Communication in an Hmo

Abstract

This paper will discuss communication within Kaiser Permanente Medical Group of Southern California a Health Maintenance Organization. An introduction to Kaiser will be given and then a profile of the organization will be discussed. The importance of physician patient communication will be explored and the effects that those communication can have on the organization. Communication theories including systems theory and organizational information theory will be discussed as they pertain to communication in a healthcare setting. Ethical considerations will be examined including addressing patient privacy, the electronic medical record, practicing medicine online, Health Insurance Portability and Accountability Act and online storage of medical records. Communication strategies that are effective when there are multiple ethical and legal issues involved in communication will be explored. A summary will be made of all of the materials presented and recommendations for communication for the future to increase communication within the and HMO will be discussed

Table of Contents

Introduction to Kaiser Permanente Southern California 1

Organization Profile 2

Communication Theories 4

Communication Challenges and Ethics 5

Communication Strategies 13

Conclusions and Recommendations 16

References 18

Introduction to Kaiser Permanente Southern California

The specific health care organization that this paper will focus on is the health maintenance organization that this author is employed with. This author works for Kaiser Permanente, which is the largest Health Maintenance Organization (HMO) in the United States. In 2005 they had 8.5 million members. Their operating revenue was 31.1 billion dollars and their net income was 1 billion dollars. Kaiser Permanente is the largest employer in Los Angeles County and has over 86,100 employees in Los Angeles County. They also have large numbers of employees in neighboring counties including Orange County, San Diego County and Ventura County.

This author works for Kaiser Permanente in Southern California. Kaiser is made up of three unique companies. The first is Southern California Permanente Medical Group (SCPMG). SCPMG is made up of a partnership of 33,000 physicians in Southern California, it is a for profit entity. There are debits and credits during the year, but at both the beginning and end of the year there is always a zero balance. SCPMG has no assets. If the physicians come out with a positive balance for the year all profits are distributed back to the physicians, so the balance sheet is again back to zero. The physicians pay taxes on their earnings.

The second unique company is the Kaiser Foundation Hospitals (KFH). It is composed of 11 community not-for-profit hospitals. The KFH owns all of their assets. They contract with the Health Plan to provide services to Kaiser health plan members. The KFH has no revenue as they just provide services. The Kaiser Foundation Health Plan funds the KFH.

The third unique entity is the Kaiser Foundation Health Plan (KFHP). In Southern California there are over 3,125,000 members covered by the prepaid health plan. The Health plan pays the KFH. The KFHP collects the fees for the insurance premiums and they sell the insurance. They write a contract with the KFH to provide for care of the members of the health plan. The health plan owns all of the capitol. The major assets are the buildings and land that all of the medical office buildings and hospitals are located on. The second largest assets are software programs. HealthConnect (electronic medical record) is the largest expenditure at this time, and both the buildings and the software will be depreciated over a period of time.

There is no accounting department in SCPMG all of the accounting services are outsourced to the KFHP. KFHP accounts payable department processes more than 1 million invoices and 250,000 payments in a year.

Organization Profile

With an organization this big there are multiple communication issues and this author continues to wrestle with the system on a daily basis. There are communication issues within the clinic, between the clinics, within the region and between the regions. There are problems in communication between therapists, nurses, psychiatrists, medical physicians, and administrators. There are problems with communication via e-mails, patient messages, memos, and in the patient charts. The organization has recently implemented an electronic medical record, which has had its own issues regarding the Health Insurance Portability and Accountability Act and confidentiality.

The organization emphasizes communication and communication skills as evidenced by many of their programs and their focus on training communication skills. An example of some of their communication programs include classes for physicians on the Kaiser intranet system (Anonymous, n.d.) that teach physicians communication skills including small talk, the needs of the audience, managing conflict, engaging others as part of a team and rewarding others for their efforts towards change. Another example is the organizations focus on clinician-patient communication (Physician Education & Development, 1996) some of their trainings include communication in occupational health, in the hospital setting and talking with patients with cancer. The role of communication cannot be overstated as an article by Stewart et al. (2000) demonstrated. The authors found that when patients felt their visit to the physician was focused on them they needed fewer tests and referrals and had better mental health for up to two months after the visit. Improved communication also increases patient satisfaction according to Roter et al. (1997) they found that that when five types of communication patterns were compared in a primary care setting that patients were most satisfied with the visit that included the most social interaction. The fact that tests were ordered or not made no difference in their satisfaction rating. An article by Tallman et al. (2007) looked at the communication patterns of physicians that had the highest patient-satisfaction ratings and they found that it was important that the physician did not interrupt the patient when he was speaking, that the physician used active listening skills, and gave the patient