“Making the right things easier to do”. Evidence based management supports integrated care in Kaiser Permanente – Reply to editorial Guus Schrijvers December 2007

First and foremost, KP’s history of being a supporting facility for an industrial production line seems to play an essential role in the way that the system has developed into an integrated delivery system. From the beginning, the KP system focused on keeping the insured workers healthy and treating their symptoms to prevent illness. KP became a self contained delivery system with its own full-time doctors, nurses and staff, based on a prepaid, fixed budget model. KP still recruits clinicians who value prevention, a whole systems approach to health care, and who embrace team based treatment w1x, all important factors in building an environment for integrated care delivery. While health prevention and health promotion have historically been separated from the care delivery system in most other US and European health care systems w2x, the KPNC health care delivery system has integrated these from the start.