, Heritage writer
Prevention has always been fundamental to Kaiser Permanente’s mission. That includes both the prevention of illness through healthy behaviors and the prevention of injury by taking safety precautions. Even outside the health care field, Henry J. Kaiser’s Kaiser-Frazer automobile company strove to build safer cars and educate drivers, especially newly licensed teenagers, about safe driving. The 1953 Kaiser Manhattan was dubbed the “World’s First Safety-First Car!”
A current Kaiser Permanente campaign to encourage the wearing of helmets when riding a bicycle (“Making Bicycle Helmets the New Safety ‘Seatbelt,” May 3) may be our newest effort in this arena, but it’s certainly not our first. Here are just two notable bike safety efforts from our archives:
Maryland’s bicycle helmet law, which became effective in October 1995, covered children under the age of 16. The legislation was spearheaded by Maryland Governor’s Bicycle Advisory Committee (now called the Governor’s Bicycle and Pedestrian Safety Advisory Committee). Kaiser Permanente was among Maryland’s bicycle helmet legislation partner organizations, providing testimony, incentives, and education.
Oregon’s law was even earlier. It passed in July 1993 and took effect in July 1994. The year’s delay was built in to educate the public about the law and because of concerns about the ability of low-income children to afford bicycle helmets. The legislation was pushed by the Oregon Bicycle Helmet Coalition, which included a wide range of people and groups, including Kaiser Permanente.
As soon as the law was implemented, Kaiser Permanente distributed 1,500 free bike helmets to students at schools in Portland in hopes of reducing bicycle-related injuries and deaths. Ellen Hall, MD, from the Beaverton, Ore., Medical Office, was quoted as saying, “We’re concerned about how few children in our communities have helmets.”
In addition, Kaiser Permanente worked with officers from the Portland Police Bureau’s Bicycle Safety Unit and the Community Cycling Center in northeast Portland to teach traffic safety classes at north Portland schools. Kaiser Permanente also sold bike helmets at cost at three ‘cash-and-carry’ sales. By the end of 1995 Kaiser Permanente had donated nearly 2,000 bicycle helmets to low-income and at-risk children.
“Even though Oregon law requires everyone under age 16 to wear a hike helmet when riding, many families can’t afford one,” said Adrianne Felustein, MD, co-chair of Kaiser Permanente’s Trauma Committee. “At Whitman school, just over half of all students qualify for free or reduced lunches—and the majority don’t have bike helmets.”
In 1995, the U.S. Consumer Product Safety Commission selected Kaiser Permanente’s “Evel the Weevel” (a parodic reference to the motorcycle daredevil Evil Knievel) bilingual bike helmet safety brochures in Oregon to be distributed nationwide. The brochures were praised as an “example of a best practice in preventing childhood injuries.”
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, Heritage writer
Change rarely comes easily. People get used to doing things a certain way, and physicians are no exception. One such shift was a technology Kaiser Permanente adopted early on, creating patient medical records electronically rather than on paper.
In 2013 I interviewed Jim Gersbach, senior hospital communications consultant for Kaiser Permanente’s Northwest region. As their unofficial historian, Jim had accumulated many stories during his 28 years of service. This is an edited version of one of his learnings.
Prior to that, we had computerized lab records, computerized this, computerized that. But you had to go and get those records sent to you, and it was not all integrated the way it is now. It was interesting, from that one discussion of them beta testing in that one medical office, to then see that it later succeeded, and they made the decision to roll it out to the Northwest. Then they gradually put all of Kaiser Permanente’s systems onto EpiCare.
I can remember some of the older doctors didn’t even know how to type. That was the biggest barrier; they were doing the old hunt-and-peck because they had never needed to type. They just did dictation, or their nurses would type it up for them. The younger physicians were very eager to adopt computerized medical records, because they were a little bit more familiar with computers.
But after 1998 the Northwest Permanente Medical Group had done some survey work – [which had some] pushback— and heard that ‘This is adding to our day; it’s 45 minutes more a day to try and enter all this stuff in.’ People were complaining that ‘When I did paper, I didn’t take so long to do all this stuff, so it’s not a time saver for us.’
We started looking at that, and found was that sometimes when doctors would get busy, they would just sort of scribble something illegible in the chart, and send it off, because they could get out of their office faster. EpiCare was forcing them to actually enter data on every patient; they couldn’t just leave it blank. That was a major ‘Aha!’ moment. What became evident was, ‘Wait a minute; we’re not necessarily charting everything we’re supposed to.’ And the computerized system actually helped.
Not only did it make everything legible, but it forced clinicians to put something in; you had to type something in, or it wouldn’t advance you forward. It definitely improved the quality of the data.
In the Northwest, at the time EpiCare was being adopted, the doctors were very free to say what they didn’t like about it. But despite all the grumbling about ‘It’s adding to our length of day,’ when we asked, “Would you ever want to go back to paper?” they said ‘Absolutely not! I couldn’t live without the system, because it actually provides me everything I need to know for the patient.’ They very quickly saw the value of it as a clinical aid.
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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.
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[i] “Present at the Creation: The Birth of Northwest Kaiser Permanente,” unpublished interview edited by Portland historian Michael Munk, 2013.