Posts Tagged ‘Health Education’

Looking Through You: How a Kaiser Permanente Nurse Transformed Health Education

posted on May 4, 2017

Transparent woman on cover of 1967 Kaiser Foundation Medical Care Program report.

Lincoln Cushing
Heritage writer


In 1967, wife and husband Bobbie and Morrie Collen toured Montreal’s Expo 67 and were transfixed by a pair of transparent mannequins that rotated and lit up to reveal organs and display physiology. They later purchased the figures and shipped them back to Oakland to become the centerpiece of a major Kaiser Permanente health education program led by Bobbie.

Frances Bobbie Collen (née Diner, 1914-1996; always called Bobbie, never Frances) was an accomplished professional as well as being the wife of Morris “Morrie” Collen, MD. She was a nurse with a master’s degree in health education, and was the force behind the groundbreaking Health Education Research Center at the Kaiser Permanente Oakland hospital.

Bobbie graduated from Winnipeg (Canada) General Hospital as a Registered Nurse in 1937 and worked at the University of Minnesota Hospital where she met her future husband, Morrie. They wed secretly when he was a medical student because the university hospital would not hire married nurses. Later they moved to Chicago where he interned at Michael Reese Hospital and she was the evening supervisor at the Meyer House patient wing. While there she also a graduate student at the University of Chicago in Nursing Education.

Bobbie Collen, RN, circa 1980.

In 1939 the Collens moved to California where Dr. Collen began his residency at Los Angeles County Hospital. When World War II began, Dr. Collen’s 4-F status due to asthma kept him from serving in the military, but the Permanente health plan was ramping up to care for defense industry workers. Dr. Collen was one of the first ten physicians hired by Kaiser Permanente’s founding physician, Sidney Garfield, MD.

Bobbie was a founding member of the Permanente Medical Wives in Oakland, an important support group during the challenging postwar years. Dr. Collen’s oral history credits the group as a key factor in the success of Permanente medicine.

But it was Bobbie’s role in patient education that would be her lasting legacy in the advancement of health care. Dr. Garfield asked her to be the Director of the Educational Research Center in the spring of 1967: “Start with the development of a Health Exhibits Theater as an adjunct to our planned health care program for the healthy in our Health Plan membership, because this first step will be the easiest.”

Dr. Garfield with transparent man in Health Education Center

In May 1967 Bobbie submitted her thesis “Factors Associated with Continuing Education of Adult Women” for a Master of Arts in Education at U.C. Berkeley. Then the Collens toured a dozen facilities on the East Coast, including the Cleveland Health Museum and the Lankenau Hospital Education Center in Philadelphia.

Her field work in reviewing health education displays led her to this conclusion:

In my opinion, they have all missed one important feature which is a further step forward in preventive medicine, and that is, to demonstrate not only what the body looks like on the inside, and how it functions, but also how to care for it to keep it healthy. Here I think exists the potential which, when materialized in the shape of a Health Exhibits Theater, will provide a service to our membership that is unique in the country.

The Health Education Research Center at 3779 Piedmont Avenue in Oakland (next to the Kaiser Permanente Oakland hospital) opened its doors in January 1969 as a supporting function for Dr. Collen’s Multiphasic Health Testing Services.

The Principal Investigator for the demonstration research project was Krikor Soghikian, MD, and Bobbie Collen was the Education Director. The U.S. Public Health Service partially supported the Center through the Kaiser Foundation Research Institute because of the research component and its potential application elsewhere in the nation.

One key feature of the Center was the Health Education Library which opened July 1969, equipped with 24 individual projection booths for viewing films, slide-sound programs, and videotaped TV programs.  A patient would visit the library with a physician’s “prescription” to see a specific program.  Adjacent to the Library was an exhibit area that featured the transparent man and woman, a variety of health exhibits, and a children’s area with educational games, toys, and play figures. Later, when the Center was relocated, the children’s section included a doll with leg braces, a stuffed elephant with a hearing aid, and a monkey in a wheelchair.

Caren Quay, MLS, started as the Center’s first librarian in 1970. She recalled that from the beginning visitors requested more information, so she began to build an extensive collection of books and audiovisual materials, with every title reviewed by Permanente Medical Group physicians.

The health librarian would retrieve the prescribed audio-visual program from the files and play it on the projector in the individual’s booth. The list of educational videos grew to over 250 titles; a notation on one of the librarian’s catalogs records that the most popular subjects were stress, nutrition, birth control, breast self-examination, headaches, lifestyles, and high blood pressure.

Health Education Library for Patients, librarian Caren Quay at desk, circa 1974.

The program was quite successful. Audio-visual requests grew from 98 in 1969 to almost 8,000 by mid-1973. Attendance for women was triple that of men. Dr. Collen reflected on how well it reached members of the community:

They would bring in schoolchildren from all over Oakland, who would come in and go through this health education center. They would look at the exhibits—there was a normal lung and a smoker, smoker’s black lung, and I think that helped a lot of kids realize what smoking can do.

After Dr. Garfield and Mrs. Collen passed away (1984 and 1996, respectively) the education display lost its primary advocates. The grant money ran out and the Oakland hospital needed the space. The transparent man and woman went to U.C. Berkeley’s Lawrence Hall of Science. But what continued was an expanding role for health educators and the growth of health education centers at the Kaiser Permanente medical centers for patients and members of the community.

Health Education Library, 1978.

Ms. Quay later became the health information specialist in Northern California’s department of Patient Education and Health Promotion, and recently reflected on the legacy of the program:

The Health Library broke ground as the first library I know of in the U.S. to provide health and medical information to the lay person. It was the model and inspiration (and then flagship, resource, and consulting lead) for health education centers that provided health information (and more) for the Kaiser Permanente Medical Centers throughout Northern California and, eventually, for the other regions of the Medical Care Program. The library served as a model for Planetree in San Francisco and for others throughout the country.

Dr. Collen lamented in his oral history that “[Bobbie] doesn’t get enough credit . . . for all the things she contributed.”

On this Nurses Week we thank Bobbie Collen, RN, for improving public health through education.


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Fontana’s Sinister Garden

posted on December 11, 2013

by Lincoln Cushing, Heritage writer

Sinister Garden1

Dr. Guy Hartman, pediatrician, and Franklin Boeckman, hospital administrator, take a look at the expanded Sinister Garden at the Kaiser Permanente Fontana Medical Center, 1976.

In 1974 physicians at Kaiser Permanente Fontana (Calif.) Medical Center planted a most unusual garden at the center’s entrance. Behind a fence and locked gate they displayed 17 common poisonous plants found in homes and gardens, and called the collection the Sinister Garden – complete with a warning skull.

Pediatrician Guy Hartman, MD, (1922-2008) was concerned about the high number of local cases – as many as 300 in 1973 – that resulted from ingesting poisonous vegetation. “Children who are 4 years of age are our most frequent patients,” he told reporters. “This is the age of curiosity for these youngsters who are learning about their world by touching, feeling, and tasting just about everything.”

Dr. Hartman became interested in poisonous plants as a Boy Scout master in Southern California. “While working on a Scout project, we discovered that many common ornamental house and garden plants contain enough poison that, if accidentally eaten, could kill an entire family.” [i]

His garden was actively used for teaching. All plants were labeled and keyed to an exhibit sign explaining what the plants were named, which parts were poisonous, and what symptoms would occur if the plants were eaten. Busloads of children were brought to the garden to hear his warnings about castor beans, oleander, and wild mushrooms, to name a few.  In 1976 the positive response led to the garden more than doubling in size, to 49 plants.

Around that time the pediatrics department produced a short video to broadcast the message, using a hand puppet named Amigo to charm the children. They also published a seven-page booklet, Welcome to the Sinister Garden.

In 1986 Kaiser Permanente’s Rockwood Clinic in Gresham, Oregon, installed its own garden, also as a response to local children’s poisonings. And in 1988, the physician-in-charge Thomas Hartman, MD, (no relation) planted a sinister garden at the old Bellflower (now Downey) service area at the Kaiser Permanente Imperial Medical Offices.

The garden in Fontana continues to be maintained and modernized, with landscape architecture students from nearby Cal Poly Pomona using it for design projects.


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[i] “Enlarged Sinister Garden Flourishes,” Kaiser Permanente Insight (Southern California), Fall 1976

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Healthy lifestyles: tough to achieve, worth the effort

posted on May 31, 2013

By Ginny McPartland, Heritage writer

Kaiser Permanente’s Northwest Region initiated its Freedom from Fat program in 1989. Exercise was an integral part of the healthy living program. This photo of Donna Dean, a Health Plan member, William Cooper, associate regional manager of the Northwest Region, and Chris Overton, health education staff member, appeared on the cover of the Spring 1989 Spectrum, a magazine for Kaiser Permanente employees.

Kaiser Permanente founding physician Sidney Garfield caught on early that changing people’s habits would have positive results for their health. Urging his patients to avoid accidents by following safety guidelines and eating right to avoid health problems was a no-brainer for Garfield. Everyone would be happier and healthier, and the need for costly medical care could be minimized.

Voila! Prepaid care with an emphasis on prevention. Garfield adopted this theme in 1933, and Kaiser Permanente leaders have held this as a predominant tenet ever since.

Garfield’s interest in nutrition and exercise programs for shipyard workers in the 1940s, multiphasic examinations (annual physicals) in the 1950s, data processing of patient records in the 1960s, health education centers in the 1970s and the Total Health Project in the 1980s all fed into the push to promote healthy lifestyles and prevent illness.

Newsletters in the World War II Kaiser shipyards constantly reminded workers to eat three square meals a day and avoid too much fat and sugar. “Are you starving?” one article asked. “You can be starved without being hungry. . . Are you aware: 24 million man-hours per month (nationally) are lost through minor illnesses preventable by better nutrition?”

‘Are You Starving’ article in the Oct. 6, 1944, issue of the Kaiser Richmond Shipyard newsletter Fore ‘N Aft. The message: Eat healthy food and stay fit.

The Kaiser child care centers served healthy meals, and parents could buy nutritious family dinners to take home when they collected their offspring at the end of the day. Shipyard management sponsored intramural sports teams to help workers blow off steam and stay fit.

Screening workers for unhealthy habits

In 1950 Dr. Garfield responded to labor leader Harry Bridges’ request for a preventive care screening program for the members of his longshoremen’s and warehousemen’s union. The examinations, union-mandated for all workers, highlighted lifestyle problems and educated the men on how to avoid heart disease and other chronic illness.

In the 1960s, the first computer technology recorded the examination results so physicians could track their patients’ progress electronically and identify trends that could aid in the care and treatment of other patients, even in subsequent decades.

The 1970s saw the debut of the health education centers in which patients could seek disease prevention information and partake in groundbreaking programs to help them maintain healthy lifestyles and a healthy weight. (This was the beginning of Kaiser Permanente’s Healthy Living centers that offer a myriad of programs designed to preserve good physical and mental health and help patients manage chronic conditions.)

Health appraisal gains momentum

Health appraisal programs were established in a number of Kaiser Permanente locations, and healthy members were encouraged to visit the clinic when they were well, not just when illness struck. They filled out questionnaires and discussed their health status with practitioners who tracked their lifestyles and gave advice on staying well.

The transparent woman was a prominent exhibit in the first Oakland Health Education Center. Instructors could light up various parts of the body and describe the functions for visitors to the center. This photo appeared on the cover of the Kaiser Permanente’s 1967 annual report.

In the 1980s, Dr. Garfield conducted the Total Health research project in which he expanded the health assessment theme and had new well members diverted to a Total Health Center in which the emphasis was on promoting healthy lifestyles.

In the 1990s, Kaiser Permanente researchers participated in studies to test the success of a dietary regimen meant to reduce blood pressure and help prevent heart attacks and strokes. The Dietary Approaches to Stop Hypertension approach called for a healthy diet rich in fruits, vegetables, whole grains, low-fat dairy, fish, poultry and nuts.

The participants who followed DASH experienced a significant reduction in 24-hour blood pressure. The others, who continued to eat red meat, sweets and sugary soda, saw no improvement in blood pressure. Following the study, the DASH approach became the basis of Kaiser Permanente’s teaching about the prevention of hypertension and related conditions.

Also in the 1990s, Kaiser Permanente physician Vincent Felitti discovered while running a health appraisal clinic in the San Diego area that some patients needed help overcoming childhood trauma before they could change unhealthy behavior. Felitti conducted the Adverse Childhood Experience study and urged the consideration of psychological as well as physical issues in assessing a patient’s ability to adopt a healthy lifestyle.

Thriving in the 21st century

Kaiser Permanente offers a wide variety of healthy living classes at its facilities in all regions. Here, students enjoy an exercise class in Oakland, Calif.

In 2004 Kaiser Permanente launched its Thrive advertising campaign, which spotlighted the health plan’s continuing emphasis on healthy living to help patients stay well. In the 20-Teens, the organization gave birth to other behavior change modalities, including online healthy lifestyle programs, Healthy Eating and Active Living community programs and free classes open to the public.

In 2012, Kaiser Permanente launched “Every Body Walk!” a campaign to get literally everyone up on their feet to take the first small steps that can lead to success in achieving a healthy lifestyle.

Today, patients who choose to alter their habits to achieve better health can get help in Kaiser Permanente’s Healthy Living classes, by enrolling in online Healthy Lifestyle programs, and by accessing the bonanza of health information on

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