Kaiser Permanente Rethinks Ambulatory Care Vision
At the Ontario Hospital Association (OHA) conference's Capital Planning Session, Kaiser Permanente (KP) presented the Reimagining Ambulatory Care project. The objective was to create a vision for the future of ambulatory care, determine how and where care will be delivered, and identify the technologies needed to facilitate it.
Since the typical ambulatory care experience is built around the provider-patient visit, the original goal was to design the Medical Office Building (MOB) of the future. The project quickly evolved from a focus on the MOB and defining outpatient space to become the catalyst for a movement in which KP redefined the way in which it would do business.
Both the KP process and the findings were instructive. First, KP looked outside the health care industry for inspirational models. Their research considered
- the Netflix model which is highly intuitive and designed around what the consumer wants and needs;
- the Starbucks model which is designed to be pervasive, operating in so many locations that it is 'top of mind' and creates an intentionally designed experience that is replicated all over the world; and
- the Nike model which is designed to be aspirational, conveying the message to consumers that it is possible to attain health and fitness through their product.
Secondly, KP did several rounds of ethnograpic research to understand the attitudes their patients/clients have about their health. They met with KP members in their homes, in the community, and in the clinic setting and explored their healthcare experiences, technology use in healthcare, the nature of members' healthcare appointments, and their feelings about alternative venues and modes of interaction with their physicians. This type of research is designed to be participatory and to generate new insights and big ideas. It allows organizations to stimulate innovation and create their own 'best practices' which then need to be prototyped and tested continuously as part of the service delivery implementation process.
Key findings of interest? It became clear to KP that its core business is about relationships that influence people to take responsibility for their health and to work with them towards higher levels of health and wellness. In order to influence people, it would be important to meet people where they live, work and play. KP would have to conceive and embed ambulatory care solutions in the community offering alternative venues such as the home, retail establishments, and 'virtual' care sites in addition to traditional appointments in the physician's office and the MOB. The design and implementation of these solutions will involve a rethinking of the relationships that people seek with health care; in the future, these relationships will extend beyond the physician to include the hospital, hospital brand, team, and process of care.
Relevance of the KP ambulatory care vision in the Canadian context? Both the vision and the process of achieving it have relevance. Certainly, the concept of bringing healthcare options into the community and into people's homes is aligned with the priorities of the LHINs and the MOHLTC. In fact, the Minister of Health, in his remarks at the closing session of the OHA conference, spoke about the increased focus on the home and community sector as a cornerstone of the province's health system transformation. There is no question that people both here and south of the border want multiple points of access in order to meet their needs at the right place and at the right time and in a manner that is most convenient and streamlined into their lives. The challenge in our publicly funded system will be how to provide services in alternative venues given the barrier resulting from the potential impact on physician remuneration and the significant investments in technology and, perhaps, to a lesser extent, facilities that will be required.
The process reminds us to avoid myopia in planning - to look beyond our industry and the established processes - and to meaningfully engage consumers in planning.