Kaiser Permanente has a tradition of diversity, inclusion, innovation, and advocacy. The integrated managed-care organization has developed a multifaceted diversity program that serves as a primary strategy to build, sustain, and continually improve its core business of providing quality, affordable healthcare services.
Central to Kaiser’s diversity strategy is its people. The company’s approach for attracting the best and most diverse employees and physicians is to reinforce its standing as the best place to work, by nurturing an inclusive, welcoming workplace environment.
“I’m openly gay, and it hasn’t been a hindrance,” says Randy DeBoer, Kaiser’s chief compliance and privacy officer of the Greater Southern Alameda Area. “I progressed from an entry level position to leadership.” DeBoer got his BS and MBA during the 20 years he’s been with the company. Not only did he receive tuition reimbursement, but flexibility in his work schedule to go to school. He loves what he does and where he works, “I’m totally comfortable,” he says. “I grew up as a gay White boy in middle-class San Jose. I didn’t know what else existed. When I came here, I got exposed to a lot of other types of people and because diversity was embraced, I made a push in my life to understand different cultures and people.”
For the first time last year, Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals Chairman/CEO George Halvorson and Ronald Knox, senior vice president and chief diversity officer, rode on a float in San Francisco’s Gay Pride parade, and about 300 Kaiser employees marched. DeBoer says that while Kaiser employees and physicians have participated in the parade for more than 15 years in the parade, this year was unique. “That George and Ron were there made a statement to employees,” he says. .
Kaiser, headquartered in Oakland, California, was founded in 1945 and is comprised of Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and subsidiaries, and the Permanente Medical Groups. It has 8.6 million health-plan members, over 173,000 employees and physicians, and in 2008 had operating revenue of $40.3 billion.
The numbers are compelling. Its 14-member board of directors is 50 percent people of color and 36 percent women. The workforce is 56 percent people of color and 74 percent women. In fact, the overall workforce is so diverse there is no ethnic or racial majority. “We have only two numerical majority groupings inside our organization; the majority of our staff is female and a majority of our staff are caregivers,” noted Halvorson in a recent weekly letter to employees and physicians.
Diversity is broadly defined and interpreted at Kaiser, and includes race, religion, gender, subcontracting, gender identity, national origin, ethnicity, sexual orientation, age, disabilities, veterans’ status, culture, as well as health disparities, language services, and culturally competent care, for starters. “Kaiser Permanente has for many years seen diversity in a very broad sense and has included disenfranchised groups such as LGBT and disability communities in its mission and initiatives,” says Elizabeth Sandel, chief of physical medicine and rehabilitation at the Napa/Solano service area and director of research and training, of Kaiser Foundation Rehabilitation Center.
But diversity’s nothing new for Kaiser. It hired its first female doctor in 1946, followed five years later with its first Black doctor. “In the late 1940s, Kaiser made the decision to provide racially integrated healthcare. An African-American male would be in a bed beside a white man,” says James Taylor, PhD., director of diversity strategy implementation.
Almost 20 years ago, the board of directors endorsed and approved the National Diversity Agenda, which set forth the vision that governs the organization’s current diversity management effort. The agenda consists of three strategic cornerstones designed to grow membership through effective market segmentation approaches that target specific populations which are the fastest-growing segments of society; provide culturally competent medical care and culturally appropriate service to improve the health and satisfaction of its increasingly diverse membership; and enhance the diversity, cultural competency and performance of its workforce. “Successful achievement of the goals of the agenda will demonstrate the values, ideals, and mission of the program and enhance Kaiser’s competitive position in the market, and support accomplishment of our
primary objective — the delivery of high quality, accessible, affordable, personalized, convenient, culturally competent, comprehensive healthcare to its diverse members,” says Knox.
The primary vehicle for diversity governance is the National Diversity Council, a geographically and occupationally diverse group of senior executives, which serves as diversity policy advisor to Kaiser’s executive leadership. It establishes strategic direction and provides high-level advocacy to support implementation of the National Diversity Agenda. “Kaiser Permanente has managed to fully integrate diversity into the core fabric of the business that we do,” Taylor adds. “Changing demographics dictate that diversity plays a significant role in how we deliver care.”
Leading From the Top
“Without question it helps when diversity advocacy comes from the top,” says Taylor. “We have visionary leadership that gets it.”
Halvorson has been a lifelong student of cultural diversity and champion of diversity in the corporate environment for many years. “Being in a world of multiple cultures, multiple ethnicities, multiple alignments and multiple points of view is exciting, energizing, and constantly intellectually challenging, growth-provoking and rewarding,” he says. “My own work experience has been that when I am in a setting where everyone is the same color, same race, same age, same gender, same sexual orientation, same ethnicity, and same religious affiliations, I find an overload of sameness.”
“The energy and creativity that results from diverse perspectives, points of view, life experiences and skill-sets that can achieve the kind of interactive synergy where the whole is very much greater than the sum of its part,” Halvorson noted in his letter.
Preparing the Pipeline
Kaiser maintains a strong commitment to employee retention and applicant pipeline development. Its Diversity Leadership Program (DLP) builds internal leadership at the middle-management level that mirrors the diversity of the communities it serves, as does the executive mentoring program that involves the company’s top 20 executives as mentors.
Members of the leadership team and regional presidents comprise the executive mentor group, an action-oriented program designed to assist those from underrepresented groups in the executive workforce increase their organizational knowledge, obtain feedback on development strategies, and refine issue-resolution and decision-making skills. Integral to the DLP is the tracking and measurable outcomes and return on investment for both mentors and protégés. A case study presentation following four years demonstrated a sustained impact on the number of people of color. When compared to the baseline year of 2002, the percentage of people of color in higher-level leadership roles had more than tripled.
Kaiser’s plan also includes a training component implemented through its Learning & Development (L&D) department. Each year, senior leaders nominate diverse candidates from their areas for the Strategic Leadership Skills (SLS) and Core Leadership Program (CLP) training programs. The 5 ½ day trainings are held twice a year. Twenty- eight candidates are admitted at a time into SLS, and 42 to 45 into CLP.
“In today’s marketplace, especially with the rise of foreign trained health care professionals, it underscores the importance of employing and developing managers who can manage effectively in a multicultural and multilingual environment,” says Gayle Tang, national diversity director of national linguistic and cultural programs. “Diversity Managers must be equipped with a specific knowledge base and skill-set to harness diversity as an asset and to manage the different dimensions of diversity effectively.”
Kaiser also seeks out minority/underserved youth with pipeline programs such as INROADS. Its Summer Youth Employment program began in 1968 to provide jobs for disadvantaged youngsters aged 15-20. Many of the 11,000 students who have participated selected careers in healthcare or business operations. Many are physicians, employees and managers at Kaiser. The company also co-sponsors and annually awards scholarships to African-American, Asian, Latino and lesbian, gay, bisexual and transgender high-school students through its many employee resource groups.
Kaiser maintains a high level of commitment to the communities it serves. “Our extensive community benefit program embraces diversity, and focuses on communities that have historically been under-represented and underserved,” says Ray Baxter, senior vice president of Community Benefit. “It’s founded on a goal of health equity — advancing access to high quality care for all people; supporting social, economic, and natural environments that promote health for everyone; and developing and sharing knowledge that improves health and healthcare. In 2008 we invested over $1 billion in these programs.”
Kaiser has staff associations, or affinity groups, that include African-Americans, Latinos, LGBT, American Indians, Armenians, and the disabled. “They’re a tremendous resource in strengthening our times to the community,” says Taylor. “We keep in contact with each other and share best practices. We learn from each other and come together on issues.”
Kaiser holds monthly town-hall meetings where senior leadership meets with staff to share information and updates about the priorities of the organization and to highlight ongoing activities. The CEO writes weekly letters to the workforce discussing what they’re doing right and what they have reason to celebrate.
This year, Kaiser will sponsor its 32nd annual National Diversity Conference, a two-and-a-half day educational forum featuring diversity and healthcare experts on leading-edge diversity issues, concepts, practices/trends in diversity management, culturally competent care delivery, linguistic services, care access, workforce diversity, and marketing to diverse populations.
The company also has a Diversity Hall of Fame award. Inductees are employees whose courage, integrity, and determination in leading diversity have advanced the principles and practices of inclusion, fairness and equity, equal opportunity, cultural competency and awareness have inspired others. The R.J. Erickson Diversity Achievement awards are presented to those demonstrating exemplary efforts to advance Kaiser’s diversity agenda, and recognize achievements in the fields of culturally competent care, cultural and linguistic service excellence, workforce diversity, multicultural marketing and community service. The Kaiser National Diversity HIV/AIDS Award spotlights organizations that demonstrate excellence and innovation in leadership and advocacy for HIV/AIDS prevention and/or care.
But despite Kaiser’s achievements on the diversity front, Halvorson is humble. “I know for an absolute fact we don’t do everything right when it comes to diversity, “he says. “We make mistakes, and have times when we’re imperfect in our approaches, understandings, behaviors, and sensitivities. But we’re … getting consistently better at doing the right thing.”
What advice does Kaiser offer other organizations? “It’s important to clearly define what diversity means in the halls of your organization given that it can because it can be a relatively ambiguous term to some and mean so much to different people,” says Taylor. “Clearly articulating both the business and human case for diversity is critical to its integration and sustainability, particularly in times of scarce resources and competing priorities.”
And though the economy has affected many organizations, diversity remains a priority for Kaiser. “Diversity is more of a priority now,” Tang says. “It brings creativity and innovation. If we continue to leverage our diversity assets we will continue to excel in our care delivery and in the marketplace. As workforce diversity becomes increasingly important in health care, consider the enhancement of staff’s skills to manage situations that arise outside their cultural scope or understanding. Cultural competence begins with diversity, and is enhanced through support systems and ongoing training programs. Furthermore, the health care system is a culture in itself, augmenting the complexity of cultural interplay. Continuous monitoring of care, services, and satisfaction levels can reveal opportunities for change and improvements in a timely fashion.”
Taylor adds, “Our commitment doesn’t change when the economy does. We plan to keep building the workforce of the future today, to design leading-edge and next-generation diversity strategies and initiatives to further develop and advance our cultural competency and diversity management capability – to maintain our national presence as a diversity leader and re-define quality in the care and service provided to our members and the community.”