Why Branding Permanente Matters


Deb Friesen, MD

Perm J 2017;21:16-074 [Full Citation]

E-pub: 12/22/2016

Believe it or not, Captain Jack Sparrow says something profound in Pirates of the Caribbean. He tells Will Turner, “Wherever we want to go, we go. That’s what a ship is, you know. It’s not just a keel and a hull and sails; that’s what a ship needs. Not what a ship is. What the Black Pearl really is, is freedom.”1

I can’t think of a better way of illustrating a brand. Brands are the composite experiences that consumers have with a company: “In this way, brands can hold certain values, have specific personalities, possess admirable qualities, stand for something, make promises, and create emotional connections with people.”2p6 “Far more than a name and logo, it is an organization’s promise to a customer to deliver what the brand stands for not only in terms of functional benefits but also emotional, self-expressive, and social benefits.”3p1 “[A brand] promises relevant differentiated benefits.”2p5 This knowledge then turns brands into assets that drive strategy.3

Historical Perspective of the Kaiser Permanente Brand

The struggle to define ourselves as Kaiser Permanente while elucidating our unity of purpose as well as our separation of functions (Permanente Medical Groups, Kaiser Foundation Health Plan, and Kaiser Foundation Hospitals) is by no means a new one. In 1955, there was an attempt to change the name of the Medical Group from Permanente to Kaiser, the argument being better recognition of the Kaiser name and better pronounceability.4p80 The Permanente physicians adamantly opposed the name change, saying that it “‘would give truth to the lie that we were just [Kaiser doctors].’”4p81 This conflict, as well as others, was ultimately resolved with what came to be known as the Tahoe Agreement, in which “[Henry] Kaiser ceded control of medical matters to the physicians … . The health plan and hospitals would retain the name Kaiser, while the physicians would keep the name Permanente, thus leading to [our] lasting organizational name” and structure, intended to recognize the contribution of each entity.4p83

Fifty years later, the careful balance of power in the Kaiser and Permanente partnership had once again shifted.5 A yearlong negotiation, completed in June 1997, led to “Tahoe II,” which resulted in the formation of The Permanente Federation, ensuring equal representation of both Kaiser and Permanente leaders.6 This renewed partnership led to Kaiser Permanente’s first explicit brand strategy, “rooted in … the core principles of Permanente Medicine as defined by the Medical Group leaders and the Federation.”6

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The Current Permanente Brand

I take great pride in my profession and even more as a Permanente physician because, as I tell my patients, “I’m a better doctor because I’m part of Permanente.” As Permanente physicians we practice Permanente Medicine: we provide the best care, at the right time, with the right incentives. It’s this shared perception of ourselves that contributes to our internal brand.

But brand isn’t just what we think of ourselves; it’s the totality of the perceptions of everyone around us. Our customers, our patients, and the market are often confused about who we are as Permanente, and the confusion about our brand and the weakness of our brand increases the further you are from California. When I recently Googled “should I buy Kaiser insurance,” the top hit was a comment that we are employees of Kaiser, gatekeepers withholding care to generate profits.7 The belief that Permanente physicians work for Kaiser persists even among highly educated, highly informed Human Resources Chief Executives that I interact with in my role as a Physician Market Lead supporting National Account Managers. I frequently have to resort to a diagram to adequately explain the complex relationship between the Permanente Medical Groups, Kaiser Foundation Health Plan, and Kaiser Foundation Hospitals, as well as our medical and hospital service agreements. Even in California, the state where our presence is the strongest, the Permanente brand is weak in the media. In December 2015 the Los Angeles Times wrote about Kaiser Permanente’s planned medical school.8 “Kaiser” is mentioned 25 times, “Kaiser Permanente” 3 times, and “Permanente” just once.

We struggle with how to convey our identity. Our patients love their “Kaiser doctors” without understanding that we are Permanente physicians. We’ve all experienced the blank stare when we share with friends or acquaintances that we work for a Permanente Medical Group. Clarity occurs only when the Permanente brand is associated with Kaiser’s. A review of Kaiser Permanente executive profiles on LinkedIn reveals the identity struggle again—do they work for Kaiser Permanente, Kaiser Foundation Health Plan, or a Permanente Medical Group?

This lack of positive external Permanente brand identity and brand recognition is detrimental to both the K and the P. Permanente is often seen as subordinate when our joint success depends on our being indomitable equals. Most profoundly, the weakness of the Permanente brand undermines trust, in both the system and the physician. Without trust, we hinder our growth. Without growth, we lessen our influence. And without influence, we diminish our relevance.

Strengthening the Permanente Brand Strengthens the Kaiser Permanente Brand

As a Permanente Medical Group representative, my presence at meetings with national accounts customers is literally conveying the Permanente brand message. Within the conference room there is often a palpable and dramatic shift of the combined Kaiser Permanente brand as I explain by way of care stories how Permanente physicians partner with Kaiser to deliver the best integrated health care as defined by Permanente. My colleagues who manage those accounts and make those sales realize the benefit of that branding in terms of retention and growth. And although undeniably beneficial, this incremental branding of Permanente will never result in the momentum needed to fundamentally change our brand identity. Defining and articulating the Permanente brand will allow all of us to occupy our place as leaders in the Kaiser Permanente partnership. It will allow us to embody our values and our value, to connect emotionally with customers and patients, to become irreplaceable (despite the changes in the insurance market), and to create lifelong relationships. We will become better and stronger partners to the customer, to the patient, to each other, and to Kaiser Foundation Health Plan. Extrapolating on the sentiments expressed by Jay Crosson, MD, the first Director of The Permanente Federation: One needn’t minimize the vital role of Kaiser in Kaiser Permanente’s story to assert the essential role played by Permanente.9

Marketing the Brand Internally

The other market that benefits from Permanente branding is Kaiser Permanente itself. It’s our connection to the meaning behind the work we do that makes us—and the brand—come alive. Developing a strong brand strategy allows us to step back and take stock, gleaning insights from the members, patients, and customers that we serve, to reignite that individual calling and common mission.10

It Starts with Us

Before we can begin the work of managing/improving our brand, we must begin by understanding what that brand is. Let me tell you about the brand journey through the experience of the Colorado Permanente Medical Group (CPMG).

In 2015 while Chair of the CPMG Board of Directors, I initiated and executed on the work of the CPMG brand, the CPMG brand identity, articulating CPMG’s “why,” and drove the development of an independent CPMG strategy, engaging the expertise of a highly experienced consulting firm. We began with conversations and interviews with physicians in all of our regions, incorporating a wide variety of brand perceptions informed by length of service, specialty, and work locations. We interviewed the entire executive team, each director on the board, and frontline physicians. A day was set aside for the board and executive team to participate in interactive exercises using design thinking to dig deeply and come upon ideas and answers obliquely rather than head-on. All the information from the interviews and exercises was distilled into the essence of CPMG’s brand identity statement, which then became our lodestar, providing direction for our 2016 strategic plan, guidance for our communications and engagement strategy, and a beacon for our behavior.

This Will Take Commitment

Until 1980, the American Medical Association Code of Medical Ethics11 prevented physician advertising. Thus, the primary way of managing our brand was by taking excellent care of our patients and then relying on word of mouth. Perhaps this has remained in our institutional unconscious, making us reluctant to vigorously project our brand. In the current environment of competition, consumerism, and social media, it is time for The Permanente Federation to make Permanente branding, marketing, and communication a priority, inclusive of all of the Regions, powerfully partnering with Kaiser Foundation Health Plan. We may consider Kaiser Permanente a partnership of equals, but unless and until the consumer—the customers, the patients, the members, and the market—understands who we are, Kaiser Permanente will experience the repercussions of the associated negative branding while failing to take advantage of the brand strength each entity can bring to the partnership. The deliberate separation of roles within the Kaiser Permanente partnership helps us deliver the best, most affordable health care to our patients. The independent branding of Permanente will fulfill the promise of a partnership of equals, with influence and relevance that is so much more than the sum of its parts.

Our Aspirational Brand

Imagine the day when your patients tell their neighbor how much they love their Permanente physician. Imagine our patients understanding that they are purchasing Kaiser insurance because it’s the portal to Permanente Medicine. Imagine the news article that calls out Permanente and Kaiser equally. That’s the day when the internal brand matches the external. That’s the day of phenomenal growth for all of Kaiser Permanente because people understand that our model is truly dedicated to the best and most affordable health care. That’s the day of powerful Permanente influence beyond the examination room, because consumers and legislators understand that patients come first with us. That’s the day of amazing trust in our care delivery, and reform of the rest of the health insurance industry, because we believe everyone deserves Permanente Medicine.

Jack Sparrow didn’t buy a ship. He bought freedom. Our customers and our patients aren’t buying health insurance, nor are they buying integrated health care powered by a unified electronic medical record. They are buying a healthier, better version of themselves. Who better to deliver on that promise than Kaiser Permanente? Our patients, our customers, are buying a journey to better health upon an amazing vessel made up of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. And it’s Permanente who captains it.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.


Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.

How to Cite this Article

Friesen D. Why branding Permanente matters. Perm J 2017;21:16-074. DOI: https://doi.org/10.7812/TPP/16-074.

1.    Verbinski G, director. Pirates of the Caribbean: The curse of the Black Pearl [film]. Burbank, CA: Walt Disney Pictures; 2003.
2.    VanAuken B. Brand aid: A quick reference guide to solving your branding problems and strengthening your market position. 2nd ed. New York, NY: AMACOM; 2003 Jul 7. p 6.
3.    Aaker D. Aaker on branding: 20 principles that drive success. New York, NY: Morgan James Publishing; 2014 Jul 15. p 1.
4.    Debley T, Stewart J. The story of Dr Sidney R Garfield: The visionary who turned sick care into health care. Oakland, CA: The Permanente Press; 2009 May 1. p 79-83.
5.    Crosson FJ. Permanente medicine: The path to a sustainable future. Perm J 1999 Winter;3(1):56-9. DOI: https://doi.org/10.7812/TPP/98-093.
6.    Crosson J. Purpose, partnership, and the Permanente Federation’s tenth anniversary. Perm J 2007 Summer;11(3):61-2. DOI: https://doi.org/10.7812/TPP/07-070.
7.    Should I use Kaiser Permanente or Blue Shield for health insurance? [Internet]. Mountain View, CA: Quora; 2012 Sep 24 [cited 2016 May 25]. Available from: www.quora.com/Should-I-use-Kaiser-Permanente-or-Blue-Shield-for-health-insurance.
8.    Terhune C. HMO giant Kaiser Permanente plans to open a medical school in Southern California. Los Angeles Times [Internet] 2015 Dec 17 [cited 2016 Oct 4]:[about 3 p]. Available from: www.latimes.com/business/la-fi-kaiser-school-of-medicine-20151217-story.html.
9.    Crosson J. Dr Garfield’s enduring legacy—challenges and opportunities. Perm J 2006 Summer;10(2):40-5. DOI: https://doi.org/10.7812/TPP/05-146.
10.    Mitchell C. Selling the brand inside. Harv Bus Rev 2002 Jan;80(1):99-101,103-5,126.
11.    AMA code of medical ethics [Internet]. Chicago, IL: American Medical Association; 2016 Jun [cited 2016 Oct 11]. Available from: www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page.


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