, 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
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
By Lincoln Cushing, Heritage writer
The image of Kaiser Permanente founding physician Sidney R. Garfield as a hammer-wielding workplace safety diehard has been passed down through the decades from his early days as a desert doctor. But is the legend true? Did Garfield really charge out into the dust and dirt himself and pound down rusty nails, shore up tunnels to prevent rock showers, and insist workers wear hard hats?
This story of Dr. Garfield’s passionate preventive practice on the Colorado River Aqueduct project has endured for eight decades, since about 1933. The oft-told tale conveys the young doctor’s commitment to worker safety and preventive care once he instituted the unconventional prepaid model of health care that saved his little hospital from extinction.
Garfield was certainly committed, but his allegedly active role in the cleanup of aqueduct work sites is a stretch of the imagination. And he was not alone in promoting workplace safety.
Fact or fiction?
The story has sometimes been presented as fact:
“There was a funny little story that Dr. Garfield, on the first day in which prepayment began in the desert, got up early in the morning with his hammer, and went around the worksite pounding down nails. . . The notion is that if you can keep the patients healthy, then it’s a good thing not only for the patient, but it’s a good thing, financially, for the program.” [i]
Sometimes it’s told as legend:
“There (in the Mojave Desert) he also discovered the importance of preventive medicine, and he strove to remove potential health hazards for the workers – although it is only legend that Garfield would go to the construction sites and pound down any protruding nails himself.”[ii]
And at least once the story has been cited in a novel about the desert doctor’s operations, where a fictional Dr. Sidney Garfield speaks to a fictional nurse:
“I picked up another nail. ‘Look at all these dirty nails. Just lying around, waiting for someone to step on them and end up with a puncture wound, tetanus, or worse.’ ”[iii]
In his own words
When we examine the historical record and let the doctor speak for himself, as in this circa 1934 quote in which he describes a disquiet of conscience from collecting fees from illness and injury, we see his true role.
“We had been anxious to have sick men or injured men come into the hospital because that meant income and that we would continue to exist. . . It was embarrassing to me to want people to get hurt. So we started to do safety engineering. . . We would get a bunch of nail punctures from a job and we would go out there and get them to clean up the nails. Or we would get a lot of head injuries . . . and we would get them to shore up the tunnels better.”[iv]
Garfield’s commitment to worker safety was genuine, but it was his nurse, Betty Runyen, RN, who actually went to the work sites to speak to the importance of taking salt tablets and drinking water to avoid sunstroke, and of donning gloves to prevent the spread of impetigo from pick axes and shovels. The competent nurse was also the visage of an angel in those hostile environs with her blonde curls and pretty smile.
Water district’s safety efforts
It should also be noted that Garfield and Runyen had help as well. The Metropolitan Water District of Southern California, the builder of the aqueduct, and Workmen’s Compensation insurance companies all placed their own safety engineers in the field to remedy dangerous job situations.
The 1937 Colorado River Aqueduct project manual describes their role thusly: “It is the duty of the safety engineer and members of his organization to visit all work on the aqueduct at frequent intervals to see that the work is being carried on in accordance with established safety rules, to offer advice and instructions to those in charge of construction operations, and to assist in the elimination of dangerous operations and equipment.
“In addition, each division engineer is charged with the responsibility of reducing accidents to the minimum. Special safety meetings are held at various points along the aqueduct at frequent intervals and a regular plan of safety education is maintained.”[v]
All of these efforts apparently had an impact – accident frequencies were reduced to a point well below the average rate experienced in that class of construction during that period.
In the desert years (1933-1938), Garfield did not wield a hammer or gather stray nails at the job site. But it is still fair to say that he overturned the conventional wisdom that a physician must derive his income from illness and injury. In the desert he realized the incentive to keep people well and on the job. Thereafter, preventive care became paramount, first in his imagination, then in reality when he partnered a few years later with Henry J. Kaiser at Grand Coulee Dam project in Washington State.
Kaiser Permanente Core Values,” conducted by Martin Meeker in 2007, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 2007.[ii] Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group, by John G Smillie, MD; book review by Morris F. Collen, MD, The Permanente Journal, Summer 2001
by Tom Debley, the Permanente Press, 2009, p. 21
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.