Cultural Medicine: Speaking Up at Kaiser Permanente


Grace Balbuena; Vanessa Benavides, JD;
Quristin Coleman; Kathy Gerwig; Linda Leavell, RN, PhD

Introduction: A “speaking-up” environment is one in which people feel valued and respected, have a say in their jobs, are comfortable voicing opinions, can speak up about problems, and action is taken on their input. When people speak up, we learn about issues and hazards as well as opportunities to innovate and improve.
Methods: Analysis of the 2014 through 2016 People Pulse results identified correlations between speaking up and business outcomes. Practices that correlate to improved speaking up were also identified through People Pulse, focus groups of employees, and interviews with managers.
Results: Departments that score well on the People Pulse Speaking Up Index have 58% fewer workplace safety injuries, 41% fewer lost work days, and 14% lower patient mortality rates. But the Index shows that a speaking-up environment is not fully present across Kaiser Permanente. We score 9% below “best-in-class” benchmarks. Barriers to speaking up include: Lack of management follow through on ideas or concerns, fear of retaliation, exclusion behaviors, and lack of trust.
Discussion: A proven practice for improving speaking-up environments is Direct Report Rounding. These are short, private discussions between a manager and an employee that occur on a monthly or other regular schedule. Information on how to conduct this practice is available at:
A second proven practice is involving employees in their work. The Food and Nutrition Services Department at the Los Angeles Medical Center achieved an 11% improvement in their Index in one year. They initiated a “respect” campaign that included team-building activities and bringing family and social traditions into the workplace.
Conclusion: Great health care is inherently built on significant trust. Creating a speaking-up environment links to our ability to fulfill our mission.


Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.


2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, and CrossRef.




ISSN 1552-5775 Copyright © 2021

All Rights Reserved