Archive for March, 2010

Harry Bridges and Sidney Garfield: Synergistic Collaboration

posted on March 31, 2010

Harry Bridges at ILWU meeting 1960

By Ginny McPartland
During the Cold War, the average American scorned any ideas that even hinted at socialism. Going against mainstream politics in the 1950s was fraught with danger.

Henry J. Kaiser and Sidney Garfield, MD, took their licks from the conservative medical establishment for their nontraditional ideas of health care. They were called “socialist” even though both were adamantly opposed to “socialized medicine.”  

Their contemporary– and sometimes collaborator — militant labor leader Harry Bridges was accused of being a communist, which he was not, as he fought hard and dangerously for bargaining power for dock workers.  

Marking the 20th anniversary of Bridges’s death this month brings to mind the groundbreaking 20th century achievements of these working class heroes. Despite the opposition, they didn’t back down.  

For Harry Bridges, elevating the worker to the bargaining table was a lifetime passion. His heart was with the “working stiff” who was considered almost like property of the employer before unions. “The basic thing about this lousy capitalist system,” Bridges declared, “is that the workers create the wealth, but those who own it, the rich, keep getting richer and the poor get poorer.” 

Born in Australia in 1900, Bridges was inspired by Jack London’s books to go to sea. He jumped ship on his first job because he disagreed with the skipper on the treatment of the seaman. He landed in San Francisco and soon began to organize the waterfront workers.  

His work culminated in 1934 in the San Francisco dock workers strike that resulted in the death of two men, casualties of police bullets. Union members refused to work until they could negotiate higher wages and a method of getting work on the docks without having to pay a kickback. The strikers won and Harry Bridges was set for 40 years as the president of the International Longshoremen and Warehousemen’s Union (ILWU) starting in 1937.  

“A Working Class Hero Is Something to Be” — John Lennon

By 1950, the ILWU had become a strong advocate for its members, and its leadership worked to spread unionism to other industries. The ILWU pioneered health and welfare benefits for its members. 

Enter Sidney Garfield: 
After the War when the Richmond shipyards closed, Kaiser and the Permanente doctors were ready, willing and able to take care of people. Both men had track records of providing affordable care to the working man. The health plan had been opened up to the public in 1945 but the enrollment was small. 

Enter Harry Bridges: 
It was a marriage with great potential. Bridges needed a health plan for his members and Henry Kaiser needed health plan members. Instant symbiosis.

In many ways, the goals of the two organizations converged. Bridges wanted all of his workers to have a health assessment and screenings to prevent disease. Kaiser Permanente’s Garfield saw how to accomplish the “multiphasic” examinations for all twenty thousand workers and later set up a way of collecting the results, at first on paper, and then in KP’s pioneering computerization of medical records. In effect, the ILWU members were guinea pigs for what has grown and expanded into KP’s electronic medical records prowess.  

Young Harry Bridges aboard ship about 1920.

Along the way, Bridges helped Kaiser Permanente by writing editorials in the ILWU newsletter supporting the health plan physicians. In 1953 Bridges assailed the San Pedro Community Hospital in Los Angeles for refusing privileges to KP doctors. In 1954, he criticized the American Medical Association for trying to block group medicine. “Group medicine is here to stay,” he wrote. 

In turn, Permanente physicians at times provided medical care on credit for striking ILWU members. Henry Kaiser was in favor of unions. In 1954, Kaiser said problems can be averted “simply by genuine recognition that the right of collective bargaining . . . is sound, essential human relations. I agreed a long time ago that unions are here to stay.” 

In 1965, Kaiser received the AFL-CIO’s highest honor for his achievements in voluntary medical care, housing and labor relations. Previous winners included former President Harry Truman and former First Lady Eleanor Roosevelt.  

To view Arlo Guthrie’s tribute to Harry Bridges on Youtube:

Top photograph by Otto Hagel, from Men and Machines, 1963; reproduced by permission of the Center for Creative Photography; © 1998 The University of Arizona Foundation
Ship photo courtesy of ILWU Archives, Anne Rand Research Library, International Longshore and Warehouse Union, San Francisco

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Innovation is in KP’s DNA

posted on March 29, 2010

What is innovation? In a very real sense, it is the heartbeat of Kaiser Permanente. As a short video put it at a recent Innovation 4.0 Retreat that I was privileged to attend, “It’s in our DNA.”

Dr. Morris F. Collen in a photo featured on the December 1968 cover of Modern Medicine magazine.

But if you want to know the definition, “innovation” is summed up in a few seconds by Dr. Morris F. Collen, on the job at Kaiser Permanente since 1942. Yes, that’s right, 1942. He still comes to the Division of Research he founded in Oakland, California a couple days a week.

“Innovation, to me,” says this pioneer physician who helped create the field of Medical Informatics, “means new developments that create change of sufficient importance to alter and even disrupt the practices and procedures that they’re designed to change.”

Want a quick tutorial on innovation at Kaiser Permanente? Take at look at the short video Innovation at Kaiser Permanente to learn more.

A Design to Match the Miracles

posted on March 23, 2010

by Bryan Culp

I recently attended a reception to celebrate the opening of the new Kaiser Foundation Research Center (KFRC) Hospital in Vallejo, California.  This hospital is Kaiser Permanente’s National Center of Excellence for people with disabilities, and it offers unique care to patients recovering from trauma, stroke, neuromuscular and orthopedic diseases.

“Many will rise and walk,” I remembered as I entered the new therapeutic gym, which is the at the heart of this facility because every new patient aspires first to return to mobility. The memorable phrase, evocative of miracle stories, was the title given to an article penned by science writer Paul de Kruif, who described for readers of Reader’s Digest in 1946 Dr. Herman Kabat’s experimental treatments for the disabling effects of polio.  Kabat offered a glimmer of hope to many afflicted with polio and neuromuscular diseases, Henry Kaiser, Jr., being one of them.

I walked from the gym into the open air of the roof-top terrace where patients on the path to mobility learn the pavement surfaces, curbs and cutouts a pedestrian encounters in daily routines.  I admired the recently installed, vintage 1953 Kaiser Manhattan in which patients learn how to transfer from a wheelchair to a car and how to maneuver in the confined space of an automobile. 

That's Tom Debley, Director of Heritage Resources, with the 1953 Kaiser Manhattan transfer vehicle.

For years the hospital had used a nondescript Chevrolet for this purpose.  But when the new hospital was in the design phase, the planners consulted with Heritage Resources with the idea to build-in to the new facility signature artifacts.  The Kaiser Manhattan was an ideal choice for a transfer vehicle.  The center’s therapists knew its heft and spaciousness offered real advantages, and true to history, the marquee had once served in this capacity in the hospital’s founding era. This particular example, with 76,000 miles on the odometer, was located in Arizona bearing a California heritage plate that read, “Henry.” After battery and oil were removed for safety, and adjustable seats were installed to aid patient training, the car was lifted into place on the roof terrace.

I can say confidently, having seen this new hospital close-up, that the mirror-like chrome on the magnificent Manhattan reflects more than past glory.  It reflects this stunning and entirely new facility that speaks to every patient, past and present, in so many words saying:  “We believe in you!”

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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.

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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“New Economy of Medicine:” An Idea for Which the Time Has Come?

posted on March 9, 2010

By Tom Debley

Harvard Business School Professor Clayton Christensen has taken to the pages of Business Week magazine to argue we would better off with health care systems in which doctors and insurers are on the same side of the ledger as the patient.  That would be a system such as Kaiser Permanente.  So what is the difference between his position and that of Sidney R. Garfield, the physician co-founder of Kaiser Permanente? Well, 65 years.

Professor Christensen, an expert on the topic of disruptive innovation, says that to do otherwise means “we’re guilty of business model malpractice on a grand scale.” As the headline on Christensen’s article put it, “The way to cut costs is to put care and insurance in the same bed.”

Dr. Sidney R. Garfield in 1975

Dr. Garfield, in designing Kaiser Permanente, made that argument 65 years ago when he addressed the Multnomah County Medical Association on April 4, 1945.

Garfield, talking about what he called his “new economy of medicine,” responded to the belief expressed a day earlier by another physician who claimed the most expensive thing in a hospital was an empty bed.

“He wasn’t referring to our hospital,” Garfield told his Portland, Oregon, audience, referring to the first Kaiser Permanente hospital in the Pacific Northwest, built during World War II in Vancouver, Washington.

“The most expensive thing in our hospital is a filled hospital bed,” Garfield added. “This new economy is geared to the preventive medicine of the future. It puts the patient, the doctor, the hospital, the employer and the insurance company all on the same side of the ledger. They all benefit by the patient remaining well.”

Garfield was a disruptive innovator long before the modern term was coined by Professor Christensen in 1995.  As Garfield once said, “We are talking about changes – and changes are irritating and disturbing, but being disturbed is essential to progress.”  (See my earlier blog, “Disruptive Innovation” at the Core of Kaiser Permanente History.)

Argues Christensen today, integrated delivery systems, including Kaiser Permanente, “can provide better care at 20 to 30 percent lower cost. Clearly, systemic problems require systemic solutions.”

If Dr. Garfield was 65 years ahead of the curve on that one, consider that it was 50 years ago this spring that he first argued that the computer should become the center of medical care delivery. Last week, on March 3, he would have been smiling as Kaiser Permanente announced that every medical facility within its health system — 431 medical offices and 36 hospitals — is now equipped with Kaiser Permanente Health Connect®, the largest private sector electronic health record in the world.

We’ll have more to say about Dr. Garfield and the computer on the 50th anniversary of his first talk on that topic in May.

Tom Debley is director of Kaiser Permanente’s Heritage Resources program and author of “The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” available directly from the publisher, The Permanente Press, as well as  from both in paperback and on Kindle.

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