, Heritage writer
June is National Safety Month, during which we are asked to pay particular attention to something that we usually don’t think about – our own personal safety and that of our loved ones. Yet reducing our risk for injury at work, on the roads, and in our homes and communities is as vital to our health as diet, exercise, and regular checkups.
Kaiser Permanente has a long history in working to protect its employees from harm and injury in the workplace, a commitment that goes back to the World War II home front. At precisely the same time that the conventional industrial workforce of healthy young men went off to fight, everyone else stepped up to produce the materials to arm the Arsenal of Democracy and win the war. Among these unsung heroes were the almost 200,000 people in the seven Kaiser shipyards. Most of them had never engaged in heavy industrial work before. They were housewives, farmers, the disabled, and those too old to serve in the military.
This January 14, 1944, article from the weekly Oregon Kaiser shipyard newspaper The Bos’n’s Whistle does a good job of explaining the challenges:
Safety pays dividends in shipbuilding production. That is apparent in the safety record of the three Kaiser yards during the past year. In all three yards, from superintendents to laborers, men and women showed more interest in observing safety rules. As a result, sizeable cuts were made in the two major causes of time loss injuries – handling tools or materials, and eye injuries- bring the total percentage of injuries in these two classifications down from 64 per cent to 53 per cent. National Safety Council figures show that, in terms of production, industry last year lost 380 million man days of work because of accidents. And the death rate on the war industry front is still four times higher than on the nation’s battlefronts. First Aid stations in the Vancouver and Swan Island yards treated a total of 704,435 cases during the year.
While hundreds of workers manage to stay on the job after an accident, their efficiency is impaired.
That steady progress is being made in the war on injuries is shown in the drop in accident insurance cost. At the start of the program, the cost was $3.75 per $100 of payroll, and the three yard average is now down to less than $1.00 per $100 payroll.
Before the war was over, the successful health plan for Kaiser shipyard workers was opened to the public. Today at Kaiser Permanente is a leader in occupational health as well as employee and patient safety. “Kaiser On-the-Job,” first started in the Northwest Region in 1991, incorporates prevention, case management, clinical protocols, and return to work programs with impressive results.
Safety still pays. Work safe, be safe.
Short link to this article: http://k-p.li/28Ywcw2
, Heritage writer
Previous part: “Injured on the job! The history of Kaiser Workers’ Compensation care“
Beginning with Dr. Sidney Garfield’s pioneering developments in occupational medicine in the 1930s, and Henry J. Kaiser’s expansion of that care for thousands of workers in his seven West Coast shipyards and Fontana steel mill, further advances in programs for handling worker health care evolved as did labor in America.
After the end of World War II, the composition of the national workforce bagan to shift from blue-collar to white-collar occupations, and the percentage of the Kaiser Permanente Health Plan devoted to industrial care waned. Still, in 1967 over a fifth of the Permanente Medical Group’s (the entity of the KP Health Plan that represents doctors) income was derived from industrial medicine.[i]
Yet a prejudice about this sphere of medicine had grown where many doctors had become cynical about both employee and employer versions of injury. As PMG Director Dr. Cecil Cutting ruefully commented, “…we practice Industrial Medicine in a manner which ranges from half-hearted to reluctant, reserving our active interest and most attentive effort for the care of Health Plan patients.”
Kaiser Permanente developed a bad reputation among insurers as being uncooperative in processing the admittedly large amount of paperwork required for industrial claims. Dr. Cutting found this unacceptable, and sought to overhaul and invigorate its industrial medicine practice. He hired the respected and experienced Dr. Walter Hook to oversee the creation of Departments of Industrial Medicine at all major medical centers, each headed by a Chief.
The efforts paid off, and in less than two years the number of industrial patients grew from 21,257 to approximately 33,892.[ii] These departments were not clinical services, but handled the reporting and billing functions required to process workers’ compensation claims.
During the 1980s California employers saw dramatic workers’ compensation cost increases. The workers’ compensation system quadrupled in size between 1983 and 1993, from $2.5 billion to $11 billion, and efforts were made to contain costs and streamline services.
Kaiser Permanente responded with a program called “Kaiser On-the-Job” (now called Kaiser Permanente On-the-Job, or KPOJ), first started in the Northwest Region in 1991. The program was implemented with the goals of meeting employer needs to decrease employee time lost from work and to help reduce health costs related to workplace injuries. KOJ now covers more than 300,000 workers in the NW Region’s service area.
To achieve optimal patient outcomes, it incorporated prevention, case management, clinical protocols, and return to work programs with impressive results. Between 1990 and 1994, the NW Region reduced average loss time per claim by more than two days and achieved a cost savings of $666 in average cost per claim.
The program was so successful that it received the Northwest Region’s 1996 James A. Vohs Award for Quality.[iii] Soon afterward, the Hawaii Region started opening KOJ clinics on the islands of Oahu, Maui and Hawaii.
This approach was soon adopted in other KP settings. Dr. Doug Benner, Coordinator of Regional Occupational Health Services at the time, remarked: “We had a system that just wasn’t working for employers, and wasn’t working for our physicians and staff either…This model goes a long way toward fulfilling our members’ expectations for access and service.”[iv]
KOJ later expanded to California in 1993 when Northern California started building dedicated occupational health centers integrated with our KP program, eventually opening 30 KOJ centers.
In January, 1993 the first of the new KP “one-stop” occupational health clinics opened at the Bayhill Medical Offices in San Bruno. A network of occupational health clinics were fully equipped and staffed with physicians, nurses, and physical therapists specialized in treating work-related injuries. Whereas injured workers frequently used KP’s regional emergency rooms as a first resort, they are now directed by their employers to seek care at the Occupational Health Centers.
Kaiser On-the-Job occupational clinics in the Northwest region were featured in KP’s Perspectives video magazine, promoting the innovative provision of “comprehensive array of services for the workplace.”
Four KP Divisions (Northwest, Northern California, Southern California, and Hawaii) now operate KOJ programs that share many of the same clinical guidelines, care philosophies and processes, and – most important – the same commitment to integrated managed care.[v]
Work will always pose hazards. But the treatment of injuries on the job, which was the spark that in 1933 led to the eventual formation of Kaiser Permanente, continues to be one of the many ways that this health care organization serves this nation’s working people.
Short link to this story: http://bit.ly/1i7dUup
Special thanks to Dr. Doug Benner, Coordinator of Regional Occupational Medicine Services (1993 to 2011) and Connie Chiulli (Director of Operations, Occupational Health Service Line, Regional Occupational Health, TPMG) for help with this article.
[i] Newsletter from the desk of the Executive PMG Director, June, 1967.
[ii] Newsletter from the desk of the Executive PMG Director, March 1970.
[iv] “Designated Occupational Medicine Services: New Model of Care for Injured Workers, Opening Soon Everywhere,” Contact, 12/1993.
By Lincoln Cushing, Heritage writer
Part of a series about our regional origins
When Henry J. Kaiser’s shipyards closed at the end of World War II, the Permanente doctors lost almost all of their patients. Roughly 200,000 members had been employed in the seven West Coast shipyards and most were covered by the Health Plan.
To survive in the postwar era, Kaiser Permanente needed to gain a large number of new members in a competitive market.
A handful of Permanente physicians in the Pacific Northwest had caught group practice fever and were inspired to stay on despite the uneven odds against their success. Six or seven (nobody recalls for sure how many) out of 45 wanted to give it a go.
Charles Grossman, MD, one of those who hung on, recalled:
“All of us were firmly committed to the prepaid, group health concept, and we decided to rebuild Northern Permanente rather than allowing it to close down,” Grossman told Portland historian Michael Munk. The Permanente physicians judged their wartime hospital to be in good enough shape to withstand a few more years of service.
A cool reception from traditional medicine
Not only were the doctors at first without patients or income, they were given the cold shoulder by the leaders of both the Oregon and Washington medical societies, the states in which Permanente hoped to offer care.
The traditional fee-for-service physicians, unaccustomed to the concept of salaried physicians practicing as a group, branded Kaiser Permanente as “socialized medicine.”[i] The Health Plan and its doctors in all regions faced this type of criticism for decades in the 20th century. The Multnomah County Medical Association of Oregon didn’t accept Permanente physicians until 1963.
Meanwhile, Northern Permanente opened its first clinic in 1947 on Broadway in Portland, Ore. In 1959, the Health Plan opened the Bess Kaiser Hospital in Portland to its 25,000 members; membership doubled to 50,000 in the next two years. In 1975, Kaiser Permanente Sunnyside Medical Center was completed in Clackamas County, southeast of Portland.
Today, the Kaiser Permanente Northwest Region has about 470,000 members. Its newest hospital, green-award-winning Westside Medical Center, opened Aug. 6 in Hillsboro, Ore., on the west side of the Portland Metro Area.
Innovation a hallmark for Northwest
Over the years, the Kaiser Permanente Northwest Region has been at the forefront of innovative and successful health care practices. Below are some examples of the region’s innovations.
- Dental coverage – Head Start children residing in the Model Cities area of Portland were eligible for dental care through an Office of Equal Opportunity pilot program offered in the Northwest Region in 1970. The program was so successful that dental coverage has continued to be offered as an optional benefit to all group members in the region.
Study of health care delivery for the poor and elderly – Kaiser Permanente Northwest took part in a Medicare and Medicaid demonstration started in 1984 to identify the best ways to integrate acute and long-term care for patients covered by prepaid, per-person, per-month (capitation) financing arrangements.
- Testing of an occupational health model — With the goal of decreasing injured employee lost work time and reducing medical costs related to workplace injuries, the region started Kaiser-on-the-Job in 1991. Between 1990 and 1994, the region reduced average lost time per claim by more than two days and achieved a cost savings of $666 in average cost per claim. The occupational medicine program, separate from the Health Plan, covers more than 300,000 workers through their employers in the Northwest Region.
- Sunday Parkways – Recognizing not everyone can succeed in challenging athletic pursuits, Kaiser Permanente’s Northwest Region helped launch a special, less taxing mobility event with the city of Portland in June 2008. Six miles of local streets were closed to traffic from 8 a.m. to 2 p.m. In 2009, up to 25,000 Portland area residents walked, biked, jogged and skated in three summer Sunday events.
- Sustainable use of resources – The Kaiser Permanente Westside Medical Center, new this year, has already received Leadership in Energy and Environmental Design Gold certification from the U.S. Green Building Council. Westside is the second Portland-area hospital to receive the LEED Gold designation and one of just 36 hospitals nationally to earn the honor.
Short link to this story http://ow.ly/pD11u
[i] “Present at the Creation: The Birth of Northwest Kaiser Permanente,” unpublished interview edited by Portland historian Michael Munk, 2013.