Second in a series on Kaiser Permanente’s 70th anniversary
From providing health care to workers and their families at Grand Coulee Dam to the massive medical program in the World War II shipyards, Henry J. Kaiser believed that cooperating with labor was more productive than fighting it. This institutional philosophy had profound positive implications on the nascent public postwar health plan. As the war was drawing to a victorious close – Victory in Europe had been announced on May 8, 1945 – Henry J. Kaiser’s health plan began to prepare for a peacetime economy by expanding beyond its own employees. The plan would be opened to the public by late July.
Given Henry J. Kaiser’s support for labor, it was not surprising that labor unions would be among the early member groups. Bay Area workers – Oakland city employees, union typographers, street car drivers and carpenters – embraced the Permanente Health Plan and its emphasis on preventive medicine.
On June 7, 1945, the Stewards and Executive Council of the International Longshoremen and Warehousemen Union’s Oakland unit voted unanimously to make coverage in Permanente a part of its future negotiations with employers. The executive council also requested that employers pay for the plan’s premiums.
Founding physician Sidney Garfield, MD., reflected on that support:
So [the postwar health plan] gathered momentum… [In 1949] the longshoremens’ union came to us and said, “We would like you to take over all our members.” They had about thirty thousand here and the [San Francisco] Bay area. They said, “We won’t give them to you unless you do it up in Portland, Seattle, Los Angeles and San Diego. We want to give you the whole thing.”
Then Joe DeSilva of the Retail Clerks’ union called up and wanted to see me. He came up here and said, “I want you to set up a health plan for our workers in Los Angeles.” I guess he had about thirty thousand workers plus families of I don’t know how many. I told him that we would need facilities because we couldn’t depend on using other hospitals because some day they would boycott us probably. So he said, “I’ll pay you several months dues in advance if that will help you build a hospital.”[i]
Years later, Kaiser Permanente CEO David Lawrence would express that relationship succinctly:
“If not for organized labor’s active marketing support immediately following World War II, it is unlikely that Kaiser Permanente would exist today.”[ii]
But labor did not just mean health plan members, labor employees were also a key part of delivering health care. A year after opening up to the public, the Permanente Health Plan signed its first nurses contract with the hospital in Oakland and the field hospital in Richmond, making it the first nurses’ union in the U.S. to do so.
On July 26, 1946 the Nurses Guild Local 699, affiliated with the Congress of Industrial Organizations, announced that they approved a contract covering wages and working conditions with Permanente Hospital of Oakland and Richmond (as well as medical staff at Kaiser Steel in Fontana). Lora Lee Swan, nurse consultant for the Guild, declared:
This is the first Alameda county hospital in which nurses have been allowed their democratic rights to a free election in choosing their bargaining agent. The precedent set here is truly a great victory for working nurses everywhere. [iii]
In 1997, after years of labor turmoil within Kaiser Permanente and competitive pressures within the health care industry, Kaiser Permanente and the Coalition of Kaiser Permanente Unions formed their groundbreaking Labor Management Partnership. Today, the partnership covers more than 100,000 union-represented employees in 28 local unions as well as 14,000 managers and 17,000 physicians in California, Washington, Oregon, Colorado, Georgia, Hawaii, Virginia, Maryland and Washington, D.C.
[i] “Sidney R. Garfield in First Person: An Oral History,” interview by Lewis E. Weeks, 8/22/1984.
[ii] KP CEO David Lawrence, “Tentative national partnership announced between AFL-CIO and Kaiser Permanente,” Newswire (KPNW) May 2, 1997
[iii] “CIO nurses approve pact at Permanente,” People’s World, August, 1946
Short link to this article: http://k-p.li/1HOxTXU
On April 24, 1997 – 18 years ago today – Kaiser Permanente and the AFL-CIO announced a groundbreaking nationwide pact that acknowledged the importance of partnering with labor unions.
John Sweeney, president of the AFL-CIO, praised the agreement:
“It is my hope that together we can fully realize the vision our predecessors had when Kaiser was originally founded in the 1940s – an affordable, high-quality health plan for working families.”
The next year, historian Doris Kearns Goodwin, author of the acclaimed 1994 title No Ordinary Time – Franklin and Eleanor Roosevelt: The Home Front in World War II, echoed Sweeney’s homage to Kaiser Permanente’s long term impact when she summed up the contributions of Kaiser Permanente’s founding physician Dr. Sidney Garfield and his colleagues during a 1998 talk in Oakland, Calif.:
“It was in the midst of that crisis that Garfield and company, through the twin ideas of prepayment and group (medical) practice, created a whole new system for the delivery of health care that would restructure the traditional relationship of the American people to their doctors – just as surely as Roosevelt’s New Deal, also created in crisis, restructured the traditional relationship of the American people to their government…
They succeeded against all odds because of a passionate belief in what they were doing and a commitment to one another, a spirit of innovation, and a sense of mission.”
Today, both The Kaiser Permanente Labor Management Partnership (“The largest and most successful in the country,” according to Jim Pruitt, vice president of LMP) and the Kaiser Permanente Health Plan continue to make history.
Short link to this story: http://k-p.li/1DYIMGU
It’s not every day a first lady visits a Kaiser facility, but it happened in the middle of World War II – and she visited two.
Eleanor Roosevelt came to the Kaiser Company shipyard on the Columbia River in Vancouver, Washington to personally launch the U.S.S. Casablanca, the first in a new class of small, versatile and inexpensive aircraft carriers.
The class was named for the Battle of Casablanca, fought November 8-12, 1942, where the U.S. Navy fought vessels under the control of Nazi-occupied France. The 50 ships the Kaiser yards produced comprised almost a third of the American carriers built during the war and were launched in less than two years.
The ship was known as the Alazon Bay while under construction and renamed the U.S.S. Casablanca two days before she slid down the ways on April 5, 1943. Five of the “baby flattops” were sunk in action during the war, and none survive today.
Health care, not warfare
But Eleanor wasn’t just there for the latest in military technology. She was more interested in the social programs affiliated with the massive shipbuilding projects, including child care, prepared meals for double-duty women, and health care.
Henry J. Kaiser listened to her and responded by introducing two controversial (at the time) programs for shipyard workers – model child care facilities near two of the shipyards and pre-cooked meals for working moms.
As for health care, Mr. Kaiser needed no convincing. Mrs. Roosevelt was given a grand tour of the state-of-the-art Northern Permanente Foundation Hospital built in September, 1942 for the shipyard workers.
Eleanor wrote a regular newspaper column, “My Day.” Her April 7, 1943, entry included this reflection on the Portland visit:
A little after 9:00 o’clock Monday morning we were met in Portland, Ore., by Mr. Henry J. Kaiser and his son Mr. Edgar Kaiser. A group of young Democrats presented me with a lovely bunch of red roses at the airport and then we were whisked off for a busy day.
Our first tour was in the Kaiser shipyard itself. It is certainly busy and businesslike. Everything seems to be in place and moving as quickly as possible along a regular line of production. I was particularly interested in the housing, so I was shown the dormitories and then the hospital, which is run on a species of health cooperative basis costing the employees seven cents a day. It looked to me very well-equipped and much used, but I was told there were few accidents in the shipyards owing to safety devices. The men come in for medical care and some surgery and their families are also cared for…
The ship went safely down the ways at the appointed time and was duly christened. It was interesting and impressive to see all the workers and their families gathered together for the occasion and I felt there was a spirit of good workmanship in this yard.
Mrs. Roosevelt was so intrigued with the new medical care program that she wrote Permanente’s founding physician, Dr. Sidney R. Garfield, who happened to be away at the time of her visit. “What is your plan for preventive care?” she asked.
“This is the solution of medical care for the majority of people in this country”
Dr. Sidney Garfield replied in a letter May 25, 1943, in which he took the opportunity to explain how aligned the first lady’s vision was with that of the Permanente Health Plan:
I regret very much not to have been present during your recent visit to Vancouver, Washington, and not to have had the opportunity of showing you through our medical facilities and hospitals in the Oakland-Richmond, California area.
Your expression of interest in preventive medicine is rather closely allied with our thoughts for medical care. Mr.Kaiser and I believe that preventive medicine is more important than the curative side. Our medical programs have always been developed with this fact in mind…
Because of the economy of such a medical plan the cost of medical care to the people is lowered. For the small amount charged at Coulee Dam we were able to provide the best of medical care and pay for the hospital facilities provided in a period of four years. When the cost ofthe facilities is paid for the charge per week to the people can be reduced, or the money used to provide more facilities, added equipment, and for research. Mr. Kaiser and all of us who have had a part in these programs feel that this is the solution of medical care for the majority of people in this country. It is self-sustaining and unites the medical profession, the employer and employee all in one common objective – “to keep the people well and to prevent their illness.”
Your interest in our organization is greatly appreciated. If we can be of further service in answering your questions please do not hesitate to call on us.
Sidney R. Garfield, M.D.
Medical Director, Kaiser Co., Inc., West Coast Shipyards
Years later, Eleanor Roosevelt’s light would shine on KP again.
In 2007 Kaiser Permanente was one of three recipients of the Eleanor Roosevelt Human Rights Award from American Rights at Work, an advocacy and public policy organization responsible for promoting and defending workers’ rights since 2003. Kaiser Permanente received the award for “creating a management-union partnership based on mutual trust and respect.”
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By Lincoln Cushing
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.
Lincoln Cushing, Heritage writer
Organized labor played a big role in Kaiser Permanente history, and Heritage writer Lincoln Cushing contributes a column to the quarterly
Labor Management Partnership magazine Hank about that rich legacy.
The Winter 2013 story is about the Health Plan’s postwar struggle for survival, and the crucial support it got from labor.
“In the boom years after World War II, the Kaiser Foundation Health Plan (KFHP) faced an uphill battle. It had expanded to the public in 1945, but the wartime truce between fee-for-service (medicine) and the prepaid, group practice model developed by Dr. Sidney Garfield had faded.
The gloves came off in 1953.” Read more here.
By Lincoln Cushing, Heritage writer
In 1930s America, manual labor of all types– farming, construction, and manufacturing – was dangerous. In those depressed and troubled times, anxious workers were glad to have a job despite the risk of injury or death. Statistics of the decade told the story: workers were killed at an annual rate of 37 per 100,000 employees.
It was in this environment that Sidney R. Garfield began to offer industrial medical care for some of the 5,000 men working on the Colorado River Aqueduct Project in 1933. Garfield addressed the problem head-on by encouraging safe work habits and identifying and eliminating hazards. Garfield, bent on keeping the workers well, actively nurtured a culture of safety awareness and accident prevention.
Garfield’s vigilance to ensure a safe workplace – key to his early preventive care philosophy – remains a vital part of the Kaiser Permanente Health Plan he started with Henry Kaiser almost 70 years ago.
Garfield and Kaiser found synergy in providing health care for Kaiser’s 8,000 workers at the Grand Coulee Dam project in Washington state starting in 1938. That was practice for the real test they faced in maintaining the health of shipyard workers during World War II.
No time to plan for war industries
With almost no time for preparation or planning, Kaiser hired almost 200,000 new employees to toil nonstop to support American and Allied war efforts. Henry Kaiser ran seven West Coast shipyards and a steel mill in Fontana, Calif. His workforce was not composed of the usual sturdy males with experience in the trades – those men were serving in the military. Most shipyard workers were migrants from the South and Midwest, and about a third of them were women. Many were disabled. Few had held industrial jobs before.
The Kaiser Shipyards managers instituted several measures to reduce workplace risk.
One approach was to take care to assign people to the right job when they were first hired. In early 1944, the War Manpower Commission contracted with Permanente Foundation Hospitals to compile data about the physical requirements of each job in the shipyard. This study resulted in a 627-page reference guide called the Physical Demands and Capacities Analysis.
After workers were hired, they were not placed in a job until managers could fully understand their physical capabilities. The job placement guide helped avoid assigning someone to a job they couldn’t physically handle.
The “Plate Acetylene Burner” job description in the guide reads: “Climbs 6 steps to and from assembly platform twice daily, and walks within 500’ x 65’ area to stand, stoop, reach down, grasp, lift, and carry up to 35 pounds of “burning” equipment (women), and up to 75 pounds (men) to place where burning is to be done (25% of job).”
An article in the June 1, 1944, San Francisco Call Bulletin noted the study’s long-term importance. The manpower commission’s regional director told the paper: “The technique (methodology) on which (the research) is based will be invaluable in the postwar period when thousands of returning service men and women will have to be fitted into new jobs.”
Another strategy was to conduct ongoing worker education about occupational hazards. The weekly shipyard newsletters regularly featured cartoons, articles, contests, and photos about the right and wrong way to perform any task. The Richmond newsletter Fore ‘n’ Aft published a “Safety Boner Contest” cartoon created in the nearby Marinship yard (Sausalito) asking readers to identify hazards. Although 112 errors were intentionally drawn in, a zealous reader in a Vancouver (Washington) yard found 118.
Changes in law, technology curb hazards
Death and injury from industrial hazards such as coal dust, explosions, and asbestos have declined markedly in the past century, partly due to changing modes of production and partly due to progressive legislation.
One key step was the enactment of the Occupational Safety and Health Act in 1970, which helped accelerate an already improving work environment. In the 22-year period prior to OSHA’s existence, death rates dropped by 38 percent from the 1948 rate; in the first 22 years following its creation rates dropped by more than 61 percent.[i]
Hazards change. The most significant workplace health problem emerging in the late 20th century was the array of musculoskeletal disorders caused by repetitive stress. And today, in the health care field, other dangers lurk, such as needle sticks, exposure to contaminated human fluids, and getting injured while repositioning and lifting patients.
LMP works for reduction of KP workplace injuries
With the 1997 birth of Kaiser Permanente’s Labor Management Partnership, worker safety programs took a huge leap forward. The LMP’s Workplace Safety Initiative, launched June 21, 2001, was the most comprehensive and ambitious effort to date, with a goal of reducing the number of workplace-related illnesses and injuries by 50 percent over the next four years.
“Too many people in our organization are being hurt on the job today,” said Dick Pettingill, then-president of the Kaiser Foundation Hospitals and Health Plan in California. “This is unacceptable to me, and it should be unacceptable to all of us.”[ii]
The next year newly appointed KP Chairman and CEO George Halvorson and AFL-CIO President John Sweeney called on employees, managers, and physicians nationwide to make their workplaces safer. “There is no reason why we should accept an environment in which accidents are occurring,” Halvorson said. “We’re all going to work together, in Partnership teams, to improve the safety of our workplace.”[iii]
Hundreds of trained two-person teams from labor and management toured medical centers and regional operations facilities in “Broad Engagement Walk-throughs” sponsored by Southern California Region’s Workplace Safety group. The teams talked to unit staff who also responded to surveys to help identify workplace safety issues.[iv]
KP HealthConnect® joins safety campaign
New technologies also demanded workplace safety planning. In 2004, the Kaiser Permanente HealthConnect® workplace safety team partnered with stakeholders in Northern California to minimize any negative ergonomic consequences of the new national electronic health record system. Equipment at 34,000 workstations and hundreds of nursing stations and exam rooms had been modified or replaced, so the workplace safety team developed customized carts, wall mounts, and other adjustments to make sure that the upgrades were safe for physicians and staff.[v]
One way the LMP plays a valuable role is through the site-specific unit-based teams and other natural clusters of workers with similar jobs. In 2004 the Los Angeles Medical Center’s Lift Teams (specially trained staff members who help nurses and physicians lift and move patients safely) reduced the number of workplace injuries by nearly 45 percent over a three-month period.[vi]
By the end of 2005, the Southern California injury rate had declined 29 percent – short of the 50 percent reduction goal but still a significant achievement. Northern California met its goal of 50 percent reduction one year later.
Another major effort is the KP Workplace Safety Program, which seeks to reduce injury on the job for all employees of Kaiser Permanente, from office workers to nurses to couriers. Planning and implementation is coordinated by a national leadership team with regional representation.
In Northern California, the WPS Program serves all represented employees, including those in non-LMP unions such as the California Nurses Association, Stationary Engineers Local 39, and the Guild for Professional Pharmacists.
The challenge continues. In 2011 Northern California WPS Program Executive Director Helen Archer-Duste, RN, MS, reiterated KP’s goal: “Working in health care is dangerous. I want to make us the safest place in health care . . . Our ultimate goal is to have a workplace with no injuries. I believe that can happen.”[vii]
Thanks to Kathy Gerwig (vice president, KP Employee Safety), Helen Archer-Duste (executive director, KP Workplace Safety and Care Experience), Patricia Hansen (KP regional workplace safety practice leader), and Maureen Anderson (Coalition of Kaiser Permanente Unions) for contributing to this article.
[ii]California Wire, “Workplace Safety Initiative: KP and Labor Partners Put Safety First,” Aug. 6, 2001.
[iii] California Wire, “U.S. Labor Leader, KP CEO, Employees, and Managers Launch Programwide LMP Workplace Safety Plans,” Nov. 4, 2002
[iv] California Wire, “Labor Management Partnership Reaches Staff in Workplace Safety ‘Walk-throughs’,” Nov. 11, 2002.
[v] California Wire, “Safety Is Key in KP HealthConnect® Deployment,” July 19, 2004.
[vi] California Wire, “Los Angeles Lift Team Wins LMP Award,” July 26, 2004.
[vii] “Workplace Injuries Plummet,” Inside KP, Nov. 8, 2011.