George Halvorson was chairman and CEO of Kaiser Permanente from 2002 to 2013. In a recent oral history, he outlined his support for the role of the organization in celebrating and sharing its heritage.
“History is an asset to Kaiser Permanente for a number of reasons. One, it’s a good thing for us to have a sense of who we are and what our values are. I’ve talked about culture a number of times, but when people are making decisions in their day-to-day context, if people have a sense of what the culture is and what the historical legacy is, that helps guide the decisionmaking in positive ways. It’s good for people’s morale to have a sense of being part of an organization that has a history and a culture and a legacy. It gives people a sense of us, to be part of a culture and to be part of a legacy.
“I gave a talk in Washington state a short while ago … I said, ‘Anybody in this room from Kaiser Permanente?’ A couple of people raised their hand. I said, ‘Do you know the story of Sidney Garfield and the nails?’
[This is the anecdote about how Dr. Garfield’s commitment to accident prevention for the workers on the Colorado River Aqueduct Project in the 1930s led him to have staff pull dangerous nails from boards on the site, a preventive routine he carried forward at Grand Coulee Dam in Washington.]
They both said yes. They got it, and I said, ‘I should have you tell the story,’ but I told it. The story is told often enough because it says, ‘Sidney is our founder, Sidney is our giant, Sidney didn’t just look at after-the-fact heart attacks. He looked at how you go upstream.’ The nail story is a good story.
“Another thing that really is positive about the history is because we’re an organization with history, people in important jobs actually will periodically do important things in a good way because they’re thinking of their historical record. I’ve heard many people talk about my role in the history, when the history of Kaiser Permanente is written, I want it to show that I did this.
So, people knowing that we have a history—a legacy and a history—care about what their position’s going to be in that history. I think we benefit from that because I think some people do better, smarter, brighter, more effective things because they’re positioning themselves for their description in the history of Kaiser Permanente. So, I think our history benefits us as an inspiration for doing good things.
“We have a department that provides historical pieces. You could have a staff meeting and use the history of Kaiser Permanente as an example of why we should do a particular thing. The fact that we were the first people to put medical information on punch cards comes up with some regularity, and it’s used as evidence that this is a good trajectory for us to be on, and in fact, it’s one we’ve been on for a long time.
Those stories get told deliberately by people to make their points, to illustrate their points, and they also get told in the internal publications. It’s one of those things that once you read one of those stories, you’re likely to remember it. It’s a paradigm-changing story, to know that we had rooms full of punch cards as we were trying to build the very first generations of medical records, that is a memorable thing and it makes the point that this is a good thing for us to do. It’s the right context for us to be in.”
Excerpted from “George Halvorson: Kaiser Permanente Leader and Health Care Advocate” conducted by Martin Meeker in 2013-2014, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 2016.
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By Ginny McPartland, Heritage writer
More than 100 years of social and political history is told vividly through the lives of the 39 figures represented in the monumental bronze sculpture whose final section was dedicated on May 31 in Oakland, Calif. Kaiser Permanente’s retiring CEO George Halvorson and incoming Chairman and CEO Bernard Tyson both spoke at the ceremony that unveiled the final installment of the public art. Kaiser Permanente is one of the donors that helped fund the piece located in the Henry J. Kaiser Memorial Park. Political leaders, civil rights activists shine The newest section, the “Visual Wall” with notes in Braille, features five heroes: writer Cincinnatus Hiner “Joaquin” Miller who called Oakland home; British Prime Minister Winston Churchill; South Africa’s Nelson Mandela; gay rights leader and San Francisco Supervisor Harvey Milk; Oakland humanitarian “Mother” Mary Ann Wright; and Fred Korematsu, champion of the rights of the West Coast Japanese interned during World War II. Leaders of the African-American Civil Rights Movement represented in artist Mario Chiodo’s massive installation include: activists and ministers Martin Luther King, Jr., and Ralph Abernathy; activist in her own right Coretta Scott King; poet and playwright Maya Angelou; Rosa Parks, who refused to give her bus seat to a white man in Montgomery, Alabama, in 1955; Black nationalist and leader Malcolm X; and Ruby Bridges, who at age 6 in 1960 was the first black student to attend an all-white elementary school in the South.
Abolitionists and farm worker advocates honored
Chiodo’s busts of historic figures responsible for moving along the campaign to abolish slavery include: Abraham Lincoln, freed slave and activist Frederick Douglass and Susan B. Anthony, who fought to free blacks from slavery and women from second-class citizenship in the 19th century. The quest for equal rights for the disabled is represented in the bronze image of Helen Keller; farm workers’ rights with Cesar Chavez; Native American rights with Chief Joseph, head of the Nez Perce Nation; and human rights for Latin Americans with the likeness of activist Rigoberta Menchu Tum. Leaders of the struggle for justice in the East are: the “Unknown Rebel of Tiananmen Square;” Mahatma Gandhi, the pacifist who led India to independence from British rule; Shirin Ebadi, Nobel Peace Prize winner and activist for human rights in the Middle East; Thich Nhat Hanh, Vietnamese Buddhist monk and anti-war activist; and Mother Teresa, also a Nobel Peace Prize winner, who spent her life taking care of the poor in India.
Oakland notables in the mix
“Local Champions” are Royal Towns, one of Oakland’s first African-American firefighters; John Grubensky, an Oakland police officer who died while rescuing residents in the 1991 Oakland Hills Fire; an unknown Ohlone woman; Carmen Flores, a young Mexican artist; industrialist Henry J. Kaiser; writer Joaquin Miller; and the first black superintendent of the Oakland Unified School District, Marcus Foster, who was assassinated by the Symbionese Liberation Army in 1973. Also in the display are: Josie de la Cruz, first woman recruiter for the United Farm Workers; Ina Coolbrith, the first librarian of the Oakland City Library and California’s first Poet Laureate; naturalist Ansel Hall; Oakland community leader Joyce Taylor; Korematsu; Mother Wright, founder of the Mother Mary Ann Wright Foundation, which feeds more than 450 people a day; and Oleta Kirk Abrams, one of the founders of Bay Area Women Against Rape in 1971. Visitors to this powerful tribute to these humanitarian giants can learn much about the historic trials and triumphs of the creation and preservation of global democracy.
By Lincoln Cushing, Heritage writer
What is the right way to reward creativity and hard work? What is an appropriate balance between corporate ownership and the public good? These issues form the root of copyright and patent law and have shifted over time and place.
Contrary to the practices of most major companies, however, Kaiser Permanente – and its earlier entity, Kaiser Industries – have long embraced the concept that sharing is not only good for the community, it’s responsible organizational practice.
On November 17, 1942, Henry J. Kaiser recommended that an independent federal agency be formed to license all new inventions and to distribute their benefits throughout industry.
His comments were published in many news outlets, including Billboard magazine’s December 1942 issue:
“Original ideas, suggestions and developments should be interchanged among allied industries, such as airplane (production) and shipbuilding and the steel industry,” Kaiser told a U.S. Senate military subcommittee studying technological mobilization.
He said he thought his position might be considered revolutionary, but added: “Industry will be more productive if patents are available to all industries able to use them. (After the war), compensation for their use should go to the individual as an incentive and not to the company that employs him (or her).”
Billboard’s article reported, “Workers in the Kaiser shipyards are encouraged to submit new ideas and techniques, and a prize is awarded each week for the best suggestion. In addition, the author of an accepted proposal works with an engineer in preparing sketches to illustrate an improved process.”
Kaiser told the committee that his industries made their data available to other builders, and likewise, he benefited from the findings of others.
Sharing tradition continues
That “revolutionary” position was not just a flash in the pan. Kaiser Permanente, Henry J. Kaiser’s most enduring legacy, has continued that tradition.
Kaiser Permanente’s fourth CEO, George Halvorson, who has led the organization since 2002, has long supported an open approach to innovation.
Some of these initiatives include:
The Care Connectivity Consortium includes Kaiser Permanente, the Mayo Clinic, Geisinger Health System of Pennsylvania, Intermountain Healthcare based in Utah, and Group Health Cooperative, based in Seattle.
The consortium is dedicated to developing systems that will allow seamless sharing of health information among provider groups.
The consortium is also committed to working toward a future where timely access to health information improves the quality of care for all patients.
The Partnership for Quality Care is a coalition of not-for-profit health care providers and health care workers dedicated to guaranteed, affordable, high-quality health care for every man, woman, and child in America. The partnership strives to improve patient care as well as prevent and treat chronic conditions by sharing best practices.
Members include Kaiser Permanente, several units of the Service Employees International Union, the Greater New York Hospital Association, Group Health Cooperative and HealthPartners in Minnesota.
In 2008, Kaiser Permanente CEO Halvorson noted: “Leading health care providers have already implemented programs that contain costs, expand access, and most importantly, improve the quality of care for chronic patients. That points the way to nationwide reform.”
Banding together to beat HIV
The HIV Interregional Initiative, a cooperative effort among all Kaiser Permanente regions and Group Health Cooperative, represents the second largest provider of integrated HIV care in the United States; the largest provider is the Veterans Administration.
Sponsors of the initiative are Kaiser Permanente Foundation Health Plan and The Permanente Federation, which represents the national interests of the Permanente Medical Groups.
The Care Management Institute, a partnership between the federation and the health plan, has developed the first clinical guidelines in the United States for HIV/AIDS treatment and the appropriate use of related drugs.
The HIV Interregional Initiative works with Kaiser Permanente’s national pharmacy purchasers to get the best prices for HIV drugs. Research using Kaiser Permanente’s electronic health records has led to exceptional success in treating patients with HIV.
In 2012, Robert Pearl, MD, executive director and CEO of The Permanente Medical Group, noted: “Our success in the treatment of patients with HIV/AIDS results from the excellence of our clinicians, our advanced [information technology] systems, our integrated delivery system and our effective coordination across specialties.”
Kaiser Permanente assists health care providers and community health clinics across the country in improving their HIV patient care by sharing its clinical best practices, provider and patient education materials, training and other expertise.
Genetic research for better chronic care
The Kaiser Permanente Research Program on Genes, Environment, and Health is one of the largest research projects in the United States to examine the genetic and environmental factors that can increase risk for chronic conditions such as heart disease, cancer, diabetes, high blood pressure, Alzheimer’s disease, and asthma.
With DNA collected from 500,000 consenting California health plan members, the project will link comprehensive electronic health records, data on relevant behavioral and environmental factors, as well as genetic information.
Working in collaboration with other scientists across the nation and around the world, researchers hope to translate project findings into improvements in preventive care and treatment.
Henry J. Kaiser started something in 1942 that continues to drive Kaiser Permanente’s quest, 71 years later, to improve health care and access to treatment for all Americans.
By Lincoln Cushing, Heritage writer
In January 2011, Kaiser Permanente launched the “Every Body Walk!” public awareness campaign. Chairman and CEO George Halvorson kicked off the initiative in his weekly celebration letter to all employees and physicians on January 14, 2011:
“It is time to celebrate walking. There are very few things that we can do that have a more positive impact on our health and our lives than walking. . . Kaiser Permanente is on a new path, so to speak, to encourage everyone in America who can safely walk, to walk. The theme is — Every Body Walk!”
Walking a prescription for health
Bob Sallis, MD, family physician at Kaiser Permanente Fontana (Calif.) Medical Center and the national spokesperson for the campaign, described the goals for Every Body Walk:
“The aim of the campaign is to inform Americans about the tremendous health benefits of walking. Walking is an excellent form of exercise for everyone. For those with conditions like diabetes, asthma, heart disease and depression, a regular walking regimen has the added benefit of helping to manage these diseases.
“I’m a strong believer in the power of walking and that’s why I literally prescribe it to my patients as front-line medicine — often in place of medications.”
From a public health point of view, the campaign is important because it addresses the many people that don’t get what is commonly thought of as “regular exercise” – going to a gym, playing tennis, or riding a bicycle.
Every Body Walk! encourages a modest amount of activity, thus opening up a new path to healthy behavior for millions of people. The campaign provides news and resources on walking, health information, walking maps, help in finding walking groups, as well as a place to share stories about individual experiences with walking.
Research validates value of walking
Medical research shows that walking 30 minutes a day, five days a week, can prevent the onset of chronic diseases, or help manage them. The roots of this prescription can be found in a 1996 report by the U.S. Department of Health and Human Services, Physical activity and health: A report of the Surgeon General.[i]
The research supports the common-sense and empowering notion that some exercise is better than none, and any approach to encourage activity will have positive health benefits:
“Emphasizing the amount rather than the intensity of physical activity offers more options for people to incorporate physical activity into their daily lives. Thus, a moderate amount of activity can be obtained in a 30-minute brisk walk, 30 minutes of lawn mowing or raking leaves, a 15-minute run, or 45 minutes of playing volleyball, and these activities can be varied from day to day . . . Through a modest increase in daily activity, most Americans can improve their health and quality of life.”
Recent studies confirm concept
Subsequent medical research amplified the benefits. A 2002 study by the Centers for Disease Control and Prevention found that patients who ate a healthy diet and engaged in moderate physical activity for 30 minutes a day, five days a week, reduced their risk of getting Type 2 diabetes by 58 percent.[ii]
A 2010 prostate cancer study found: “A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for less than three hours a week may substantially improve prostate cancer-specific survival.”[iii]
Recent research at Oregon State University’s College of Public Health and Human Sciences suggests the health benefits of small amounts of activity – even one- and two-minute increments that add up to 30 minutes per day – can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.
The study, which involved a broad demographic of more than 6,000 American adults, shows that an active lifestyle approach, as opposed to structured exercise, may be just as effective in improving health, including the prevention of metabolic syndrome, high blood pressure, and high cholesterol. Lead author of the study, Paul Loprinzi, explains:
“We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking.”[iv]
Garfield walks, jogs in desert
At Kaiser Permanente, innovation is usually framed in the context of deep previous experience. In the mid-1930s, founding physician Sidney R. Garfield, MD, was running a clinic in the Mojave Desert for the workers on the Colorado River Aqueduct project. Guess how the clinic staff stayed fit?
“When we were at the hospital (walking) is what the staff did all the time for keeping fit (and for) exercise, except we’d jog – yeah, we would run, but we’d wait until the sun went down, go out and jog and then would walk along. And about that time the rattlesnakes would come out, and then we’d really jog.”[v]
History is repeating itself, and we’re all the better for it.
See “Gift of Walking,” a short video featuring Kaiser Permanente Chairman and CEO George Halvorson.
Short URL for this story: http://bit.ly/WHcZbv
Reducing the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine has published a new article by Knowler WC, Barrett-Connor E, Fowler SE, et al entitled “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med 2002 Feb 7;346(6):393–403.
By Ginny McPartland
Seventh in a series
In 1989, Southern California quality guy Sam Sapin, MD, made a prescient plea to KP leadership: invest in information technology to improve quality of care. Having worked on quality issues for decades, Sapin saw the need for a KP database to be shared among all regions.
“This would allow us to compare ourselves to each other,” Sapin told a gathering of KP quality professionals. He continued: “The data must be accurate, otherwise one loses credibility and effectiveness. The data must be timely, not two to three years old, because the environment changes quickly these days. . .We need to develop data that will show the outside world – the public, employers and legislators – how good we are.”
Twenty-two years later, KP is positioned to capture detailed patient data across all KP regions and to analyze it in many different ways to learn what’s working and what isn’t. With an abundance of data, KP can not only record adherence to best clinical practices, but also potentially figure out more precisely how treatment affects outcomes.
Halvorson’s big initiative to improve quality with data
In 2002 when George Halvorson took over Kaiser Permanente as president and CEO, the Care Management Institute was well on its way to performing the essential function of developing and sharing best practices among all KP physicians. But Halvorson, acutely interested and knowledgeable about medical information systems, was not satisfied that KP was on the path to develop a patient data system that would support his vision for quality improvement.
He brought in Louise Liang, a physician, medical director and quality professional who had worked closely with Total Quality Management expert Donald Berwick at the Institute for Healthcare Improvement (IHI). She led the program-wide monumental task of finding an appropriate vendor, figuring out the best software and driving the implementation of KP HealthConnect, ultimately the data collection and interpretation system that would transform Kaiser Permanente’s ability to assess and improve quality.
In 2005, KP reorganized its quality management structure, creating the KP National Quality Committee (KPNQC), which took the place of the Medical Directors’ Quality Committee. The NPNQC oversees all quality activities for hospitals, outpatient clinics, and outside care for all KP regions.
Value of data to quality measurement
“Having data is extremely important,” Halvorson told the editors of the NCQA 20th anniversary report. “Whenever you have data you can reach conclusions and you can change process, you can re-engineer, you can make things better. But if you don’t have data, you don’t have any particular direction to go.”
He adds, “There is an evolution from process to outcomes, and measuring the mortality rate for different conditions is a wonderful measurement, sort of the ultimate definition of outcome. Measuring process is good, and a far better thing than not measuring quality at all, but organizations really need to focus on what happens to each person. How many people have failing kidneys is a great measurement.”
NCQA president validates KP success in quality improvement
In her 20-year assessment of NCQA’s success in improving quality of care, President Margaret E. O’Kane concludes: “Our hard work has led to many gratifying and exciting results. In Northern California, for example, Kaiser Permanente has demonstrated that aggressive management of patients with coronary artery disease (CAD) pays off in the most important ways: fewer deaths.
“CAD is the leading cause of death in every other county across the U.S., but for Kaiser (Permanente) patients in Northern California it is second. This confirms that when quality measurement and science meet, patients benefit,” she wrote.
KP’s electronic medical record system also makes it possible for physicians to access a patient’s full medical history anytime in any KP facility.
“You never ever have to make a clinical decision about a patient without information,” Andy Weisenthal, KP pediatrician and quality expert, told Charles Kenney, author of Best Practices: How the new quality movement is transforming medicine.” He adds, “I cannot tell you what that means to me as a doctor.”
Has Kaiser Permanente been successful in demonstrating its high quality of care? The abundance of accolades showered onto the KP medical care program over the past decade speaks for itself.
In the fall of 2011, KP received the highest rating in 11 effectiveness measures – more than any other health plan in the nation – in the 2011 NCQA’s Quality Compass results.
KP also won J.D. Power & Associates first place awards, as well as the prestigious Davies Award for KP HealthConnect, the patient data system.
KP also distinguished itself by garnering Medicare five-star awards in five regions, outstripping other health plans in California, Hawaii, Colorado and parts of the Northwest. Only nine Medicare plans in the country earned five stars for the overall 2012 Medicare star quality rating.
Next time: Sam Sapin: Southern California pediatrician’s career parallels KP’s quest for best quality
To learn more about KP current quality honors:
By Ginny McPartland
World War II changed everything. Women dared to strike out for the first time into a man’s world of work. America’s harbors sprouted hyperactive shipyards, and a burgeoning U.S. heavy industry turned out the steady stream of weapons and vehicles needed to outlast our enemies. “We won the war because we out-produced everyone else,” observed Lucille “Penny” Price, a Richmond, California, shipyard electrician during the war.
A grateful American society has been thanking the stereotypical “Rosie the Riveter” for her role in war production ever since the war ended 65 years ago. About 25 percent of the hundreds of thousands of West Coast shipyard workers were women, but the park is really dedicated to all home front workers – welders, electricians, pipe fitters, cleaners, helpers – everyone.
Telling the “Rosie” stories, as well as chronicling the dramatic societal changes the war spawned, is the mission of the Rosie the Riveter/World War II National Historical Park in Richmond. The park sits on the Richmond waterfront where the wartime Kaiser shipyards were situated.
Celebrating World War II’s home front legacy
As the nation marks the 65th anniversary of the war’s end this year, the Rosie park celebrates its 10 years as an institution dedicated to keeping the lessons of World War II from being forgotten. Kaiser Permanente, whose medical care program started in the Kaiser West Coast shipyards in 1945, also celebrates its decade-long association with the park to keep the war’s legacy alive.
The powerful synergy of the national park-Kaiser Permanente partnership was highlighted at a recent party to raise funds for the Rosie the Riveter National Park Trust. Debley was guest speaker and gave his talk about the history of health care reform.
About 150 people attended the annual event in the old cafeteria on the former site of Kaiser Shipyard No.3, raising $38,000 for various trust community projects. These projects include Rosie’s Girls, a summer camp for adolescent girls; restoration of Atchison Village wartime housing, which is on the National Register of Historic Places thanks to work by the Rosie trust. You can find out more about trust projects at http://www.rosietheriveter.org
The cafeteria, an ugly duckling the day before, was transformed into a lovely swan by Saturday night. NPS Ranger Elizabeth Tucker, along with Rosie Trust dinner co-chairperson Jane Bartke and others, dressed up the place with a couple hundred posters, photos and other war era artifacts. Rosemary Blaylock, a friend of Bartke, collected products and household items that recalled a simpler time before the war. She made up see-through packets that contained wartime candies M&Ms, malt balls, and bite-size York’s Peppermint patties.
Among the guests at dinner was a sunny Kaiser Permanente President and CEO George Halvorson and his photographer wife Lorie Halvorson; pioneering Permanente physicians Morris Collen and Ed Schoen, who treated shipyard workers; Diane Hedler, director of Quality for the Permanente Federation and Rosie trust board member; Alide Chase, senior vice president of Quality and Safety; Robert Erickson, retired chief counsel for Kaiser Foundation Health Plan and Hospitals; Glen Hentges, chief financial officer for the Permanente Federation; Clair Lisker, retired hospital nursing administrator and educator, her family including her son Wes Lisker a physician at Hayward Medical Center; John August, executive director of the Coalition of Kaiser Permanente Unions; Dianne Dunlap, August’s deputy and member of the Rosie trust board; Holly Potter, vice president, public relations and stakeholder management, Brand Strategy, Communications and Public Relations; Bill Graber, Kaiser Foundation Health Plan and Hospitals Board of Directors member; Richard Reed, senior project manager, Health Plan Process Administration; and Mark Aquino, Patient Care Services.
Of course, the national park service was well represented by Ranger Betty Soskin Reid, our most celebrated local Rosie who worked in the shipyards and is the oldest ranger in the park system; park Superintendent Martha Lee; Ric Borjes, Chief of Cultural Resources for four Bay area park sites; and Elizabeth Tucker, park ranger and all-around get-things-done person. Other special guests of the night were Bernice Grimes, of Walnut Creek, who was a scaler at the Kaiser shipyards, Mary Gillum, of Portland, Ore., who was a machinist in an Oregon Kaiser shipyard, and Marian Sousa, a draftswoman in Shipyard #3.
Rosie Marian Wynn, a wartime pipe welder, Marjorie Hill, a Red Oak Victory volunteer, Amanita Cornejo, a Contra Costa College volunteer, and Marian Sousa helped with set-up and clean-up for the dinner.