Posts Tagged ‘history’

James Vohs: Kaiser Permanente missionary and defender of core values

posted on September 20, 2010
Jim Vohs

By Ginny McPartland
When we talk about quality of care today, the name “Jim Vohs” inevitably comes up. That’s because many Kaiser Permanente (KP) people have heard of the annual James A.Vohs Award for Quality. It’s a great honor to receive the Vohs award, and every year since 1997 people across the program have pulled out all stops to garner the coveted distinction for quality improvement projects. But fewer people know the story of James A. Vohs, the man behind the name, and why he is associated with quality assurance.

Jim Vohs was an early health plan leader, a champion of prepaid, group medical practice, a believer in strong partnerships between health plans and the medical groups, and an adamant advocate for Kaiser Foundation Health Plan and Hospitals as nonprofit institutions that provide quality, affordable health care.

Right out of Berkeley High School in 1946, Vohs first worked as a “mail boy” for a Kaiser Industries unit called Kaiser Services, where his mother worked as a bookkeeper. After his graduation from UC Berkeley in 1952, he rejoined Kaiser Services, which provided administrative support for the various Kaiser industrial companies, like Kaiser Steel, Kaiser Aluminum and Kaiser Engineers.

With his career blossoming, he shocked his Kaiser Services colleagues by choosing to switch to the nonprofit Kaiser Foundation Health Plan and Hospitals in 1957 because he believed in its principles. It was a good choice. During a 50-plus year career, he rose to become President and CEO as well as the first chairman of Foundation Health Plans and Hospitals boards of directors who was not a Kaiser family member, succeeding Edgar F. Kaiser, Henry J. Kaiser’s son.

Quality a big priority

Quality of care was an issue early on in the life of the Kaiser Permanente Medical Care Program. Detractors of prepaid, group practice were quite happy to spread rumors about how Kaiser Permanente doctors were not qualified or competent and that their patients were “captives” of no choice.

Vohs was very much aware that these attacks contributed to a “poor reputation,” however wrong, in KP’s early days. Even the prevailing attitude at Kaiser Services was that the medical care program was an “embarrassment.”

Meanwhile, Kaiser Permanente was early and quick in its efforts to show the skeptical world evidence of its excellent care. Early physicians published research that showcased their innovative treatment, sponsored medical symposiums, aligned themselves with academic medicine, and kept their heads down when the insults were hurled.

Reputation aside, Jim Vohs had faith in the high caliber of Permanente physicians, and he bravely faced critics who implied Permanente cut corners in medical treatment. “It is quite clear to me that the economic incentive . . . for the program and the participating physicians —who by and large spend their careers (with Permanente) — is to resolve medical problems as promptly and completely as possible,” Vohs told an interviewer in 1983.

Documenting quality of care

Today’s medical quality movement got its start with the creation of the Joint Commission on the Accreditation of Hospitals in 1952. The federal government started requiring quality data following the adoption of Medicare for the retired and Medicaid for the poor in 1965. The American Hospital Association published its Quality Assurance for Medical Care in the Hospital in 1972. The HMO (Health Maintenance Organization) act of 1973 required each federally qualified HMO to have an internal quality assurance program.

In 1974, Kaiser Permanente physicians from all regions started meeting regularly to discuss quality related issues, and Vohs established a department of quality and a board of directors committee on quality assurance. The committee, including Vohs, made site visits to each of the regions several times a year.

In 1979, Drs. Leonard Rubin and Sam Sapin served on an advisory committee that set up the National Committee for Quality Assurance (NCQA), which sets standards for HMOs. The Permanente physicians were successful in getting the committee to adopt a problem-focused approach to quality assessment, which Rubin had developed and tested starting in 1967.

By 1983, Kaiser Permanente was getting good reviews. Dr. Sapin reports: “Almost without exception, published reports comparing health care delivery by Kaiser Permanente physicians to others have shown us to be better than or at least equal to others.”

Vohs award perpetual trophy. Symbol of unity.

Vohs is proud of having the quality award as part of his legacy: “It’s so important for Kaiser Permanente. The regions are competing for the award; they are supporting programs in quality because they want to win that award.”

Vohs a key player in KP milestones

Throughout the years, Vohs played a key role in many of the milestones of Kaiser Permanente’s history. Each chapter helped to make Kaiser Permanente stronger and more capable of providing high quality care.

• Passing of the Federal Employees Benefits Act in 1959. This legislation was heavily influenced by Kaiser Permanente leaders who urged Congress to include a choice of fee-for-service and prepaid medical plans. Kaiser Permanente gained many members as a result.

• Passing of the HMO Act of 1973. Kaiser Permanente leaders also heavily influenced this legislation. They worked with Health, Education and Welfare Agency officials to develop a proposal for a per-person or capitation method of Medicare reimbursement for health maintenance organizations (HMOs), which became part of the act.

• Formalizing Equal Employment Opportunities (EEO) and Affirmative Action practices in the 1960s and 1970s. Opening a Kaiser Permanente EEO conference in 1976, Vohs reaffirmed Kaiser Permanente’s commitment to the employment of minorities and women. He reported an increase of minority and women employees from 4,600 in March 1974 to 5,084 a year later, almost one third of the total work force at the time. Women held 56 percent of the management or supervisory positions in 1975, up 2 percent from 1975; minorities held 14 percent of the top jobs in 1975, compared to 13 percent a year earlier.

Vohs affirmed KP’s historical “one-door, one-class” system of health care dating back to 1945. “Each member is entitled to necessary medical care of the same quality, in the same place, irrespective of income, race, religion or age. Given this policy, it would make little sense if we were to discriminate in our employment practices.”

• Partnership and eventual takeover of the Georgetown Health Plan strategically located in Washington, D.C. This medical care program provided the springboard for the creation of our Mid-Atlantic States region.

• Convening a meeting among health plan and medical group leaders in 1996 to re-confirm the principles of the historic 1955 Tahoe Agreement. The earlier agreement set up the business relationship and clear authorities for the Kaiser Permanente Health Plan and Hospitals leadership and the Southern and Northern California medical groups. Forty years later, the outcomes of “Tahoe II” were the National Partnership Agreement and the creation of the physicians’ Permanente Federation, which represents all regional medical groups in dealings with the health plan leadership.

Kaiser Permanente on a mission

An able administrator, Vohs believed in the health plan: “There was a sense of commitment to a program that was performing social good and demonstrating a way of providing care and financing that was important to the country.”

Vohs firmly dispatched any insinuation that Kaiser Permanente was like for-profit health plans: “Over the years, Kaiser Permanente has been driven by particular values that essentially relate to providing quality medical care to enrolled members for a fixed monthly premium. We don’t conceive of ourselves as a commercial enterprise,” Vohs told John K. Iglehart of Health Affairs in 1983. Quoted in a New York Times article “King of the HMO Mountain” the same year, Vohs added: “There’s a certain missionary zeal in what we’re doing. We think this is a good model for the way in which medical care ought to be organized – so we want to see it spread.”

The Southern California Region’s Proactive Office Encounter (POE), which promotes preventive care, and the California regions’ programs to prevent heart attacks and strokes, were awarded the 2009 Vohs Awards earlier this year. The Fall 2010 issue of the Permanente Journal carries an article about the POE.

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Climb the gangplank to learn about World War II’s social legacy

posted on March 13, 2010

 

Photo courtesy of Red Oak Victory

By Ginny McPartland
Heritage writer

If you grew up in the Bay Area, or anywhere in America for that matter, you’re missing the boat if you haven’t been out to experience the Red Oak Victory ship docked on the Richmond waterfront.

Granted it’s difficult to find, and in fact, you may never have heard of it. Not to worry, most people haven’t yet visited the Rosie the Riveter National Park where the ship is found.

The Red Oak Victory, built in the Kaiser Richmond shipyards in 1944, is a huge hulk of seaworthy steel that embodies a million stories pertinent to our society’s past.

The ammunition ship, saved from scrap in 1998 by the Richmond Museum of History, serves as the chief artifact of the home front city’s museum collection. Volunteers have renovated much of the ship, which carried essential cargo for battles in World War II, Korea, and Vietnam. www.ssredoakvictory.com

Richmond, and other Bay Area shipyards, figured fantastically in WWII home front America. The Bay Area was radically changed forever by the phenomenal influx of 200,000 shipyard workers and their families from around the nation. Every type of individual was represented in the newly configured social structure of California.

The legacy of World War II’s sociological impact is fully explored and documented in books and other items in the Red Oak’s museum gift shop. Notable examples are: “To Place Our Deeds” by Shirley Ann Wilson Moore; and “World War II Shipyards by the Bay” by Nicholas A. Veronico.

Red Oak's main mast

Red Oak’s main mast

Just a few changes nudged by the war: Women working with men in industrial settings for equal pay; blacks and minorities working with whites for comparable pay; the emergence of professional child care centers; employment for the disabled; and affordable prepaid preventive health care provided by employers.
The medical care program started in the wartime shipyards lives on as Kaiser Permanente and is well documented in Tom Debley’s book “Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” published in 2009 by Permanente Press.

Changes in the status of women and minorities largely reverted after the war, but the seeds were deeply planted for the civil rights and women’s liberation movements of the 1960s.

Now for my confession: I grew up in Richmond, and I had never seen the shipyards or the Red Oak Victory until recently. My first visit to the floating museum was only a few weeks ago. Bay Area Historian Steve Gilford, a director on the museum board, gave me two tours of Shipyard 3 and the Red Oak. My eyes were opened to the treasure that is preserved in the depths of this honey-combed hunk of war grey welded and riveted steel.

The ship experience starts with a climb up the gangplank, a portable, suspended aluminum staircase to the main deck. From there, you step over the raised rims of the hatchways and navigate steel ladders to the various compartments of the midship house and the deckhouse. Down from the main deck you’ll find the museum, gift shop, and meeting room in a cleaned-up cargo hold.

Red Oak’s industrial mixer for batter

One cheery way to introduce yourself to the historic waterfront is to partake of the $6 pancake breakfast offered on the Red Oak Victory once a month from April to October. The first one for 2010 is April 11.

To get to the Red Oak Victory, take I80 to 580 West. Stay on the freeway past the Rosie the Riveter park exit and take Canal Boulevard instead. Follow Canal all the way to the bay and wind your way through the industrial area to Berth 6A.

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Richmond Shipyard Workers Suffered Their Own Casualties of War

posted on September 4, 2009

In 1942, eighteen year-old Lucille “Penny” Price joined the shipyard workforce with little idea what lay ahead for her. Read on to hear a poignant account of what those days were like and the daunting challenges Penny faced.

Building warships was a dangerous enterprise. Workers in the Richmond shipyards during World War II learned the hard way how easy it was to be injured when working at a furious speed to fulfill orders for sorely needed war vessels.

Richmond shipyard workers 1943

Richmond shipyard workers 1943

The odd mix of people who converged at the Kaiser shipyards added to the complexity and worry associated with the safety of workers of all levels of skill and socialization. The majority of them had little or no experience building ships.

There were black and white men and women from the agrarian southern states and other parts of the country. There were native San Francisco Bay Area women and men. There were men who had medical conditions that totally disqualified them from serving in uniform (Class 4F). There were handicapped workers.

Risky Business
Injuries minor and major were common. In fact, working in a shipyard was one of the most dangerous jobs in the wartime industries, more risky than the manufacture of tanks, aircraft, and explosives. The shipyards of America reported an average of 33 disabling injuries per million hours worked in 1943. (This compared favorably to the iron and steel foundries whose average accident rate was 40 injuries per million hours worked.) About 700 shipyard workers were killed during 1943 and 1944 in accidents in the nation’s shipyards.*

Some injuries were purely accidental, some were from carelessness, and others were simply vicious.

“It Wasn’t All Beer and Skittles…”
An eighteen-year-old Oakland girl, Lucille “Penny” Price, joined the shipyard workforce in October 1942. She made good money as an electrician and considered the wartime work a great opportunity. She sums up the experience in this casual understatement: “It wasn’t all beer and skittles.”**

Price, an electrician in Yard 3, was almost scared away from the shipyards when she witnessed a fatal accident on her first night of work. A guide was taking a group of new employees, including Price, on an orientation tour when they heard “beep, beep, beep,” the sound of a crane in motion. “The guide was telling us that when you hear that sound you get the heck out of the way and stay away,” Price recalled. But some other workers didn’t heed the warning sound, and as the crane lifted a heavy sheet of steel aboard a ship, one of the cables broke and the load slipped and killed several of them.

“I tell you I was ready to run, and so were the other people in our group of electricians,” she said.

Price was quickly reassigned to the relative safety of the electrical shop to give her time to get over the shock. She stuck it out and by Christmas was wiring C-4 transporters and LSTs (landing ship, tanks) and continued to work in the yards until early 1945. During her tenure there, she would experience many injuries herself.

Threatened by Male Counterparts
Now 84 years old and living in Windsor, Calif., Price recalls the time a “chauvinist” kicked a ladder out from underneath her and caused her to fall over a stack of pipes. The man who made her fall was fined and fired, never to work again in the shipyards. Penny was taken to the shipyard Field Hospital where she was treated for two cracked ribs.

Price also recalls that men also liked to sneak up on her while she was working from a plank stretched across the open deck with six floors below. “They’d make the board vibrate and that scared the hell out of me.”

Male shipyard workers’ poor treatment of their female counterparts was not uncommon. “When women managed to enter jobs that seemed still to be the prerogatives of men, they were sometimes mistreated; “harassed” is the word we would use nowadays,” said Columbia University professor http://www.columbia.edu/cu/history/fac-bios/Kessler-Harris/faculty.html Alice Kessler-Harris in an interview on PBS.

“Men often played tricks on women by sending them for tools that did not exist. Men also sexually harassed women by whistling and cat-calling to them as they worked. Most of the resistance and hostility towards women workers disappeared as the novelty of women workers wore off, the labor shortage got worse, and women proved themselves, according to Susan M. Hartmann, http://history.osu.edu/people/person.cfm?ID=695 author of The Home Front and Beyond: American Women in the 1940s.

Victim of Double Pneumonia—Before the Days of Penicillin
Penny Price was also a victim of double pneumonia that developed after she was caught in a dark corner on the same level as a dozen hostile workmen during an air raid warning drill. Price had been doing some wiring by herself above the shaft alley when the “whoop, whoop” of the siren came and the lights went out. She huddled in a space near a boiler for two hours, shaking with fear as the burly workers made comments like: “Wait ‘til I get my hands on that little chick over there.”

Lucille "Penny" Price 1943

Lucille "Penny" Price 1943

When the drill was over, her leaderman, Charlie Ryder, swooped her up from the spooky pit. She couldn’t stop shivering, so her coworkers gave her coffee to warm her up. “To this day, I can’t stand the smell of coffee with cream in a paper cup.” She “upchucked” the coffee that night at home and returned to work the next day thinking she was fine. But the shaking returned, and she was taken to the field hospital where they took a chest X-ray and diagnosed double pneumonia.

This was in March 1943 before penicillin was available to civilians. At the Oakland hospital where our doctors were perfecting the treatment of pneumonia, she was given a “horrendous” clear liquid (probably horse or rabbit serum) every few hours. That liquid along with oxygen therapy cured her of the mysterious pneumonia.

Penny Price today

Penny Price today

During the war, Permanente physician Morris Collen experimented with the treatment of pneumonia as he managed a large number of shipyard cases. By the end of the war, Collen had published his findings and earned a national reputation as a pneumonia guru. His prestige was such that he was able to get some of the first civilian penicillin in 1944 to save the lives of the 7-year-old daughter of a shipyard worker in Vancouver, Wash., and a young man in a Richmond yard.

Hospital Visits—Much Too Frequent
Throughout her time at the shipyards, Penny Price was injured numerous times and was a frequent visitor to the First Aid Station and the Field Hospital. “I was in and out of the Field Hospital like a yoyo,” she said. She frequently cut herself using a linoleum knife to cut electrical cable. She vividly recalls the inside-out eyelid treatment administered when she got bits of steel mesh from the cable in her eyes. She also recalls that when working around fiberglass she sometimes got particles down her neck that irritated like a thousand flea bites.

Her most serious injury was caused by an accidental explosion that knocked her down from the ship’s superstructure onto the deck below where workers were using acetylene torches to shrink the deck. As a result of the fall, she suffered burns and an injury to her knee when it struck a bolt on the deck. She was burned so badly that she had to return for treatment for nine months before her leg was healed. “I still have scars on my leg to this day,” she said. She returned to work after a short hospital stay wearing a splint on her knee wound.

Price remembers an inspector coming around to urge the workers to follow the Maritime Commission safety rules to avoid injuries. “He’d show us a glass eye and say ‘do you want one of these?’” We’d shudder, and he would say: ‘then, wear your goggles!”

Safety Program Launched in 1943
In 1943, the U.S. Maritime Commission launched a safety program that ultimately reduced the injuries per million hours worked in the shipyards to 23.2 in 1944. “The work of the (commission) was of value in two ways – by allaying fears that working in a shipyard was more dangerous to life and limb than working somewhere else, and by making this true through insistence on a high standard of protection and precaution,” wrote Frederic Lane in his 1951 book Ships for Victory.

*Of the 655 reported private shipyard fatalities in the nation during 1943 and 1944, vehicles or loads striking workers was the second most common type of accident (25 percent) after falls (39 percent). Half of the “strike by” accidents involved cranes.

**’Beer and skittles’ is shorthand for a life of indulgence spent in the pub. Skittles, also known as Ninepins, which was the pre-cursor to ten-pin bowling, has been a popular English pub game since the 17th century. This definition is according to the Phrase Finder, a United Kingdom Web site: www.phrases.org.uk/meanings/230200.html.

– Ginny McPartland

You can watch a lecture about Dr. Sidney R. Garfield’s long quest for health care reform by Tom Debley to the Commonwealth Club of California.

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