business Times, which usually serves as a vehicle for Kaiser PR, ran this article.