Kaiser Permanente Hawaii said it has laid off 20 management and nonunion workers in an effort to streamline operations at the state’s largest health maintenance organization.

"To continue to provide high-quality, affordable health care, Kaiser Permanente is re-aligning resources and streamlining our management functions to meet the current and future needs of our members and the communities we serve," Lori Abe, a Kaiser spokes­woman, told the Star-Advertiser in an email Tuesday.

The HMO, with 226,461 members as of June 30, has about 4,400 employees in Hawaii.

"We hope that many of (the laid-off workers) will choose to remain with us filling some of the more than 125 positions we currently have open," she added.

The company reported a $200,000 loss in the second quarter, its most recent earnings statement, reversing gains of $2.8 million in the year-earlier period.

Kaiser said earlier this year the loss was in part due to more West Oahu residents turning to the emergency room at its Moana­lua Medical Center and Clinic in the wake of the December closure of Hawaii Medical Center-West in Ewa.

The company saw a 9.5 percent boost in the average daily number of patients in the first six months of the year compared with the same period in 2011.

The higher patient volumes following HMC’s closure also resulted in greater use of pharmacy, laboratory and diagnostic imaging services, as well as more admissions and patient days, Kaiser said earlier this year.

Increased usage, especially of the emergency room, can result in lower profits for Kaiser when it does not get fully reimbursed for expenditures.