Posts Tagged ‘medical research’

Kaiser Permanente and UC enjoy common ground over decades

posted on October 3, 2013

By Lincoln Cushing, Heritage writer

Kaiser Permanente Marching Song

Jack Chapman, Kaiser Permanente Northern California Region’s director of education, adapted UC’s “Big C” fight song in 1972 to apply to the Health Plan.

Kaiser Permanente and the University of California are two major California-based institutions that share a long history of partnership. The collaboration started right after World War II with UC securing Health Plan coverage for its employees beginning in 1945, the year the plan opened to the public.

From the beginning, Permanente physicians joined UC for many medical research projects, and over the decades many have taken on professorships at UC campuses in Northern and Southern California. By all accounts, the partnership has been a fruitful one.

Professor touts KP care

A 1949 feature story in the Kaiser Permanente member newsletter Planning for Health pointed out that the University of California was the Health Plan’s fourth largest group, starting in 1945 with 59 members and reaching 1,961 members by 1949.[i]

The article included an interview with electrical engineering professor Charles F. Dalziel and his wife, who were early members of the university plan.

“During much of the period the family have been members of the group, Mrs. Dalziel has had many opportunities to evaluate the Plan in action. Like so many otherwise healthy children, their charming daughter, Isabelle, aged 8, is allergic.

“Mrs. Dalziel is enthusiastic in her comments on the results Permanente doctors have achieved in determining the child’s allergies and combating them,” the interviewer wrote.

Permanente educator adapts UC fight song

In 1972, Kaiser Permanente’s Jack Chapman wrote the “Kaiser-Permanente Marching Song,” an authorized adaptation of the UC Berkeley athletic fight song “The Big C.” Chapman was the first Kaiser Permanente Walnut Creek hospital administrator and later the Northern California regional director of training and management development.

Chapman’s first two lines:

“We are Kaiser-Permanente, finest plan in all the land
K-P stands for qual-i-ty and doing all we can.”

UC graduates lead Health Plan

"University of California is our Fourth Largest," Planning for Health, 1949-04Notable UC alumni include Eugene Trefethen, Jr., longtime Kaiser Industries president, James Vohs, longtime Health Plan president, Henry J. Kaiser’s son, Edgar F. Kaiser, and many others.

Edgar spent 3½ years at UC Berkeley majoring in economics. But in 1930, one semester short of graduation, he quit college and headed for Texas where he had been offered a chance to work as a pipeline construction superintendent.

His father gave him his blessing. “I talked it over with my father,” he once recalled, “and we agreed that I had learned about as much as I could in college, and that two months more of class work would not matter.”[ii]

Physicians join university faculty

Many Permanente physicians have associated with UC to teach and conduct research on various campuses. Morris Collen, MD, taught a public health course at UC Berkeley. Mark Binstock, MD, MPH, a Kaiser Permanente physician at Woodland Hills, was an assistant clinical professor at the UC Los Angeles School of Medicine in the 1990s. Monte Gregg Steadman, MD, was a lecturer at UC San Francisco.

UC Berkeley’s venerable Bancroft Library houses the Henry J. Kaiser Papers collection, a massive trove of Kaiser’s personal and business correspondence, memoranda, speeches, and papers. Kaiser’s documents from his Oakland, New York, and Hawaii businesses, principally from the period after World War II, are archived at the Bancroft.

The collection includes material on the Kaiser Industries corporation, the Kaiser Permanente Medical Care Program, the Kaiser Shipyards at Richmond, Calif., and other Kaiser industries.

UC’s Bancroft archives Health Plan pioneers’ interviews

UC Berkeley’s Regional Oral History Office staff has interviewed dozens of Kaiser Permanente pioneer physicians, administrators, and board members to document their roles in the development of this innovative health maintenance organization.

The initial interviews were conducted between 1984 and 1999 as the series: “History of the Kaiser Permanente Medical Care Program—Founding Generation.” A second series of interviews started in 2005 to look at Kaiser Permanente and the transformation of health care in the U.S. from 1970 to present.

 

Short link to this article: http://ow.ly/pvoLk



[i] “University of California Is our Fourth Largest,” Planning for Health, April 1949[ii] Obituary, New York Times, December 13, 1981

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Quality of care: Always foremost in minds of Kaiser Permanente leaders

posted on February 29, 2012

By Ginny McPartland
Heritage writer

First in a series
In the beginning of the modern era of medicine there were doctors and patients.  To judge the quality of care was to ask: Did the patient live? Is the patient thriving? Doctors had little science to back up their methods. They followed conventions and did what they thought was best for the patient. If a doctor went wrong, no formal mechanism existed to correct his (or her) ways.

Hard to imagine how we got from such early simplicity to today’s complicated state of quality affairs. Our 2012 definition of quality encompasses a myriad of considerations:  timely access to care, science-based treatment, adherence to well-defined practice protocols, and appropriate use of technology. Preventive care screenings, such as mammograms and colon studies to catch cancer early, and access to health education so patients can learn to avoid disease are key factors in assessing the quality of care of a provider organization.

Figuring out the best way to judge quality of care has been a monumental quest pursued by health care providers and consumers alike since the early 1950s. This pursuit has been embraced by numerous medical, government and consumer agencies in the past 50-plus years, creating a veritable alphabet soup of regulatory and review/rating organizations with varying degrees of effectiveness and longevity.

Hannah Peters, MD, a women’s physician in the World War II Kaiser Shipyards, studied the female workers’ adaptation to heavy labor.

Further complicating the issue of quality is the fact that everything doctors, hospitals and health plans undertake – staff recruitment and education, research, and technology upgrades – affects quality. So it’s difficult, if not impossible, to talk about quality without looking at these topics as well. So the subject of quality is all-encompassing and, at times, overwhelming.

A case study of Kaiser Permanente’s initiatives over the decades to assess and improve quality of care reveals many different approaches and different boards and committees formed to respond to industry trends and to ultimately crack the quality nut.

In many instances, Kaiser Permanente was in the forefront of the various quality movements, often with the intention of proving its own worth to a skeptical world of traditionalists who didn’t like prepaid group practice. At other times, Permanente was pioneering new methods of care delivery and conducting crucial quality research that would lead the way for what came to be called quality assurance, initially for health maintenance organizations (HMO) and later for all forms of managed care.

Permanente physicians came from academic tradition

Starting out in the World War II West Coast shipyards, Sidney Garfield and Henry Kaiser knew the quality of care had to be the best possible to make sure the often sickly workers would be fit for dirty, hard and stressful work. So they used the latest methods they knew – and could learn about through research – to be on top of their medical game. Coming from an academic medical center at Los Angeles County General Hospital, Garfield understood the benefits of research, collaboration and continuous quality improvement, a term unheard of at the time.

Garfield hired like-minded contemporaries, such as surgeon Cecil Cutting, internist Morris Collen, and gynecologist Hannah Peters, all socially conscious and oriented toward innovation, to carry out the wartime program. Learning all the time, these physicians developed new treatments and published their results during and after the war.

Inundated with pneumonia patients, Collen uncovered new ways to treat the often deadly condition. Treating pneumonia patients with horse serum and sulfa drugs, Collen was able to save many lives, even before the “wonder drug” penicillin became available to treat civilians at war’s end.

Hannah Peters, a German native who migrated to New York in 1934, studied women shipyard workers’ ability to adapt to heavy, industrial work. She noted how a woman’s menstrual cycle was affected by the carbohydrate-rich diet necessitated by the physical demands of welding and other shipyard jobs.

She and her colleague gynecologist Duncan Footer published their results in a 1946 issue of the Kaiser Foundation Bulletin, as well as in national medical journals. Peters went on to become the leader of the Laboratory for Reproductive Biology in Copenhagen and published many articles on women’s health.

Postwar health plan set aside funds for research and education

San Francisco pediatrician John Smillie checks the health of two young sisters and their doll, circa 1960.

After the war when the Permanente health plan was opened to the public, quality of care continued to be a top priority. With 5% of Kaiser Foundation revenues guaranteed by its charter for education, research and community benefit, the Permanente physicians continued to form bonds with academic institutions to learn, teach and conduct research.

Sidney Garfield always put an emphasis on research and continuing education. Dr. Collen recalls: “When he (Garfield) set up the Department of Medical Methods Research (1961 in Northern California), he always maintained a close association with it. He always had important projects that he wanted our department to carry out because he was very self-critical of our organization. Although he was of course very proud of what he had conceived and accomplished, he always felt we should try to do better.”

Collen adds that having a robust research program helps attract good physicians to KP. “The best quality of care involves a simultaneous interest in teaching and in research, in addition to patient care.”

Southern California pioneers had eye on the quality ball

In Southern California, the physician group was also diligent in the selection of physicians from its beginnings in the early 1950s. Sam Sapin, quality pioneer, explains: “The SCPMG (Southern California Permanente Medical Group) had many intrinsic or built-in quality assurance mechanisms.”

A maternity nurse tends to newborns at a KP hospital, circa 1965.

These included: careful selection of physicians and imposing a probationary period of two to three years before election to partnership; and an informal but very effective form of physician peer review because of KP’s group practice model. Group practice also provided the opportunity for collaboration with colleagues and specialists to avoid inappropriate care and mistakes.

Sapin says other quality ensuring factors included mandatory physician continuing education, ongoing sharing of inpatients and outpatients and their medical records as well as the accountability for quality of care vested in chiefs of service and medical directors who could withhold merit and longevity salary increases. Another key factor:  there was no incentive for overutilization or performance of unnecessary procedures and no incentive to withhold appropriate care.

Henry Kaiser triggers review of KP hospitals in 1959

Aside from the original and sincere intent to be the best in care, the Permanente physicians’ first stab at quality assurance came in 1959 when Henry Kaiser asked the question of Permanente health plan executive Clifford Keene, MD: “Do our hospitals provide quality of care? John Smillie, MD, an early KP San Francisco physician, recounts in his oral history: “Dr. Keene thought for a moment and he said, ‘I don’t know. I don’t know how we can judge how good the care is in our hospitals, but I’ll find out for you.’

Emmett Lowrey, MD, leads a discussion among early Permanente physicians about the results of an X-ray examination.

“So Dr. Keene then commissioned Dorothea Daniels (KP’s first female hospital administrator) to do a study of hospital quality of care in all Kaiser Foundation Hospitals, not just Northern California, but in Southern California, and Oregon and Hawaii. She came back, I think in a year, with a very thorough report, which showed that in some hospitals the quality of care could be improved, and in other hospitals it was excellent. But it was a very honest and straightforward report,” Smillie said.

At that time, formal external quality assessment and documentation did not yet exist. The Joint Commission on the Accreditation of Hospitals had formed in 1952 and begun a voluntary accreditation program, but before the advent of Medicare in 1965 no government, employer or consumer influence had made itself felt in the regulation of medical care. That situation would soon change and the age of innocence for physician and hospital quality review was giving way to a much more complicated and anxious time.

Next time: The late 1960s and 1970s bring much conversation, soul-searching and anxiety about quality of care.

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