, Heritage writer
August 21, 1942.
Edgar F. Kaiser, Henry J. Kaiser’s eldest son, was busy managing three Kaiser shipyards in the Pacific Northwest in a massive effort to win World War II. Part of that mobilization included providing health care for thousands of Home Front workers, many of whom were in poor health yet expected to function as productive industrial laborers.
Unable to attend the dedication of the first Permanente Foundation hospital in Oakland – the initial facility in the medical complex that would steadfastly serve the Kaiser Permanente Health Plan for more than 72 years – Edgar sent this telegram to his father. It’s a touching testament to the bond between son and father and a pledge to public service that both recognized in the nascent health plan.
August 21, 1942
Mr. and Mrs. Henry J. Kaiser Sr.
Henry J. Kaiser Co.
We know that today’s dedication marks the realization of a long cherished dream. The rebuilding of this hospital, the birth of its organization, is stimulated as we boys know by one desire – the service that individual thought and care can give to individuals. This service is the life behind doing the job well. This is one of the many principles you have both taught us all. The dedication today of Permanente Foundation is tangible fulfillment of that principle. While today we cannot be with you and the organization that will make Permanente Foundation live, we are with you in spirit. Sue and the boys here up north join me in sending you our best.
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Exercise as a vital sign prompts fitness
conversations in the exam room
, Heritage writer
Thirty years ago, Kaiser Permanente founding physician Sidney Garfield, MD, was as anxious as anyone is today to encourage members to maintain a healthy lifestyle.
Dr. Garfield knew that people could better stave off chronic illnesses such as diabetes, heart disease and cancer if they ate healthy foods and exercised for weight control and cardiovascular health. He wanted them to achieve (what he called) Total Health – physical, mental and social well-being.
But how could he get people’s attention?
First, he had to round up members to help them assess their health status before they became sick.
The elegant electronic health records system Kaiser Permanente providers have at their fingertips today wasn’t invented yet. So Garfield and his collaborators had to do it the old-fashioned way:
They mailed letters to new members and asked them to come in for a physical examination. Members completed the total health assessment questionnaire with pen on paper and handed the document to providers.
Members responded to questions such as: “Do you smoke? How many servings of fruits and vegetables do you eat each day? How many minutes do you exercise each day?” The lifestyle questionnaire content formed the basis for each individual’s preventive care plan.
Total health assessment continues
Today, the same process takes place, but advanced computer technology – Kaiser Permanente’s HealthConnect®, the organization’s electronic health records system – makes it easier, quicker and better.
With software available in KP HealthConnect®, physicians work with members to assess body mass and to have a conversation about the member’s physical activity level.
At Kaiser Permanente, both BMI and exercise as a vital sign are considered “vital signs” as important as the traditional measures of blood pressure, pulse and temperature.
BMI calculation, a ratio of height to weight, has been part of the Kaiser Permanente clinical routine for about the past five years. Southern California Permanente physicians piloted and studied EVS results in 2009, and in 2013 the Permanente medical groups in all regions added the physical activity measure to the recommended clinical routine for all facilities.
EVS study results promising
In December 2013, Kaiser Permanente researchers published in the Journal of General Internal Medicine results of an 18-month study conducted at four medical centers in Northern California. Clinicians at the study sites asked patients how many days a week they exercise and for how many minutes.
Researchers began collecting data in April 2010 and followed patients’ weight loss and blood sugar reduction progress through October 2011. The study involved more than 696,267 Kaiser Permanente members who were seen in more than 1.5 million office visits.
Investigators compared the members’ weight loss progress and blood sugar control at the four study sites with nine other medical centers that had not yet implemented exercise as a vital sign.
Even though patients who were asked the exercise question recorded a weight loss of only .02 more pounds than members of the control group, researchers were encouraged by the findings.
“Asking an individual about how much daily exercise he or she (gets) helps our providers learn about what matters to our patients and prompts patients to think about healthier habits,” said Lisa Schilling, RN, MPH, vice president for Kaiser Permanente’s Care Management Institute.
Help for personalizing exercise choices
Currently, members who need help in starting a personalized exercise regimen can consult with a wellness coach by telephone, make an appointment with a behavioral-change specialist, and take advantage of online healthy lifestyle programs.
Kaiser Permanente is the sponsor of the public health campaign “Every Body Walk!” that encourages Americans to incorporate walking in to their daily fitness routine.
In his day, Sidney Garfield was indisputably a visionary in taking advantage of then-budding technology that he believed could improve medicine. As prescient as he was, he could never have predicted the changes that would provide the tools to realize his dream of Total Health. The current edition of The Permanente Journal carries an article about the status of Total Health that would make Garfield feel gratified.
Vintage photos chronicle evolution
of Oakland Medical Center campus
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Rebuilt Oakland Medical Center
to open for business July 1
, Heritage writer
If the walls of Kaiser Permanente’s soon-to-be-replaced Oakland Medical Center could talk, they would tell an epic story with many dramatic chapters.
The structure – cobbled together with many additions over seven decades – might channel the spirit of the Victorian-era nurses who tended to the sick and injured at the Fabiola charity hospital that sat near the corner of MacArthur Boulevard and Broadway from 1887 to 1932.
The first Kaiser Permanente Foundation Hospital, which opened in Oakland in 1942, might also reverberate with the heart-wrenching tales of injured World War II Kaiser Richmond shipyard workers whose lives were saved in a refurbished wing of the old Fabiola hospital.
For 40-plus years, the medical facility radiated with the passion of a wiry, red-headed, daring and dashing surgeon who teamed up with larger-then-life industrialist Henry J. Kaiser to set up an innovative, prepaid health plan, first for Kaiser’s workers and then for the public.
Physician founder Sidney Garfield’s ideas were incorporated into the design of the original Fabiola hospital refurbishing; in fact, over the next two decades he would play an integral role in designing most Kaiser Permanente facilities.
For his part, Henry Kaiser made sure the care Kaiser Permanente delivered was color-blind; the health plan embraced all people, despite the fact other hospitals in the Bay Area were segregated.
Kaiser Permanente pioneer Avram Yedidia tells a memorable story about several local policemen who visited the Oakland Medical Center in 1946 with an eye to join the Health Plan. Yedidia recalls in his UC Berkeley Bancroft Library 1985 oral history:
“. . . The police chief said to me, ‘You know, when we walked through, I saw that you had some Negroes and whites in the same room. I don’t think we like that.’
“As I can recall, I responded, ‘Do you know this plan started that way, with blacks and whites in the shipyards, and that’s the way it goes. They worked together, and they were sick together.’ ” Yedidia told the police chief: ‘Those who don’t like it shouldn’t join the plan.’ ”
Phenomenal growth and change in 70 years
The seed Garfield and Kaiser planted in the war years has grown exponentially into Kaiser Permanente as we know it, with 9.3 million members and its significant presence in the national health care landscape of today.
Sidney Garfield, just 36 years old when he and Kaiser opened the hospital, had a vision for preventive care and total health for Health Plan members – a vision that played out in many ways in Oakland.
After the war ended in 1945, Dr. Garfield focused on improving the health plan’s quality by creating educational opportunities for physicians and nurses, encouraging research, and setting up ways members could learn how to stay healthy.
In 1947, Henry Kaiser and his wife, Beth, established the Kaiser Foundation School of Nursing and soon the halls of the medical center – expanded by then to 230 beds – were bustling with white-capped student nurses and their strict mentors, all clad in crisp white uniforms and sensible shoes.
Among their leaders was the legendary Dorothea Daniels, who set Kaiser Permanente’s high nursing standards in the early years.
Computer age begins
The Oakland Medical Center also witnessed the queuing up of burly, yet well-dressed longshoremen and other Health Plan members who followed the hospital’s version of the “yellow brick road”, a color-coded tape path that led them through the facility to stations where various tests were performed.
Initially called the “Multiphasic,” these screening tests marked the beginning of Kaiser Permanente’s pioneering work in automated laboratory testing and compilation of electronic medical records, and the Health Plan’s foray into the use of computers in the 1960s.
In 1965, the Oakland Medical Center opened its first specialized cardiac care unit with physicians and nurses trained to use the latest heart monitoring equipment to care for patients.
In 1970, physicians in Oakland began a progressive nurse practitioner certification program; specially trained nurses were assigned to see patients who needed routine primary care but didn’t need to see a physician unless a problem emerged.
In 1972, the 12-story hospital tower, which was built on top of the wartime structure, was opened. That extra space allowed Garfield to open Kaiser Permanente’s first Health Education Center, the precursor to today’s healthy living centers.
The Oakland patient education facility was stocked with books, pamphlets, films and tapes that patients could borrow to learn how to prevent and manage chronic illness.
In 1980, new radiology services, including ultrasound and CAT scans, opened on the Oakland campus. In subsequent years, hospital officials established a pediatric intensive care unit and new Magnetic Resonance Imaging and Lithotripsy centers on the Oakland campus.
Garfield separates the well from the sick
In 1981, Garfield was instrumental in the opening of a new primary care center, which was part of his mission to encourage members to take measures to stay healthy and avoid chronic disease, such as diabetes, heart problems and cancer.
Sadly, in 1984, Garfield died while still working on his “Total Health” research project. His colleagues finished his endeavor, whose results laid the foundation for the organization’s focus on Total Health that continues today.
The hospital tower that allowed Total Health to spread its wings in the 1970s was doomed in 1994 when the state of California passed seismic safety legislation that required a retrofit of the Oakland main hospital building.
Kaiser Permanente officials decided to replace the hospital with the new Oakland Medical Center across MacArthur Boulevard from the original 1972-built tower. The new Medical Specialty Office Building facing MacArthur opened in January: the new Oakland Medical Center will open on July 1.
Garfield’s Total Health philosophy can still be seen in ways great and small at the Oakland Medical Center, right down to a weekly farmers’ market – founded in 2003 – that served as a template for 50 such markets that operate in communities across the nation today. As the historic structure is abandoned and its memories fade, the passion of its original architect will live on.
Garfield summed up his philosophy of Total Health: “Remember, good health is a way to get more out of your life – more energy, more enjoyment, more potential, more purpose, more life.”
Photo history of the Oakland hospital
, Heritage writer
Before daybreak on June 6, 1944, 70 years ago this month, the biggest amphibious invasion force in history converged in the English Channel a few miles off the coast of France.
The news that the Allied Forces had finally marshaled a massive conglomeration of men, equipment and warships was thrilling for everyone in Hitler-occupied Europe and for every American.
All eyes, ears and hearts were focused on those five beaches of Normandy – codenamed Omaha, Utah, Gold, Juno, and Sword – where the Allies would land and ultimately take back Europe from Hitler’s four-year Nazi stranglehold.
The long-awaited report of the Allied attack was especially thrilling for shipyard workers who had been turning out thousands of ships deemed necessary to defeat the Axis powers in Europe and Asia.
Kaiser shipyards play role in massive D-Day thrust
Since 1941, even before Pearl Harbor, Henry J. Kaiser’s West Coast shipyards had been producing ships in record numbers (through the U.S. Maritime Commission) for the Merchant Marine, whose sailors manned most of the Liberty supply ships, and for the U.S. Navy and British Navy.
The D-Day landings in Normandy were in large part the culmination of the Herculean effort of the United States to “out-produce” the Germans and Japanese and thus outlast them and win the already long and exceedingly bloody world war.
“Overwhelming Allied might was slowly reducing the Germans ability to strike,” wrote a U.S. Navy historian in the history of the Naval Armed Guard, whose members rode aboard to protect civilian merchant ships.
Penny Price, an electrician at the World War II Kaiser Richmond shipyards, says Americans understood the urgency of the Home Front war production:
“The government said they wanted foil to break communications; they wanted rubber, so the women donated their girdles . . . I don’t care what they wanted, they got it in cards and spades.
“The Germans were not fools (but). . . We had the most ships. We had the most planes. We had the most weapons because we out-produced them at home. They (the government) said ‘we need ships’ and we’re turning them out one a day.”
Home Front workers crave news of ships
On D-Day in Europe, Kaiser shipyard workers – like everyone else – were glued to the radio to hear the latest progress reports. The ships the men and women built didn’t just drop out of mind after they slid down the way and sailed into the fray to points around the world.
The shipyard population was hungry for any bit of news of the fate of the ships they launched. The Richmond shipyards weekly newsletter, Fore ‘N ‘Aft, carried a series of articles about where the ships were engaged.
“What Happens to Our Ships” was published April 14, 1944, just two months before D-Day. An anonymous writer/cook on the Liberty ship SS Robert E. Peary’s maiden voyage in 1942 wrote:
“On all of the seven seas, in all of the great offensives we have opened, Liberty ships have written indelible chapters into the saga of the present global conflict. Many of those Liberty ships were constructed in (Richmond Kaiser) Yards One and Two.”
Fastest-built Liberty sails the world
The SS Robert E. Peary was celebrated at its launch in November 1942 because workers had built it in four days, 15 hours and 29 minutes – setting a record as the fastest ship ever built.
Henry Kaiser took on a reporter’s challenge for the Richmond yards to beat the record Oregon shipyards workers had set in the 10-day construction of the Liberty ship SS Joseph N. Teal in September.
The SS Peary had participated in many battles in all theaters of the war by the time it got to France in June 1944. The Peary crew rescued American soldiers trapped near the beach of a Pacific island held by the Japanese in 1943, and in 1944 the ship headed to England where it carried men and equipment from Cardiff (Wales) to Omaha Beach on June 7, 1944.
Other Kaiser-built Liberty ships that took part in the massive D-Day invasion and subsequent missions in the English Channel included these four Richmond-built Liberty ships:
- The SS Joaquin Miller, the first Liberty ship to arrive in London in preparation for the Normandy attack;
- The SS J.D. Ross, recipient of a battle star for its part in the Normandy operation;
- The SS William Burnham, which was torpedoed by a German submarine in the English Channel losing 10 crew members and 8 Armed Guards; and
- The SS H.D. Blasdel, which was torpedoed by a German submarine in the English Channel. Seventy-six U.S. Army personnel died in the attack and the ship had to be scrapped. The Blasdel was carrying troops, tanks, trucks, jeeps and other mechanized equipment and was on its way to Utah Beach.
Three Liberties built in Kaiser’s Oregon shipyards were also there:
- The SS Cyrus McCormick, which was torpedoed by a German submarine off the coast of North Wales and lost 17 crew members and 12 members of the Armed Guard;
- The SS David Starr Jordan, which was bombed and strafed by German aircraft; and
- The SS Sambut, which was shelled and sunk in the Straits of Dover on June 6, 1944.
Keep building more ships
Many more bloody battles were yet to be fought before the Russians reached Berlin in May 1945 and Germany subsequently surrendered. In the Pacific Theater, Allied Forces would plot more D-Days to invade Pacific islands fiercely defended by the Japanese – Saipan, Guam, Iwo Jima, Okinawa – before the war could finally end in August 1945.
Days in the shipyards were charged with excitement in June 1944 as workers realized their sustained hard and speedy work was turning the tide of the war. But their work had to continue to supply ships for the brutal battle for the Pacific.
A “Fore ‘N ‘Aft” writer put it this way: “It’s this: the faster and better we build our ships, the quicker these sons of guns will get back to their girlfriends or their wives and kids. That’s the truth.”
, Heritage writer
Most new medical center openings are big. But the 1953 grand opening of the Kaiser Foundation Hospital in Los Angeles was really big.
With major support from unions, the Kaiser Foundation Health Plan membership was growing rapidly and the plan needed to expand its facilities, especially in Southern California where the longshoremen and retail clerk unions were swelling the ranks.
In 1953, founding physician Sidney Garfield, MD, presided over the opening of three state-of-the-art hospitals in California; one in San Francisco, one in Walnut Creek, and one in the heart of Los Angeles.
Kaiser Permanente’s move to expand its Southern California presence caught the eye of a rising star in the glamorous, show business city of Los Angeles.
Years before Chet Huntley (1911-1974) would become a trusted household name as a television news anchor, he was a radio reporter for the American Broadcasting Company. At 5:30 p.m. on June 24, 1953, Huntley told the country about the spanking new Kaiser Foundation facility.
Here are excerpts from his broadcast:
“It isn’t very often you see a new hospital these days. Our rate of building new hospitals, in spite of the tremendous need for them, is decidedly not one of our national strong points. So I was interested to see the new 3-million-dollar Kaiser-plan hospital in Los Angeles.
“The use of labor-saving devices, the use of light (both natural and artificial), the furnishings, the gadgets, the décor, and the personnel are all combined to make the new Kaiser Foundation Hospital something special.
“The plan is working so well that continued expansion of the Kaiser medical program seems certain. The hospitals and clinics are operating in the black by a margin sufficient to attract splendid medical talent.
“You can, however, listen to the debate and the controversy and perhaps ultimately you’ll decide that the best place to go for a reliable opinion is to the fellow who is paying for the Kaiser Foundation Health Plan and who is using it.
“Down the line, the customers go for it. Where else, they ask, could they get treatment, care, and medical attention like this for less than the daily cost of a bottle of milk, considerably less than the cost of a package of cigarettes.
“Although this isn’t true of all health plans, the Kaiser program allows the patient to choose his doctor from those on the staff. As one patient said, “What do you mean, doctor-patient relationship? There are 250 doctors here and surely out of that many I can find one with whom I can get along.”
In the ensuing decades, Kaiser Permanente has built many a new and evermore sophisticated medical center. This year, three brand new Kaiser Permanente hospitals have opened or are opening, including an amazing high-tech and green hospital in San Leandro, Calif.
Short link to this article: http://bit.ly/1nPHZTP
, Heritage writer
One of Henry J. Kaiser’s effective approaches to industrial productivity was his encouragement of nonpunitive competition. He believed that people perform their best when tested against peers, and the evidence suggests that he was right.
While building Grand Coulee Dam on the mighty Columbia River during the Great Depression, Kaiser divided the project into two parts.
Two work teams were pitted against each other to see who could finish first and most efficiently in constructing their part of “the largest block of concrete in North America.”
The workers in the seven Kaiser World War II West Coast shipyards saw competition of all kinds as a standard feature. One account of the time described the jockeying:
“Yards were set to competing with one another, and scoreboards showing competitors pulling away in ship deliveries had the effect on output per man-hour of a shot of Benzedrine.
A graveyard-shift crew bet that it could lay a keel faster than its swing-shift competitor and, to win a kitty of $600, reduced the operation from hours to minutes.
“Welders bet burners pints of blood for the Red Cross that they could do it better. But the chief prize was the right to christen a ship. Proudest launcher was an aged Chinese woman, who christened her ship in Chinese and cherished the same silver tray souvenir accorded such sponsors as Mrs. Eleanor Roosevelt.” [i]
The Kaiser shipyard newsletters – Fore ‘n’ Aft in Richmond, and Bos’n’s Whistle in the Northwest – actively documented and promoted news of these competitive challenges. The rewards were often in the form of War Bonds, reinforcing the social good and patriotic nature of the goal.
Since Kaiser’s approach to building ships – like products in an assembly line – was new and evolving, there was a legitimate need for innovation and shop-floor creativity. Workers were always coming up with – and rewarded for – more effective and efficient approaches to their jobs. And, as at Grand Coulee Dam, crews and yards competed for top honors and bragging rights.
American ‘athletic industrialism’
One scholar suggests that this was a phenomenon of “athletic industrialism” that fused the two chief domains of competition in America: capitalism and sports.[ii]
“. . . Athletic industrialism did not merely rally workers, exploit them in a grand speed-up, or turn work into a game of outwitting management.
“Rather, athletic industrialism focused workers on the overarching goal of maximum output and offered an array of means to that end: attempts to set shipbuilding-speed records, Maritime Commission programs to laud the most productive shipyards, output contests for welders and other craft workers, campaigns to elicit labor-process improvements from workers.
“More importantly, athletic industrialism fused workers into coherent units while also pitting groups against others in rules-bound competition.”
Striving for excellence in 2014
Today’s health care worksite may not be the war-driven frenzy of the Kaiser shipyards, but it nonetheless relies on worker wisdom to serve Kaiser Permanente members. The Kaiser Permanente Labor Management Partnership’s unit-based teams continue the tradition of healthy competition to achieve results.
Here are but two examples:
An industrial kitchen can be a danger zone, with its sharp knives, wet floors, grease and hot temperatures. It’s a challenge to be safe and efficient, but between July 2010 and June 2011 the Food and Nutrition Department at Southern California’s Panorama City Medical Center dramatically improved its safety record.
The department divided into two teams and sponsored a friendly competition for a pair of movie tickets. This motivated – and liberated – the staff to approach their colleagues who might be performing a task unsafely and suggest an alternative approach.
In 2010 the number of after-visit summaries given to patients at Southern California’s Kaiser Permanente South Bay Medical Center had slipped, resulting in a high number of patient calls and reduced patient satisfaction. The staff set up a friendly competition to see who could have the best improvement in the rate of after-visit summaries printed.
The Urology and General Surgery Department improved its numbers by 45 percent and the General Surgery Department improved by 56 percent. John E. Chew, director of care experience for General Surgery and Urology, remarked: “The best solutions come from the front-line staff. We’ve always known that, but UBTs give it a structure.”
Competing for better health
Kaiser Permanente employees and physicians are also tempted to improve their health through competition. Last year Kaiser Permanente launched the Spring into Summer KP Walk! Challenge.
Participants registered online; if they logged at least 150 minutes of walking through the end of June, they were entered in a weekly random drawing for prizes that included a solar cell phone charger, a gym bag, and a 4-in-1 tote bag.
Teri O’Neal, RN, was inspired to start walking by coworkers and joined the challenge to help keep her motivated on her journey to better health.
“When I first started, after half an hour I was so exhausted that I had to go home and straight to sleep. But I kept at it.”
Now, Teri has completed several triathlons, two marathons, and a Spartan race. “When I completed that first triathlon and I got my medal, I felt so proud. And it’s nice to be able to look back and see how far I’ve come.”
This year’s Spring into Summer challenge is team-based, with the teams in the top three places winning prizes.
The Kaiser experience, from Grand Coulee Dam to today, shows that healthy competition, whether among wartime shipyard workers or today’s health care employees, is truly a “win-win” situation.
Shortlink to this article: http://bit.ly/1pB3h7l
[i] The Truth About Henry Kaiser,” three-part series by Lester Velie in Collier’s, July-August 1946
[ii] “Launching a Thousand Ships: Entrepreneurs, War Workers, and the State in American Shipbuilding, 1940-1945,” unpublished dissertation by Christopher James Tassava, Northwestern University, June 2003.