, Heritage writer
If you can’t easily get patients to a clinic, what do you do?
Take the clinic to the patients.
This year, a Kaiser Permanente grant to the Healthy Smiles Mobile Dental Foundation in Fresno, California, paid for a brand-new recreational vehicle that’s been transformed into a dental clinic on wheels, complete with exam space, X-ray machines, and dental equipment. Several hygienists and dentists work inside the clinic, cleaning children’s teeth, and filling cavities.
It’s a model that’s been researched in the medical literature — and, because of long history in mobile medicine, we know that it works.
Early innovations in mobile medicine
In the early 1970s, Kaiser Permanente undertook several projects to test the feasibility of mobile health vans to serve underrepresented communities. One was rural, one was urban.
The rural example was “STARPAHC” — short for Space Technology Applied to Rural Papago Advanced Health Care. Kaiser Permanente and NASA partnered with Arizona’s Papago Indian Reservation to test the practicality of the emerging field of telemedicine. The project used the real needs of a remote earth-bound population to see how technology and routines could work when providing health care for astronauts in outer space.
And in very urban Oakland, California, Kaiser Foundation School of Nursing student members of Kaiser Black Student Nurses’ Association served on a mobile Foot Health Clinic in 1972.
Our medical care keeps moving
In 1988, Kaiser Permanente launched a Mobile Health Education and Screening Program in the Kansas City area. The 25-foot mobile van traveled to Kaiser Permanente medical offices as well as community organizations, local businesses, and public health fairs, where staff checked blood pressure and cholesterol levels, gave lifestyle assessment quizzes, and provided educational materials on a variety of health topics.
In Southern California, Kaiser Permanente had a similar program that operated out of a 38-foot Wellness Care-A-Van. It traveled as far north as Bakersfield and as far south as San Diego, reaching out to people in their communities, testing blood pressure and body fat. Frayne Rosenfield, Member Health Education administrator and Worksite Wellness Program coordinator, was enthusiastic about the service: “The van has been very well received. We see approximately 120 people a day, and the van is out 5 to 7 days a week.”
Kaiser Permanente also used the mobile van model for immunization drives in the 1990s.
Kaiser Permanente’s 2001 Annual Report profiled a mobile bone-scan van used in the Mid-Atlantic states (complete with custom Maryland license plate “KPBONES”) to help members prevent and treat osteoporosis. It was staffed by Stephen Moki, radiology technologist and health educator, and Pat Brown, clinical assistant.
The Scan Van rotated among several Kaiser Permanente medical centers, spending 1 to 3 weeks at each facility before moving on. It proved to be a valuable outreach tool, and community organizations frequently called to request a visit from the van. Michael J. Moriarty, MD, vice president and associate medical director of Quality and Health Management, said, “I think that it helps to affirm our image as an innovator and a quality health care provider.”
Mobile health vans are in our future
In 2009, Kaiser Permanente in Hawaii celebrated the arrival of a mobile health vehicle. The 500-square-foot, 10-wheeled rolling clinic was fully wired, equipped with our electronic health record system, a digital mammography unit, and video telemedicine capability.
The vehicle was designed to roam the Big Island, providing glucose and cholesterol screenings, mammograms, urinalysis, testing for sexually transmitted diseases, and vaccinations for the flu and pneumonia.
Billy Kenoi, the mayor of Hawaii County, praised the service when it was formally blessed July 2.
“I come from a 48,028 square mile island with incredible geographical and infrastructure challenges,” Kenoi said, “and the delivery of this Mobile Health Vehicle will improve not only the health care available on the island of Hawaii, but ultimately, the quality of life for our island residents.”
The use of mobile health vans is now integrated into our health plan, visiting urban worksites and rural communities and saving members time and travel for many of their medical needs.
As Frayne Rosenfield said in 1988, “The van is out 5 to 7 days a week.”
That’s about as accessible as health care can get.
Also see: “Driver as Receptionist? Kern County union and management leaders work out innovative solution” to optimize mobile health van driver workload.
Short link to this article: https://k-p.li/2DcTiQG
, Heritage writer
Falls Prevention Awareness Week starts September 22. This 1942 cartoon from the Kaiser Richmond shipyard newspaper Fore ’n’ Aft illustrated remarks from Secretary of the Navy Frank Knox about industrial accidents on the World War II home front. “We have no time to train replacement workers… We cannot afford to permit accidents to encroach upon that bare minimum of time.”
Falls were among the largest contributors to shipyard accidents, which overall accounted for approximately 5 percent of employee absenteeism. But campaigns around safety education and rule enforcement made a difference – the frequency and severity of accidental injuries dropped 50% from 1941 to 1942, an improvement unsurpassed by any major industry in the United States.
These days, Kaiser Permanente still seeks to reduce fall-related injuries, for both employees and patients.
An injury-free workplace is an essential ingredient of high-quality, affordable patient care. Kaiser Permanente has set the goal of eliminating all causes of work-related injuries and illnesses. “Slip, trip, and fall” prevention is part of a comprehensive workplace safety strategy, designed to keep employees safe and create a workplace free from harm.
A focus on patient safety comes from the “No One Walks Alone” program – pioneered at the San Diego Medical Center and adopted at the Moanalua Medical Center in Hawaii – where the number of patient falls was reduced by more than half. And last year, the Kaiser Permanente Washington Health Research Institute contributed an editorial accompanying the latest JAMA study about preventing falls among seniors.
For 10 tips on preventing falls, see this infographic.
Short link to this article: https://k-p.li/2QKLYlj
, Heritage writer
The Automated Multiphasic Examination
Second part, follows “Screening for Better Health: Medical Care as a Right”
Last summer a major medical news story splashed across the world: “Historic Kaiser Permanente Data to Aid in Long-Term Study to Determine Extent of Ethnic Disparities in Brain Health and Dementia; new $13 million study funded by National Institute on Aging will revisit patients who were first screened as long as 50 years ago.”
Where did this remarkable trove of data come from?
In 1961 the U.S. Public Health Service awarded the Kaiser Foundation Research Institute a grant to study the automation of the multiphasic health testing it had been conducting manually for 10 years. Members would now go through the screening stations with computer cards that got marked along the way. At the end of the session, which took a couple of hours, there would now be a computerized medical record of their current health status. The Automated Multiphasic Health Test was born.
The first AMHT center was at a new building on the Oakland Hospital campus at 3779 Piedmont Ave. By the end of 1966, Kaiser Permanente had enlarged and updated its testing facility and laboratories nearby at a state-of-the-art center at 3772 Howe Street, and expanded the computer center and offices in the Piedmont building. A second center in San Francisco was linked to the mainframe computer in Oakland.
Dr. Collen, in the Journal of the American Medical Association (1966), accurately predicted that “The advent of automation and computers may introduce a new era of preventive medicine … [The computer] will probably have the greatest technological impact on medical science since the invention of the microscope.”
The AMHT continued to be seen as a vital tool in the diagnosis and treatment of occupational and industrial illnesses. A 1967 article in the Archives of Environmental Health discussed the employment data gathered, which included a list of 170 occupational titles and a battery of work-related health questions. “The computer storage of data on more than 40,000 adults annually permits extensive epidemiological research, especially directed toward the preventive aspects of chronic disease.”
It wasn’t just union members who benefitted. The Modern Hospital, May 1966 called the periodic health examinations to more than 4,000 patients monthly “… an impressive investment in the concept of ‘health medicine.’”
The test expanded to about 20 stations, measuring everything from hearing to heart function. It even went beyond mere testing – if recommended, a patient could get a tetanus booster via the new high-pressure injector system.
A 1970 article by Dr. Garfield in the prestigious New England Journal of Medicine with the provocative title “Multiphasic Health Testing and Medical Care as a Right” began with this abstract:
Although no long-term evidence exists that the course of disease is influenced by multiphasic health testing, this is largely irrelevant. Such programs are essential for other very important reasons. The existing and spreading concept of medical care as a right, with its elimination of personally paid fees, is creating a demand for periodic health checkups and health appraisals. This demand cannot be met by traditional methods totally involving the physician without great waste of doctor time.
Multiphasic health testing can help separate the entry mix of patients into the well, the asymptomatic sick and the sick. This separation makes possible optimum use of physicians’ services, which can be devoted to the area where they are most needed: the care of the sick.
The efficiencies of the AMHT were sufficient that these programs were sometimes adopted by private practice, large companies, and public health agencies. Dr. Collen remarked:
It is still of great interest to me and much personal satisfaction that the AMHT is still flourishing in Japan, Taiwan, and in China; and in the past when I visited them I found the AMHT centers in Japan to be primarily employer-sponsored for employees. I found the newest AMHT centers in Taiwan and China to be for-profit, marvels of efficiency and associated with health education centers open to the public, and with a high level of provider and patient satisfaction.
But despite the AMHT’s popularity, it was discontinued by Kaiser Permanente by the late 1970s when a federal grant supporting the work dried up and Kaiser Permanente declined to commit further resources.
Dr. Collen himself noted some of the challenges to quantifying the benefits of screening:
…Epidemiologists required us to report on gross mortality, and since the potentially postponable conditions comprised only about 15 percent of all the causes of death, most people died from other conditions … some of the criticism of urging checkups is based upon the fact that one does not decrease total gross mortality. That is, everyone eventually dies from something.
Gary Friedman, MD, former director of Kaiser Permanente’s Division of Research, recently explained additional medical limitations to the AMHT:
Initial enthusiasm for multiphasic health screening was tempered by experience in using it and by scientific studies that did not confirm benefits vs. costs of specific screening tests. For example, it was initially hoped that routine chest x-rays, included in AMHT, would lead to early detection and increased curability of lung cancer. Studies did not confirm this benefit. A yes/no question about chest pain provoked by exercise and relieved by rest was included in the AMHT symptom questionnaire. Although a yes answer seemed almost diagnostic of angina pectoris, this often did not prove to be the case in the follow-up examination by the physician, who could question the patient in greater detail, consuming valuable time.
Clearly however, the value of some screening tests has been amply confirmed. Finding and treating high blood pressure in asymptomatic individuals prevents strokes. And screening for colorectal cancer by the various tests available can lead to early detection and cure, or the removal of polyps that could later progress to cancer.
Despite these issues, Dr. Collen defended the value of the AMHT in a 1986 UC Berkeley oral history by Sally Smith Hughes:
…The study [on AMHT] did clearly demonstrate that for those conditions that are potentially postponable, there is a significant decrease in mortality.
He went on to note larger policy and commercial impediments to the AMHT:
Blue Cross/Blue Shield and other indemnity insurers to this day still do not pay for checkups. They take the position that periodic health checkups are schedulable and elective, so are not insurable events. Medicare to this day does not pay for checkups. The contrast, in other countries, like in Japan and in France, their social security and governmental supportive systems pay for periodic health checkups for well people, but do not pay for sick care. Just the opposite from the U.S. So if our Public Health Service is so interested in
preventive medicine, why do they fail to support the financing of checkups? A very key reason that multiphasic testing has not proliferated in the United States is because it is not reimbursed by any of the insuring agents. That has been reported by vendors who try to sell the systems.
I should point out that the Public Health Service had asked us to patent the system because it was an invention. Whether I was right or wrong, I refused to do so. I felt that it should be in the public domain, and it is. It’s never been patented.
Dr. Collen concluded with deep pride in the accomplishments:
We actually developed the most comprehensive inpatient and outpatient medical information system in the world. And this book, Hospital Computer Systems, describes that. There were only a half-a dozen others in the world that were doing that.
As the 2016 medical news story about the persistent value of the AMHT data shows, this was a significant accomplishment in medical practice. Thank you, Dr. Collen.
Short link to this article: http://k-p.li/2n00mcW
, 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
By now, everyone’s heard the jokes about the new International Classification of Diseases, the disease and health problem taxonomy standard managed by the World Health Organization. ICD is the latest in a series of efforts to classify diseases, starting in the 1850s. Originally called the International List of Causes of Death, the WHO assumed responsibility for the ICD when the organization was created in 1948. ICD version 10 (or ICD-10) is the newest code set. October 1 is the date on which ICD-10 compliance is required by the Centers for Medicare and Medicaid Services.
With 68,000 discrete diagnosis codes (as opposed to the previous 14,000), we are now able to define diagnoses at a very precise level of detail. Very, very, precise – such as “V97.33XD: Sucked into jet engine, subsequent encounter” or “Y92.146: Swimming-pool of prison as the place of occurrence of the external cause.” Yes, these are actual codes.
But, jokes aside, precise classification has its merits. It strengthens the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes. ICD descriptors also provide the basis for the compilation of national mortality and morbidity statistics. Kaiser Permanente has actively joined other health care providers in this massive project.
However, Kaiser health care practitioners during World War II were also trying to use precise descriptions to improve health, in a slightly different way.
In May, 1944, the 627-page dense tome Physical Demands and Capacities Analysis was published as a joint project of the Kaiser Foundation Hospitals and the Occupational Analysis and Manning Tables division of Region XII War Manpower Commission. The physician in charge of the study was Clifford Kuh, MD.
One of the primary goals of the Analysis was to make sure that individuals were assigned to jobs which they could perform without risk to their health. The study detailed 617 distinct job titles in the shipyards, from “Asbestos Worker, Cutter” to “Window Cleaner.” Although the Richmond shipyards did have the opportunity to use pre-placement physical examinations prior to hiring, the study provided the basis for accurate review of work-related health problems and suggestions for reassignment. During a short three-month survey period, only three workers had to leave their assigned job due to physical failure. During the four war years Kaiser’s yards employed almost 200,000 people.
An article in the Call Bulletin touted the survey, quoting William K. Hopkins, regional director of the United States War Manpower Commission:
“While the study has in mind the placement of all workers, the technique on which it is based will be invaluable in the post-war period – when tens of thousands of returning service men and women will have to be fitted into new jobs. I am particularly impressed with the study’s positive approach in emphasizing what a worker has the physical capacities to do, rather than the handicaps, often minor, which tend to prejudice his employment.”
Kaiser Permanente, building and using precise medical data for social benefit since 1944.
Short link to this article: http://k-p.li/1O5V9GK
, Heritage writer
Fourth in a series on Kaiser Permanente’s 70th anniversary
“Problems are only opportunities in work clothes.”
– Henry J. Kaiser.
Innovation has been a part of Kaiser Permanente’s culture from the beginning. While many people think of a new technology or exotic surgical device when they hear the term “medical innovation,” Kaiser Permanente’s view is much broader.
From its very beginnings, Kaiser Permanente proposed a radical – and innovative – shift in the delivery of health care.
When Henry J. Kaiser and Sidney Garfield, MD., were taking care of the almost 200,000 workers on the Home Front during World War II, few of them had ever experienced routine medical care. People feared the expense of seeing a doctor, and delayed seeing caregivers, thus guaranteeing a more difficult treatment and a less positive result. But because the prepaid Permanente Health Plan was affordable and run under the same system that was already handling their industrial care, it changed how people accepted early treatment. Dr. Garfield himself was amazed by this phenomenon during his “dress rehearsal” of medical care for worker families at Grand Coulee Dam in 1938:
One of the most impressive lessons we learned was, prior to the family plan, you would go walking through our hospital and you would see quite a few very sick women and children – ruptured appendices, bad pneumonias and so forth, even diphtheria cases. Once the plan was in operation for a while, that changed. You no longer saw ruptured appendices, we saw early [inflamed but not ruptured] appendices. Never saw bad pneumonias, we would treat them early. And diphtheria entirely disappeared. In other words, people, once the barrier of cost was removed, were coming to us earlier and we could treat them earlier and keep them from getting complications and, I’m sure, keeping them from dying.[i]
Later, in the World War II shipyards, Dr. Garfield experienced the same conditions but on a much larger scale. He reflected on the challenges of treating the rookie workers:
Some of them were in such bad condition we jokingly would refer to our shipyard workers as a walking pathological museum. But in spite of all of that fact, they really built ships and built ’em fast. And not only that, but our plan was able to succeed and work and be sustaining with that tremendous load of all those sick people to take care of. It was a tremendous demonstration of the merits of our health plan and of its value of its economics.[ii]
Other preventive features of the shipyard health care plan included a rigorous process for assigning workers to suitable job classifications, training for the women in the industrial workforce, and extended child care services. And during the war, some of the more conventional medical innovation took place as well – such as Morris Collen, MD’s groundbreaking work on using penicillin to treat pneumonia cases.
Fast forward to the present, and Kaiser Permanente is continuing to promote preventive health services while also conducting high-quality, innovative research. Kaiser Permanente is coordinating a national health initiative to improve colon cancer screening rates to 80 percent by 2018, with a special emphasis on screening minorities and those without health insurance. And when a screening does detect cancer, a progressive Oncology Clinical Trials program selects promising new medications and techniques for members to consider, even before they are FDA approved and commercially available.
In Portland, Ore., Kaiser Permanente led a study showing that mailing test kits to patient homes improved colon cancer screening rates by 40 percent in underserved communities. Sometimes basic delivery systems — like the U.S. mail — can deliver innovative health care solutions.
As Henry Kaiser noted, not all medical innovations need to come forward as bright, shiny objects. Some of the most important ones appear in simple work clothes.
Short link to this article: http://k-p.li/1KmGi87
[i] “Sidney R. Garfield in First Person: An Oral History,” by Lewis E. Weeks, Hospital Administration Oral History Collection, 1986.
[ii] Dr. Sidney Garfield interview by Dan Scannell, 9/1978.
The Occupational Health and Safety Section of the American Public Health Association is celebrating its 100th birthday this year, and the progressive role of that branch of medicine will be highlighted at APHA’s annual conference in New Orleans November 15-19.
Among the media being generated to explore and learn from that history is a full-color poster. “Protecting Workers for a Century,” designed by Kaiser Permanente Heritage Resources archivist Lincoln Cushing, features 12 images covering a range of occupations and dates.
Six illustrations and six photographs offer visual evidence that work can be dangerous and that workplace safety is a constant battle. Two of the images are by Kaiser Permanente Labor Management Partnership photographer Robert Gumpert.
The poster image is featured as the first-ever color cover of the peer-reviewed independent journal New Solutions: A Journal of Environmental and Occupational Health Policy, for their special issue on the 100 year anniversary. The articles may be downloaded for free courtesy of NIOSH and the CDC.
For more on Kaiser Permanente’s long commitment to the field of occupational health and safety, see our earlier Heritage article here.
Happy birthday, OHS!
Image credits, upper left to lower right; all are cropped from original format.
Lewis Hine, “Breaker boys working in Ewen Breaker of Pennsylvania Coal Company,” 1911; Lincoln Cushing, “Mujeres embarazadas! Pregnant women!” 1979; Earl Dotter, Cable Inspectors on Verrazano Narrows Bridge, NY, 2000; Luther D. Bradley, “$acred Motherhood,” 1907; Earl Dotter, Brooklyn hospital laundry workers with needles found in linens, 1997; Richard V. Correll, “An injury to all,” 1980; Robert Gumpert, fiberglass insulation manufacturing, Willows, Calif., 2003; Marilyn Anderson, “100 years of solidarity,” 1989; Lewis Hine, “Bibb Mill No. 1, Macon, Georgia,” 1909; Simon Ng, Our Times magazine (Canada), 1985; Robert Gumpert, garment presser, NY, 1983; Domingo Ulloa, “Short-handled hoe,” 1969.
Short link to this article : http://bit.ly/1prejdp
, Heritage writer
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.
, 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.