Posts Tagged ‘Jim Vohs’

Brisk daily walks keep retired KP CEO Jim Vohs in the pink

posted on September 21, 2012

By Ginny McPartland
Heritage writer

Jim Vohs created this outdoor portrait of his red-headed grandsons in the autumn red leaves in his front yard. This framed portrait hangs in his home.

I had the pleasure one day this summer to take an early morning brisk walk with Jim Vohs, retired Kaiser Foundation Health Plan and Hospitals CEO. Formerly a marathon runner of some note, Vohs enjoys the physical benefits of walking, as well as the time it affords him for reflection. He subscribes to KP CEO George Halvorson’s belief in the power of walking. “Every Body Walk!” is the mantra of Halvorson’s current campaign to get people moving.

I had heard through the grapevine that Vohs, who retired in 1991 and is in his 80s, was an avid walker. So I called to see if I could talk to him about his daily walking routine. He invited me to walk with him at 7 in the morning a few days later. On the phone, I asked: “What if I can’t keep up with you?” He said: “I can adjust to your pace.”  OK! I was up to it.

I met him outside his Piedmont home at the appointed hour. The charming gentleman came out of the gate wearing beige casual pants, white walking shoes, a stylish sweatshirt – and a nice, welcoming smile. My first time to meet him was smooth and relaxed. We began to walk the gentle hills around his neighborhood at a clip talking as we went. He shared with me his thoughts on retirement, his time as leader at Kaiser Permanente, and his views on exercise.

This cartoon appeared in Harper’s in December 1978. Fun-loving friends added “J.V.” to the male jogger’s shirt and presented their version to Vohs. Cartoon and prayer by famed writer of “The Right Stuff (1983)” and “Electric Kool-Aid Acid Test (1968)” Tom Wolfe.

He confided that he used to look down his nose at walkers, considering them “wimps” who weren’t serious about their fitness. He later showed me a cartoon from Harper’s magazine featuring a runner with the initials “J.V.” on his chest who recited Tom Wolfe’s “The Joggers’ Prayer”:

“Almighty God, as we sail with pure aerobic grace and striped orthotic feet past the blind portals of our fellow citizens, past their chuck roast lives and their necrotic cardiovascular systems . . . past their inability to achieve the White Moment (jogger’s high) or slipping through The Wall . . . help us . . . to be big about it.”

Today, however, Vohs has changed his mind and believes walking can be the best kind of exercise, indeed for everyone. “What are the benefits of walking for you? I ask him. “Everything that George (Halvorson) says in his missive on walking,” he replies, referring to Halvorson’s weekly letters to KP colleagues.

The number of benefits of walking 30 minutes a day is astounding. They include: lowering the risks of diabetes, stroke, hypertension, breast cancer and its recurrence, colon cancer, prostate cancer, hip fracture and gallstones. Such a regimen can also boost high density cholesterol, lowering the risk of heart attacks and stroke.  Walking helps people to lose weight and makes them feel better psychologically. The list goes on and on.

After our 30-minute walk, we returned to the Vohs home, and he invited me in for breakfast and to meet his wife, Eileen. The fare consisted of decaffeinated coffee, bananas, blackberries, yogurt and muesli. Basically, very healthy, it goes without saying.

The display case for Vohs’ KP service pins was also made of Koa wood by his Hawaiian friend. Koa wood, found only in Hawaii, is prized for many uses, including fine furniture and guitars.

Jim Vohs was the CEO of Kaiser Health Plan and Hospitals from 1975 to 1991. He is credited with many accomplishments at the helm of KP, including initiating an active Board of Directors Quality of Care Committee, expanding the Health Plan into new geographical regions, supporting a rigorous Affirmative Action policy, and defending the core values in times of change. The annual Vohs Award for Quality was established in his name when he retired in 1991.

In reflecting on his KP career, Vohs says he wishes he would have thought of the health plan’s current focus on healthy lifestyles as exemplified by the Thrive advertising campaign, started in 2004. He was  opposed to advertising when it was first suggested in the 1980s because he did not want the not-for-profit Kaiser Permanente viewed as just another commercial organization and says he only agreed to it if the people featured in commercials were actual KP members or staff.

Keeping KP from becoming a commercial enterprise was a no-brainer for him. “We started out as a nonprofit organization providing care that people could afford. I fought against us becoming a profit-making business. That’s not who we were (are).”

Mail Room Clerk Travis Bailey and KP President Jim Vohs show off the March of Dimes TeamWalk trophy — a bronzed shoe worn by baseball star Willie McCovey — from 1985. KP Reporter cover photo by Jaime Benavides, July 1985.

While KP CEO, Vohs was heavily involved with local communities and charitable organizations and urged KP staff across the regions to participate in public events.  In 1985 and 1986, he served as Alameda County chairperson for the March of Dimes’ TeamWalk and marshaled 900 KP walkers in 1985 and 1,000 in 1986.

With Vohs in the lead, the KP team raised $35,000 in 1985 and $60,000 in 1986. Vohs is quick to note that the March of Dimes walk – 32 kilometers for more energetic participants – wasn’t a promotion of walking. “That was different. We were walking to raise money, not for fitness.”

The KP walking team attracted staffers from all over Northern California. As the top team, KP won the traveling trophy, which was a bronzed shoe originally worn by baseball star Willie McCovey. “Once again we proved we’re number one.” Vohs said at the time.

Of his athletic pursuits, Vohs is most proud of his success as a marathon runner. He competed in the Avenue of the Giants 26-mile marathon, which only accepts 1,000 qualified runners, and two full-length Oakland Marathons when he was in his 50s. He stopped running a few years ago when he developed plantar fasciitis, a condition affecting his feet. He continues to play golf, walks the course and carries his own bag.

This clock of Koa wood was made for Vohs by a friend and Hawaii Permanente Medical Group physician. He treasures it and keeps it on display in his study.

After retirement, Vohs maintained a KP office for about five years and continued his participation on a number of boards, including the Federal Reserve Bank in San Francisco, the Oakland Coliseum, Holy Names College and the Oakland Port Commissioners. “My wife (Janice) said I failed retirement,” he offered, half joking. “She said it was like I was still working because I went into the office every day.”At a certain point, he vacated the office to spend more time at home.

Vohs has four daughters, among them a couple of runners who have entered the Bay to Breakers with him over the years.  He also has nine grandchildren. Grandpa Vohs snapped a beautiful photo of two of his grandsons playing in the autumn leaves in a season that has long passed. The boys’ thick red hair blends with the leaf baskets’ contents to create an impressively artful photograph. Vohs has a large framed print of the scene hanging in his family room.

In his study, Vohs displays two special mementos from his KP days – a hand-crafted clock and a display case for his service pins, both made of Koa wood by a Hawaii Medical Group physician and friend. The case shows all his pins from his Kaiser Permanente career under glass. The last one marks his 40 years with the company.

 

Vohs and his boating friends have a running joke about this papier mache-covered shoe and the memory of a mishap when their boat was swamped.

Another prized object is a tennis shoe preserved with papier mache to remind him of a water excursion with friends that ended with a swamped boat. He and his fellow boaters have a running joke that involves sneaking the shoe back into each other’s possession.

Sadly, Vohs lost his wife of almost 50 years to cancer about 10 years ago. He remarried recently after renewing his acquaintance with Eileen Galloway, a college friend, at a UC Berkeley alumni reunion. Eileen sometimes walks with Jim, but mostly she likes to walk later in the day and a bit slower.

“I want to enjoy myself and appreciate my surroundings,” she said. “And I don’t want to get out of bed at dawn.”

http://bit.ly/OJODcQ

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1990s begin with supercharged Kaiser Permanente quality agenda

posted on March 28, 2012

By Ginny McPartland
Heritage writer

Fifth in a series

Many KP physicians round out their experience with community service. Eimear Kennedy, MD, KP Georgia, volunteered for an AIDS clinical research project in Atlanta. 1988 Kaiser Permanente Annual Report photo

If the 1970s and 1980s brought a quality of care frenzy, circumstances in the 1990s conspired to create a veritable quality tsunami. Health care leaders reacted dramatically to a 1989 paper by industrial quality guru Donald Berwick and began to second guess health care reformers in Washington. Realizing their survival was at stake due to market pressures and government and employer demands for quality data, physicians and other health plan leaders dove head first into the quality quagmire.

Berwick’s message was revolutionary. His call to action was to take away the punitive side of quality review and bring all medical disciplines into a discussion of how to improve care processes and thus ensure better quality. Berwick’s influence was to abolish “The Theory of Bad Apples” in quality assurance and replace it with “The Theory of Continuous Improvement.”

Stepping Stones to Quality, cover of the KP employee magazine Spectrum, Summer 1991

Berwick, a physician in the Harvard Community Health Plan, had gotten his inspiration from Japanese industrial quality experts. Their carefully defined philosophy called “kaizen” led Japan to high quality factory production success. “An epigram captures this (Japanese) spirit: ‘Every defect is a treasure.’ In the discovery of imperfection lies the chance for processes to improve,” Berwick wrote in the New England Journal of Medicine Jan. 5, 1989 edition.

He adds: “Quality can be improved much more when people are assumed to be trying hard already, and are not accused of sloth. Fear of the kind engendered by the disciplinary approach poisons improvement in quality, since it inevitably leads to disaffection, distortion of information, and the loss of the chance to learn.”

Flawless care requires support for decisions

Physicians rely on a support system to carry out high quality health care, Berwick noted. “Flawless care requires not just sound decisions but also sound supports for those decisions . . . In hospitals, physicians both rely on and help shape almost every process pertaining to patients’ experiences, from support services, such as dietary and housekeeping, to clinical care services, such as laboratories and nursing. Few (processes) can improve without the help of the medical staff.”

Cover of the Quality Agenda in Action, 1992

Berwick urged significant investment in assessing and improving quality of care. “In other industries, quality improvement has yielded high dividends in cost reductions that may occur in health care as well. . . The most important investments of all are in education and study, to understand the complex production processes used in health care; we must understand them before we can improve them.”

With Berwick’s message ringing in their ears, Kaiser Permanente leaders jumped into high gear. In September of 1990, the Kaiser Permanente Committee embraced Berwick’s bold new approach, which had been dubbed “TQM,” for Total Quality Management. At the same time, the Joint Commission on Accreditation of Hospitals also adopted TQM principles in its reviews.

Vohs and Lawrence put force behind the Quality Agenda

In 1991, Jim Vohs, chairman of the board, and David Lawrence, MD, vice chairman and CEO, launched the Quality Agenda, an ambitious, all encompassing plan of attack to improve quality across all KP regions, involving all levels of the organization.

The 1991 Annual Report, titled the Quest for Quality, was devoted to chronicling the TQM phenomenon and explaining its genesis and hope for the future. The report acknowledged the work done previously by pioneers Sam Sapin, MD, and Leonard Rubin, MD, but declared the need to step it up:

KP Quality Agenda graphic emphasizing improvement as a key step in the quality assurance process, 1992

“The role of quality assurance historically has been to identify problems within the system,” explained Susan Leary, director of quality assurance in the Program Office. “But with TQM,” she says, “we’re given new empowerment to go out and get involved in the planning process and to make system-wide changes once those problems are identified.”

A 53-page binder produced at the launch of the Quality Agenda defined the campaign as “A Roadmap for the Future.”  The guide was to speed up KP quality improvement efforts and to intensify efforts to share good ideas and innovations across the regions.

The campaign emphasized the need to get all employees to understand and take part in quality initiatives. The roadmap outlined five specific tasks: 1) creating of a positive work environment; 2) measuring what we do; 3) improving what we do; 4) developing new approaches; and 5) telling our story.

KP’s first program-wide Total Quality Management conference

In 1992, the first annual interregional conference on Total Quality Management featured workshops conducted by Don Berwick, MD; Brent James, MD, renowned quality improvement expert and statistician of Intermountain Healthcare in Utah; and David Eddy, MD, the man who invented the computer model that could compile a wide range of health data and simulate a realistic clinical situation.

Article in 1991 Spectrum magazine about David Eddy, MD, hired by KP to help discover which treatments would have the best outcomes.

Eddy was hired by the Southern California Permanente Medical Group in 1991 to use clinical research data to evaluate the benefits and harms of different clinical interventions. Eddy compiled actual patient outcomes and ascertained which treatment would likely bring the desired results.

“One treatment (for lower back pain) might have a 30 percent chance of returning a patient to work, while another has only a 10 percent chance,” Eddy said. “But the first treatment might have greater risks. How do we decide if the greatest benefits of the first treatment are worth the risk? To determine this, we’d like to ask patients what they prefer. They’re the ones who will live or die by these decisions.”

Physicians need help synthesizing complex medical research

From his research, Eddy set up a system to develop clinical guidelines or best practices to help physicians with decision making. “It’s simply unrealistic to think individuals can synthesize in their heads scores of pieces of evidence, accurately estimate the outcomes of different options, and judge the desirability of those outcomes for patients,” Eddy wrote in a 1990 article for the Journal of the American Medical Association.

In 1993, Lawrence published the Quality Agenda in Action, a report on quality initiatives across the program. Highlights included KP’s work with HMO groups and six large employers to develop the HEDIS (Health Employer Data and Information Set) quality measures and specific data collection methodologies for various treatments and preventive screenings.

"How we're learning from each other" was the theme of the Spring 1992 Spectrum magazine.

The update also called out the Northern California Permanente Medical Group for its own launch of a program to establish best practices, vetted through research, and to implement and evaluate them. The Interregional Nursing Task Force brought together nurses from all regions to set up a system of best nursing practices.

A five-year study conducted by Southern California concluded that normal childbirth after a Caesarean section was possible and safe; while another study of 2.5 million patients in Northern California showed that screening for rectum and distal colon cancer with sigmoidoscopy decreased the rate of death from these conditions by 60 to 75 percent. In all, more than 350 TQM projects had been launched across KP’s 12 regions in the four years prior to the publication of Lawrence’s report.

Next time: How do physicians know they’re doing the right thing?

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Kaiser Permanente’s early struggle to stand up to AIDS

posted on December 2, 2011

This illustration of a Kaiser Permanente physician with an AIDS patient was originally published with a 1988 article about AIDS and medical ethics in in-house publication, Spectrum.

Lincoln Cushing
Heritage writer

 

How did Kaiser Permanente, one of the nation’s largest not-for-profit health plans, deal with the outbreak of a new and unpredictable disease? Depending on who was talking in the 1980s, that answer ranged from “not nearly well enough” to “better than any other provider.” And both were true.

The epidemic appears

AIDS was first reported in the summer of 1981. The next year, when the Kaiser Permanente San Francisco Medical Center began treating its first patients, diagnosis and treatment protocols were in their infancy. Doctors, nurses, administrators, and other caregivers struggled to know what to do.

Sometimes standard procedures worked fine, other times they were inadequate. One early conflict erupted in 1983 when two nurses at a Santa Clara, Calif., hospital (not a Kaiser Permanente facility) resigned over a dispute regarding caregiver safeguards in that facility’s first AIDS case. “I think most nurses would agree. . . There really isn’t anyone who wants to go in the room,” one nurse said.

However, the president of the Registered Nurses Professional Association concluded that “enough precautions are being taken” per the hospital’s AIDS guidelines. 1

At Kaiser Permanente  San Francisco, Infection Control nurse Barbara Lamberto described Kaiser Permanente’s response:

“We called a department head meeting immediately [and] we talked about our personnel policies and our posture about that kind of situation, and I think in the long run it made a difference because everybody knew [that] this is how we felt. We are a health care organization. We are here to care for patients.” 2

Michael Allerton, Operations and Policy Practice Leader for The Permanente Medical Group, describes the situation as he saw it: “Here was a disease that was invariably fatal, in a horrible way, and nobody knew where it came from, how it was transmitted. . . and in this incredible environment of fear and anxiety, our doctors walked in those rooms. Our nurses walked in those rooms. Our engineers went in to fix TVs. We had people who really rose to the occasion.” 3

The lack of solid data compounded treatment of “the mysterious disease” in unexpected ways. In a 1985 interview, Kaiser Permanente San Francisco RN Grace Rico-Peña explained the challenge in the early years:

“This is very different than any other illness we’ve needed to educate about. We’re trying to dispel myths and rumors. When news media reports stories about AIDS they have a certain bias — they want to make things seem a little more dramatic, a little more exciting, and so they highlight certain parts of the story and get everybody all charged up about it.

“There are a lot of people with crazy ideas about AIDS. I remember one story about a bus driver who didn’t want to take money when he was in the “gay areas,” people who don’t want to wait on people. That’s part of our getting sensitized and taking care of these patients. AIDS patients frequently become social lepers.” 4

She describes how Kaiser Permanente responded with reason and balance:

“Our philosophy in our educational approach, which has been dictated by our top level administration here in Epidemiology, has been to not let ourselves get carried off into emotion, or political controversies, but to educate very solidly along the lines of the information that’s known. We’ve done educational programming always on the facts. [We ask] “What are our patients’ needs, how are we going to meet those needs?”

Tom Waddell, MD, Olympic decathlete, SF physician, AIDS patient, and activist for better medical care for people with AIDS, 1987.

Patients get involved in care

And, as is true with all quality care, part of the solution came from the patients themselves. Tom Waddell, Olympic decathlete and a physician at San Francisco General Hospital’s emergency department, was diagnosed with AIDS in 1986.

Initially publicly critical of the treatment of AIDS patients at Kaiser Permanente  San Francisco, he fought for better care. “I made a lot of noise,” he said. Other patients did so as well. On June 8, 1988, the Kaiser Patient Advocacy Union (with the suitably explosive sounding acronym “K-PAU”) was formed, demanding a voice in a range of issues. This was a life-and-death issue, and emotions flared.

But, as Dr. Waddell later admitted, “Much to Kaiser’s credit they responded.  I think they may now have a model program for treating AIDS patients.” 5 It was clear that motivated, informed patients needed to be part of the solution.

An HIV Support Group Program was established in 1988 at Kaiser Permanente  San Francisco, and the next year a system-wide Kaiser Permanente  HIV Member Advisory Panel was formed. In 1998, Kaiser Permanente hired the top San Francisco HIV specialist, Dr. Stephen Follansbee.

Documentary highlights Kaiser Permanente’s central role

In the year 2000, Critical Condition, an independent three-hour documentary about the politics of managed care, observed this high-stakes match between institution and critics. One segment included footage of AIDS activists picketing Kaiser Permanente, angry that it moved slowly and would not prescribe medication other than standard and approved drugs. 6

Tensions were high and tempers flared, but the strategic choice of Kaiser as a target was revealing:

“We only picketed Kaiser — not because it was the worst but because you knew where Kaiser was.  It’s like the big kid on the block.  If you can bring that kid to his knees, the others are going to get in line also.” 7

Another protestor reflected on the choice: “Do I think those protests were effective?  Absolutely.  I think it slapped Kaiser in the face and I think Kaiser stood up to it and said, ‘Okay.  What can we do here?’ ”

A third activist agreed: “The fact is we still have to acknowledge that Kaiser is the only HMO that I know of that’s ever allowed the members to come in and be part of the process.” 8

The strength of many

The San Francisco Bay Area quickly became one of the national centers confronting the epidemic. By 1989 two cities (San Francisco and Oakland) accounted for 67% of the region’s cases.  But other Kaiser Permanente regions were affected as well and mounted their own responses.

In 1989 Kaiser Permanente Colorado created an AIDS-specific social services program to help patients manage their own care, led by Barry Glass.  Glass’ holistic model proved so effective that it was extended into other areas, including care of the elderly and those with catastrophic illness. Broader health care lessons were being learned.

Some answers were found through the strength of massed medical resources. In 1987 Kaiser Permanente established a multidisciplinary Interregional AIDS Task Force, expanding to an Interregional AIDS Committee the following year.

James Vohs, Kaiser Permanente health plan and hospital president and CEO in the 1980s, reflected on that process: “One of the best interregional committees that we established was in response to the AIDS epidemic. It was an excellent way to educate our other regions on the basis of the experience that we had in Northern California, especially because we had so many AIDS cases.

“Kaiser covered something like 2 percent of the population of the United States when I was there, but we had about 5 percent of the AIDS cases. . . Having the Interregional AIDS Committee was very, very helpful in providing a good knowledge base of what was working, what wasn’t working, and how to organize services. It was extremely successful.” 9

Kaiser Permanente continues to lead

Kaiser Permanente Educational Theater actors rehearse scene from 1989 Bay Area production of “Secrets,” a play about HIV/AIDS.

At the 30-year anniversary of the first diagnosis of the mysterious disease, Kaiser Permanente continues to be a leader in AIDS treatment and research, and in partnering with community-based efforts. Kaiser Permanente Southern California has provided grants totaling over $4 million to nonprofit organizations for a variety of services for people living with HIV and AIDS, including dental care, youth education and screening programs.

The nature of the epidemic has changed, but the work remains, and Kaiser Permanente has demonstrated its commitment to applying the full weight of its health care resources to finding solutions.

Learn more about Kaiser Permanente’s response to the AIDS epidemic at the Center for Total Health.


1 Spokane, Washington Spokesman-Review, June 12, 1983.

2 Transcript from Kaiser Permanente video interview, 3/1985; HIS07-508

3 Kaiser Permanente: 30 Years of HIV/AIDS with Coordinated Care, Compassion, and Courage, video produced by the Kaiser Permanente BSCPR Department winter 2011.
http://www.youtube.com/watch?v=LnXEseA4HwI

4 Transcript from Kaiser Permanente video interview, 3/1985; HIS07-509

5 Article in Spectrum, Summer 1987, p. 7.

Jay Lubbers, from film transcript, available at http://www.hedricksmith.com/site_criticalcondition/index.htm

7 Dave Mahon, from film transcript, ibid.

Mr. Sokolksi, from film transcript, ibid.

James Vohs interview, courtesy of Regional Oral History Office. The Bancroft Library. University of California, Berkeley. Berkeley, Calif., 94720-6000; http://bancroft.berkeley.edu/ROHO
http://content.cdlib.org/view?docId=hb8t1nb3kr&brand=calisphere“Ascending the Ranks of Management, Kaiser Permanente Medical Care Program, 1957-1992,” by Vohs, James A.; Malca Chall, editor,1999 (issued)

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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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