By Ginny McPartland
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.
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
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
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.”
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.’
“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.
By Ginny McPartland
The 1990s brought much debate about how to improve health care in the U.S., Europe and in far flung locations across the globe. So it wasn’t too surprising that many countries showed a strong interest in studying Kaiser Permanente as a successful model for preventive and cost-effective health care.
Across Kaiser Permanente, many health plan and medical group leaders have for decades participated in international organizations and spoken at conferences around the world, occasionally accepting brief consulting engagements.
However, in 1996, a new initiative emerged as Kaiser Permanente International (KPI), not to be confused with the 1964 to 1975 agency called Kaiser Foundation International (KFI).
Again, 21 years later, KP set itself up to share its secret sauce with health planners everywhere. Again, a nonprofit subsidiary organization was established with the goal of being self-supporting.
During its early years, KPI ran consulting projects abroad, including multiyear projects in Russia and South Africa. However, as consulting activity slowed, and interest in visiting Kaiser Permanente grew, KPI transitioned to offering primarily educational programs in our regions.
Since 2006, Molly Porter has been the director of Kaiser Permanente International and, since 2008, KFHP/H Senior Vice President Ray Baxter has served as president. Porter is a longtime KP communications professional who produced beautifully readable employee and member publications for the health plan for many years.
Today, she develops KPI’s educational programs and has a small staff that includes Manager Joy Lewis, LCSW, MPH, who is based in Washington, D.C., and shared with Kaiser Permanente’s Institute for Health Policy, and Program Coordinator Christine Aguilar.
Occasionally, KPI’s faculty and staff travel abroad to give speeches or short seminars on the Kaiser Permanente model. More often, foreign governments and health care organizations send health care leaders to California and Washington, D.C., to participate in KPI’s programs, which include presentations by Kaiser Permanente’s most knowledgeable leaders.
British study generates renewed interest in KP
Porter says interest in studying Kaiser Permanente’s operations has surged in the years since 2002 when the British Medical Journal carried an article about a study comparing Britain’s National Health Service (NHS) to Kaiser Permanente’s California health plan.
Titled “Getting more for their dollar: A comparison of the UK’s NHS with California’s Kaiser Permanente,” the report stated that Kaiser Permanente members experienced more comprehensive and convenient primary care services and more rapid access to specialist services and hospital admissions than patients of NHS while KP’s age-adjusted acute hospitalization rates were about a third of those in the NHS.
The report concluded that Kaiser Permanente achieved these results through: 1) more efficient use of hospitals; 2) integration (providing a comprehensive range of care services at each medical center); and 3) use of information systems.
In recent years, health leaders from 43 countries have participated in KPI programs. (Many of these countries were customers of Kaiser Foundation International between 1960 and 1975. See previous blog: posted February 27.) Among the countries sending the most participants are Brazil, Canada, Denmark, the Netherlands, Norway, Singapore, and the United Kingdom.
Visit to Oakland KP inspires Danish health leaders
Guests are also surprised to learn that Kaiser Permanente physicians receive regular feedback on their performance, she says. Recent Danish visitors found it odd that Permanente doctors aren’t allowed to have second jobs with other health facilities, as is common in Denmark.
In a 2010 letter to employees discussing the value of foreign leaders’ visits to KP, CEO George Halvorson included a link to Danish Medicine, which carried an article about the Danish Health Minister’s educational experience in Oakland.
In an article titled “Minister pa inspirationstur hos Kaiser Permanente,” which roughly translated means “Health Minister gets inspiration from Kaiser Permanente,” appeared shortly after the group’s visit.
The article addressed the positives of Kaiser Permanente’s delivery of care, including the emphasis on disease prevention and how doctors don’t order superfluous tests and treatments.
“It is exemplary, not to make money on the number of operations. You earn the most money if you can avoid to operate, and to keep patients healthy. So the tendency to treat, as we see in the United States (is not the practice) at Kaiser Permanente,” Danish Health Minister Bertel Haarder is quoted as saying.
Emulating KP can improve quality
Frolich said she believes that a part of Kaiser Permanente’s success is due to pressure from other health providers in Northern California. “The only way Kaiser (Permanente) can survive is to keep themselves fantastically good,” she is quoted as saying.
In another article, Frolich said: “Our analyses indicate that we will be able to deliver more cost-effective health services and possibly also better quality if we learn of their (KP) model.” She said her study compiled data collected from 1,000 physicians and other practitioners in Denmark.
KPI sponsors a three-day program titled “Learnings from the Kaiser Permanente Model” twice a year, often in the San Francisco Bay Area. These programs can accommodate 60 participants.
Two-day sessions for 20 to 30 participants may also be scheduled in our Southern California Region and at our Center for Total Health in Washington, DC.
KPI charges fees for its educational programs, as it is a self-supporting nonprofit subsidiary not funded by Kaiser Permanente members. Staffers and their KP colleagues also regularly meet with international guests for one- or two-hour meetings at no charge.
Educational visits to Kaiser Permanente often include tours to patient care facilities where foreign health leaders can see the integrated system of care up close. As Danish Medicine reported, Health Minister Bertel Haarder “was lucky enough to get a tour (of the ultramodern Garfield Innovation Center) where they are testing new products and facility designs before (they are) purchased and installed at hospitals.
“He was impressed and could take some inspiration with him on the airplane home to Denmark, where we need to build a number of new hospitals,” the article read.
Haarder added: “It is important that we do not build past (outdated) hospitals but (rather) hospitals for the future.”
—Former Heritage associate Kathleen Haley contributed to this report.
by Ginny McPartland, Heritage writer
Second in a series
Established initially as an industrial health plan, Kaiser Permanente had grown and morphed into a community health plan with over one million members in six states by the mid-1960s. Meanwhile, Henry Kaiser’s ventures had spread across the globe and the basic concepts of industrial and preventive health care traveled with him.
This meant the idea of prepaid health care provided by doctors in group practice was getting a lot of exposure in places where it might be needed most.
The World Health Organization was busy helping African and other developing countries set down their “national health plans,” and industrial nations were taking a serious look at investments in these countries. Already with health care programs in Jamaica, Ghana, Argentina and Brazil, Kaiser Permanente seemed in a prime position to take the lead in other emerging nations.
“At first, we held the belief that since we managed a large, comprehensive and widely-accepted health care system in the United States, that we were in a favored position to cope with the health problems associated with industrial enterprises all over the world,” KP Health Plan President Clifford Keene told a group at Harvard University in 1969.
“This theory turned out to be true in a limited sense,” he continued. “We learned quickly that the medical care circumstances in rural India and in Jamaica are essentially different from those in California.”
Keene explained that developing nations, especially those with a national health plan, urgently needed primary health care workers, clean water, sanitation and disease control before they could even think about clinics and hospitals. Adjusting to local circumstances, Kaiser industrial health care leaders filled in the gaps where needs were most urgent – and bided their time.
KP establishes independent international agency
By 1964, Kaiser Permanente was getting requests from the U.S. and foreign governments to help plan and launch health care services in needy countries. Feeling the strain and drain on the Permanente Medical Care Program whose staff was responding to the calls, Keene and the board of directors established Kaiser Foundation International (KFI).
This not-for-profit entity, with an $55,000 initial grant from the Kaiser Foundation, was a separate self-sustaining agency established to fulfill government contracts to provide help setting up health care in foreign or domestic rural areas.
In its life between 1964 and 1975, KFI was involved in projects in more than 30 countries, including the U.S. where the agency helped set up programs in rural areas of California, West Virginia and Utah. Its workers took on projects in 13 countries on the African continent, as well as in India, Pakistan, Bahrain, Italy, Indonesia, Venezuela, Argentina, Brazil, Peru, Jamaica, the Bahamas, Canada, Okinawa, Taiwan and the Island of Curacao.
Nigerian civil war leaves damaged hospital in its wake
KFI was called upon in 1969 to bring back to life a Nigerian hospital that had been debilitated in the civil war that started in 1967. James Hughes, MD, Kaiser Industries vice president of Health Services at the time, explained:
“This project was completely unrelated to any commercial activities by Kaiser Companies in Nigeria. It was undertaken strictly in response to an urgent request by the government (U.S. Agency for International Development) for technical assistance in a matter of general medical care. Presumably, the request was based upon our prior experience in the organization and delivery of health care on other West African (Ghana, Ivory Coast, Togo, and Senegal) projects.”
The 250-bed hospital at Port Harcourt in the area of Biafra previously had been the referral center for the entire Rivers State of Nigeria with a population of one million. “The Port Harcourt situation looked particularly grim,” reported Keene.
“The war was still in progress 50 miles north of the city and the Biafran troops were making periodic sorties toward the airfield on the outskirts of Port Harcourt. KFI existed to handle tough overseas assignments, but we have never acted in a war zone,” Keene continued.
“When the physician (Carl Friedericks MD) arrived, he told us his first impulse was to turn around and come home. Medical care was critically needed by the remaining civilian population and by refugees streaming out of the jungle zone,” Keene reported.
KP team resuscitates Port Harcourt hospital
The initial team of five acquired a package disaster hospital (PDH)* from the U.S. Public Health Service. Electrical generators, emergency water equipment, and medical supplies and equipment were “scrounged from unbelievable sources,” Keene said. “A Nigerian staff was recruited and trained, on a counterpart system (that matched) native physicians, technologists and nurse volunteers to (our 20) personnel from the United States.”
In the first months at Port Harcourt, the hospital had a daily census of 80 to 100. Dr. Friedricks saw patients with familiar diseases such as diabetes, hypertension and pneumonia. But he also noted many patients with tuberculosis, parasitism, malnutrition and severe anemias.
“Tropical ulcers are common and yield to prolonged medical treatment and skin grafting. Malaria is the most common cause of fever . . . One young lad suffering from a heavy hookworm infestation came in with a hemoglobin of 2.0 grams, or about 13% of normal levels; blood transfusion and medication brought him up to 42% of normal hemoglobin to permit his discharge for home medication.”
They also dealt with issues such as having no dishes to feed the inpatients, getting fuel for the repaired coal stove and outfitting the makeshift operating room and exam rooms with light fixtures. Transportation was not a problem: the U.S. government supplied them with four Land Rovers and a Rambler station wagon. Nigerian Airways had regular flights between Port Harcourt and Lagos, the largest urban area in Nigeria.
San Francisco KP nurse goes to Nigeria
Frances Fuller, formerly assistant director of KP’s San Francisco Medical Center, arrived in Nigeria in September of 1969 as the KFI chief nurse. She went to work setting up nursing classes for 40 Nigerian students as well as developing a hospital procedure manual and a central supply and distribution system.
Fuller reported remodeling of a lecture theater for use as a temporary surgery. “When the room is ready, we will take the instruments and other supplies from the PDH (package disaster hospital) and start doing more surgery.” In the midst of her reporting on the status of the medical facilities, she interjected: “Grounds are being well kept. We even have flowers in the courtyard.”
In 1971, the KFI team departed Port Harcourt leaving a locally staffed, well-functioning and well-equipped community hospital.
Financial troubles doom international agency
Unfortunately, all of KFI’s ventures didn’t end happily. In Peru, a project to set up a hospital system for blue-collar workers was ended abruptly when the government was overthrown and all funds for health care projects withdrawn.
In 1968, politics killed another KFI project, this time in Libya. At the request of the U.S. state department, KFI sent a physician to discuss improved medical staffing of hospitals and clinics in Libya. When Libyan government officials learned that Kaiser assembled its Jeeps in Israel, they dropped the project, due to the Arab League boycott of companies doing business with Israel.
An ill-fated project to bring prepaid group practice to Saudia Arabia in 1974 ultimately brought down KFI, Permanente medicine’s first but not last international arm. Scott Fleming, KP senior vice president, said the project presented major cultural and legal problems that were costly to solve. In general, the KFI financial picture didn’t look promising at that time so the directors decided to discontinue its operation altogether in 1975.
Next time: Great press about Kaiser Permanente abroad fuels renewed initiative to teach eager foreign health officials about the KP care delivery model.
Photograph of Douglas Boyd, creative genius of Boyd Communications, who designed the modern Kaiser Permanente logo in 1985. -LC
See full story.
By Ginny McPartland
First in a series
In the 1960s, dubbed the “Development Decade” by the United Nations, Henry J. Kaiser’s enterprises were literally all over the map. Kaiser’s companies were mining bauxite for aluminum in Jamaica, manufacturing cars in Argentina and Brazil and working on a huge hydroelectric project and aluminum smelting plant on the Volta River in the emerging West African country of Ghana.
Kaiser Engineers were also building a dam on the Bandama River in Ivory Coast, West Africa, as well as undertaking projects in various parts of India, including construction of a dam, hydroelectric plant, an aluminum plant, a steel mill and a cement facility. Kaiser Engineers were involved with the Snowy Mountain project – construction of tunnels, aqueducts, dams and hydroelectric plants in the mountains of eastern Australia.
As in his American ventures, Henry Kaiser’s enterprises on foreign soil developed medical services for workers at the job sites and often in the community. In many places, including Australia, India, and Ghana, the government required Kaiser to build hospitals at each of the construction locations.
“In a sense, this was a recapitulation of the early experience of our domestic medical care program, which had its origins in providing health care for workmen and their families at construction sites in the Western United States,” wrote James P. Hughes, MD, Kaiser Industries vice president of Health Services in 1972.
KP executives tapped to develop health facilities abroad
Clifford Keene, MD, Kaiser Permanente president at the time, was thrilled to participate in the launching of medical care projects in foreign lands.
“I went to Australia several times because Kaiser Engineers were involved in the Snowy Mountain Project and I was involved in the location and construction of hospitals there. . .I went to India twice, once for a period of almost a month. I found myself in places with exotic names, Uttar, Pradesh, Mysore, and Jamshedpur.
“So all of this was going on and it was just a big, spreading, challenging, wonderful, exhilarating kind of existence. While we were having all the troubles in the Permanente Medical Program (in California), getting reorganized, I was involved in these other challenges, which gave me satisfaction and sort of balanced the scales against the frustrations of dealing with the Permanente program.”
Ernest Saward, MD, medical director of Kaiser Permanente’s Oregon Region, traveled to Argentina in 1960 to help establish a medical care program for Kaiser automobile workers in Cordoba and Buena Aires. Saward said the Argentines didn’t trust the Kaiser organization initially and expected the company to superimpose a foreign health system on the community.
“The reaction back from Argentina was, ‘You folks in California put some millions in this and build us a hospital and everything will be all right.’ From what I’d already learned, I saw that if (Kaiser in partnership with the Argentines) put any millions in a hospital it would be confiscated within months. That was the nature of Argentina at the time. They play rough. Now I never personally got shot at; I was only threatened with a saber,” Saward said with a laugh in a 1986 oral history.
Saward and his artist wife managed over time to infiltrate the Argentine culture and make essential contacts for Kaiser. “They saw that we were somebody they could relate to, that (we) wanted to understand them and to understand what I would call their general, cultural events, and not be an isolated colony.
“They began to entertain us, and I spent hours lying on the living room floor, drinking red wine in front of a fireplace with these guys, until they finally understood what it was we were trying to do, and once they really got a feeling for what we wanted to do, they said, ‘Let’s do it’. We did it with the best medical group in town and with the best hospital in town, and it’s still going (1986) and it cost us in toto, $55,000.
“What had to be done in Argentina was to make an indigenous plan and not a foreign plan and (to make it go) it had to be done as an indigenous plan by what were respected elements in the community. (That’s how) we did it,” Saward said.
Requests for help from international community multiply
As Kaiser Industries continued to work abroad into the 1960s and 1970s, the challenges for providing health care kept coming.
This was a period when African nations were gaining their independence, and the international community was interested in promoting industrial development to improve the economies of all underdeveloped countries. With new industry and its attendant growth, the budding nations were struggling to provide essential services to their citizens, both natives and newly arrived workers and their families.
To address these issues, seven hundred industrialists from 70 nations gathered in the San Francisco Bay Area in September of 1969 to figure out how to close the gap between the “have” and “have not” nations.
“There was much talk about the responsibilities of private enterprise in developing countries; about the need for more effective allocation of resources; about the need for business to interact with the society in which it finds itself,” noted KP President Clifford Keene in a talk to the Industrial Council for Tropical Health at the Harvard School of Public Health in Boston in 1969.
Kaiser’s people learned the hard way what this meant. In Ghana on the Volta Dam project, Kaiser leaders discovered pretty quickly that – despite the government’s well-laid plans – the company needed to initiate environmental programs to ensure safe water and pest-control measures to protect workers from the spread of debilitating disease.
Once the dam was completed, Kaiser began construction on a smelter plant to manufacture aluminum. “. . .the first responsibility was to provide care for the work injuries, since the existing health care facilities in the town were grossly overburdened,” wrote Hughes.
Health planners forced to improvise
For these foreign projects, many necessitating brand new cities or towns, Kaiser’s goal was to establish health care facilities for its workers, their families and often for the community at large. Hughes said in most countries where Kaiser had developments health care services had to be introduced in waves, depending on available services. Often, sanitation and safe water needs and the dire need for training of locals in basic care methods were the first priorities.
To provide health services, Kaiser Industries initially engaged the Kaiser Permanente Medical Care program. By 1964, however, Kaiser leaders realized the need for a separate entity and established the not-for-profit Kaiser Foundation International (KFI) to administer the foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence.
Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. By 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah and West Virginia.
Next time: Kaiser Foundation International gets contracts to resurrect a hospital devastated by the Nigerian civil war, to train Peace Corps workers for African rural health projects and to consult on many foreign health care projects.
President Franklin D. Roosevelt greets a crowd at the Kaiser shipyards in Vancouver, Washington, on September 23, 1942. Here Kaiser turned out combat ships including small aircraft carriers. His workers were delivering “baby flattops” at the unprecedented and seemingly impossible rate of one a week for the Allied cause. When Mr. Kaiser was asked about this time what interested him most, he replied, “the power that is in the souls of men and how to reach it.”
First Lady Eleanor Roosevelt strikes up a conversation with an injured shipyard worker at the Permanente Hospital in Vancouver. Mrs. Roosevelt was so intrigued with the new medical care program for the Kaiser workforce that she wrote Permanente’s founding physician, Dr. Sidney R. Garfield, who happened to be away at the time of her visit. “What is your plan for preventive care?” she asked. Stay tuned. We’ll post Dr. Garfield’s reply in these pages.
– KP Heritage Resources Photo Archive
By Lincoln Cushing
On January 18 of this year, executives and contractors gathered in a top floor conference room a block away from The Ordway building in downtown Oakland, California. As darkness settled, brief speeches were made, a ceremonial switch was flipped, and huge Kaiser Permanente signs on both sides of the structure’s summit lit up with the energy-efficient brilliance of thousands of light emitting diodes.1
This was the first signage ever mounted on The Ordway, and it represents the most current appearance of the Kaiser Permanente logo, a copyrighted symbol that brands everything from pill bottles to skyscrapers. The new signs can be seen from across the city at night, and with the 1950 Franklin building, present two pairs of KP illuminated signatures on the Oakland cityscape.
The Ordway, constructed in 1970, was named after Henry J. Kaiser’s first employee and long-time and trusted operations manager A.B. (Alonzo Benton) Ordway. “Ord,” as Kaiser called him, was hired in 1912 –100 years ago – when Kaiser was with the Canadian Mineral Rubber Company.
The Ordway is adjacent to the Kaiser Center at 300 Lakeside, Henry Kaiser’s pride and joy in 1960, which at 28 stories was the tallest building in the East Bay at the time it opened. Formerly the Kaiser Industries headquarters, the center still carries a sign that simply says “Kaiser.” The Ordway, Kaiser Center and the nearby 1950 Franklin St. building accommodate many of KP’s administrative offices.
KP brand identity evolved over decades
Sporting a consistent and polished brand signature is relatively new in Kaiser Permanente’s 67-year existence. During World War II, Permanente Metals, which operated a medical care program for its wartime workers, did not develop a separate logo for the health plan. Rather, the Permanente Metals logo of three ship hulls inside a compass rosette appeared on the health plan brochure. The trio of ships likely represented the three West Coast wartime shipyards where Henry Kaiser built warships.
Although the health plan evolved on its own after the war, there is no evidence leaders sought any brand identity other than adopting for Kaiser Permanente’s signage the same typeface and style used to identify each of the Kaiser Industries companies.
‘Family of four’ mark emerges in 1970s
In the early 1970s, a silhouette nuclear “family of four” mark began to appear in publications and signage for the Kaiser Permanente Medical Care Program. In 1982 the Southern California Region hired Boyd Communications of Los Angeles to produce its own regional logo. Douglas Boyd designed a mark that featured one of the human figures but also integrated a stylized “K” for Kaiser Permanente.
The idea of a unified graphic representing all Kaiser Permanente’s regional health plans did not emerge until 1984, when a corporate identity committee was formed. The committee included Kaiser Foundation Health Plan and Hospitals Chairman and President James A. Vohs, Don Duffy, head of Corporate Communications, corporate identity experts, KP regional managers, and medical directors.
Logo design sparks debate in the 1980s
Kaiser Permanente was growing, and the “family of four” graphic that had been used by several – but not all – KP regional health plans was not only amateurish and antiquated, it had been imitated by competitor health care organizations because it was not protected by copyright. Vohs reflects on some of the challenges involved:
“As with almost any issue in Kaiser Permanente, there was a range of opinions about a new logo. Quite often the leaders of the medical groups had different views from the leaders of health plan. Also, the Southern California Region felt that the organization should adopt the logo they were using.
In addition, consultants from a previous design firm felt that we should change the name of the organization. They thought strongly that ‘Kaiser Permanente’ as a title for a health care organization was a negative, and urged us to abandon it. (They were concerned that the name “Kaiser” was too closely identified with Henry J. Kaiser’s steel and aluminum industry, not with patient care and wellness).”
Vohs continues: “But from my point of view there were really just two concepts that needed to be reflected in any logo: that the arrangement between the ‘partners’ in the enterprise, the health plan and the Permanente Medical Groups, be recognized; and that there be just one style of logo used consistently throughout the organization to reinforce that Kaiser Permanente is one single multiregional and national enterprise.”2
The resulting logo, created by Douglas Boyd of Boyd Communications, was a distillation of concepts that reflected KP’s mission. When the new graphic identity was released in 1985, a brochure was distributed explaining some of the design parameters and solutions:
“It had to convey: a feeling of warmth and caring; a sense of quality and professionalism; concern and commitment to one another; the partnership we share in providing health care to the community; and a progressive feeling.
“. . . The sense of community is there in the three figures. They can represent the three entities which make up our program (the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups), the families we serve, and the communities we’re located in. The radiating light transmits a sense of health and healing. The sunburst also reminds us of our roots in the desert, where (KP founding physician) Sidney Garfield started providing prepaid medical care more than 50 years ago (1933).”
Signature suits company’s mission
Boyd, who has created logos for many international businesses such as Apple, Hilton and Toyota, is humble when describing his team’s part in designing the KP logo. He likens his role to a “tailor” who simply put a nice “suit” on Kaiser Permanente.
“To be somewhat objective, it’s what the organization has done that makes the logo,” Boyd said. “A logo can’t make a company. And Kaiser (Permanente) has done an extraordinary job at becoming the best in the country at providing health care.”3
In 1999 the “family” symbol was slightly revised, this time under the direction of Landor Associates, another world-class strategic brand consulting and design firm, as part of the most comprehensive identity system KP had ever rolled out. This included a revised logo called the “signature”.
The 17 rays of light in the image were reduced to 14 and the typeface of the words “Kaiser Permanente” was changed. KP also standardized the horizontal configuration of the logo and type. Subsequent additional tweaking by the design firm of Kate Keating and Associates used even fewer rays in the “people” for enhanced legibility in specialized applications such as embroidery, pharmacy labels, and large signage.
Fittingly, during the centennial of A. B. Ordway’s hire, the towering edifice named after him glows with the most modern Kaiser Permanente symbology.
1 The energy-efficient sign is specially designed to illuminate white through the blue lettering for enhanced visibility at night.
2 Email correspondence with author 1/30/2012
3 Interview 12/2011 with Boyd by KP communications associate Kathleen Haley