September 8, 2015

A legacy of innovation lives on

The Sidney R. Garfield Center

Early exam room prototype at the Garfield Center, March 12, 2007.

Contributed by Lincoln Cushing, Archivist and Historian

In sleepy San Leandro, California, a non-descript warehouse building is ground zero for innovative health care designs that are changing care delivery around the world. Named after an innovator who was ahead of his time in many ways, the Garfield Center is a place where the people of Kaiser Permanente — members, physicians, staff and experts — envision the future of health and are empowered to create it.

Dr. Sidney Garfield (1906–1984) may be most well-known as the founding physician of the health care system we now call Kaiser Permanente. What many don’t know is that he was a passionate innovator of architecture and hospital design, care delivery, technology and the computerization of health care, and the concept of total health. His spirit of curiosity and drive to improve systems are reflected in the mission, projects, and future-minded vision of the Garfield Center today.

An opportunity wrapped in a challenge

The Sidney R. Garfield Health Care Innovation Center’s beginnings were sparked by some specific problems arising from a technology-induced shift in health care delivery and design. Around 2005, an avalanche of new technology was burdening nurses and other clinicians with devices that were disrupting their workflows and ability to provide care. At the same time, Kaiser Permanente’s HealthConnect ®, a massive electronic health record system, was readying for deployment and would affect every aspect of the organization. Moreover, facilities teams, architects and designers were redesigning and building new facilities to accommodate technologies such as MRI and CT scanners, and to meet new seismic standards.

Key leaders at Kaiser Permanente saw that these huge shifts would soon start upending workflow and systems organization-wide — and would ultimately impact the ability of teams to deliver care. They also realized that such changes to technology, physical space, and workflow could not be assessed in existing care settings or at isolated sites. So as is perhaps fitting, they launched an experiment: an innovation center they hoped would help Kaiser Permanente lead the coming transition in health care.

A center for cross-functional innovation

The Garfield Center was given the green light in 2005 — a mere 21 years after Dr. Garfield’s death. It was an idea championed by Jennifer Liebermann, the Center’s founding director, and Marilyn Chow, vice president of National Patient Care Services and Innovation.

Naming the Center after Dr. Garfield was a natural choice since, as Liebermann said, “Our mission and work scope continue his legacy of innovation in the name of health care improvement.” The naming process was a collaborative one, with Liebermann and Chow reaching out to the Kaiser Permanente’s Heritage Resources department for input.

Tom Debley, the department’s founder, recalled how Kaiser Permanente’s institutional history and contemporary vision of innovation intersected in the naming of the Sidney R. Garfield Center:

When I was approached about a possible name for the center, after reviewing the details I recommended considering naming it after Dr. Garfield. This suggestion was also in the context of the celebration of the centennial of Garfield's birth, in connection with the Garfield biography I was writing at the time.

Bryan Culp, archivist with Heritage Resources at the time, explained how the historical fusion went further:

We worked with the Center's leadership on the naming of their rooms. For this we prepared short biographies and photographs of key figures such as Morris Collen, MD; Francis Bobbie Collen, RN, MPH; and Cecil Cutting, MD. We also arranged conversations for the Garfield Center team with doctors Collen and Cutting, and even held a 95th birthday celebration for Dr. Collen at the Center in 2008.

Covering 37,000 square feet, the Garfield Center is a labyrinth of mocked-up rooms (some complete with equipment and furnishings, others simply of moveable plywood walls), wandering robot prototypes, walls of interactive screens, and futuristic simulation environments. Installations include a surgical suite, labor and delivery area, patient home, hospital ward, consulting room, and nurse workstations.

The Center is a place where the introduction of technology into the workplace can be studied in a simulated, safe environment away from the patient. Front line teams are able to investigate the intersections of space, technology and workflow and find ways to align them to improve care. Using tests, prototyping and simulations as near to real world conditions as possible, technologies and new designs can be tested in a hands-on, mocked-up environment before being implemented.

This process allows project owners to test innovations before investing significant resources in capital improvements, and provides a way to get systematic input from the clinicians, care teams and patients who would actually use the space. Bringing users and stakeholders together in the testing space is invaluable because their diversity of views and perspectives allows the center to assess issues from multiple angles, ultimately strengthening the ideas or revealing insurmountable problems.

Cecil Cutting, MD., and first Kaiser Permanente African American female physician Ella Mae Simmons, MD. at Garfield Center opening June 26, 2006.
Cecil Cutting, MD., and first Kaiser Permanente African American female physician Ella Mae Simmons, MD, at Garfield Center opening June 26, 2006.

When the Center opened June 26, 2006, Bernard J. Tyson (who was then senior vice president of Health Plan and Hospitals Operations and later served as chairman and CEO) made these remarks:

I've had a chance to take an early look at the Garfield Center. It is a wonderful facility and clearly the embodiment of everything I've learned about Dr. Garfield's commitment to improving people's lives by providing forward-thinking health care.

How will this benefit the … members of Kaiser Permanente? After the initial testing at the Garfield Center, successful initiatives may undergo additional testing in live patient environments at various Kaiser Permanente medical centers, medical offices, and clinics across the nation. Kaiser Permanente physicians, labor representatives, and management will use the research and information produced at the Garfield Center to serve [our] members. Like so much of the work done on behalf of our members, the center is a strong reminder that we are fully committed to making lives better.

Projects and clients

In the last decade, the Garfield Center has tested, mocked up and simulated hundreds of projects. As should happen with good innovation testing, many have failed, but a good number have grown legs, are now in practice, and are improving health care both within Kaiser Permanente and at large. KP MedRite, a successful and now widespread initiative that has significantly cut down on medication errors, began at the Center. So did recently-launched micro clinics in retail spaces, as well as the Interactive Patient Care system — a screen-based technology hub in the hospital patient’s room that lets them communicate with their care team, browse the web, learn about their procedure, and prepare for discharge from day one.

The Garfield Center is one of several Kaiser Permanente innovation entities, serving a unique role as the physical place where Kaiser Permanente employees and groups can go to “greenhouse” new ideas tangibly. In large organizations, and especially within health care, it’s easy to dismiss new ideas before they’re able to be tested — the Center is a safe place to nurture innovations, test them, and give them the space and time to play out.

The Center does not initiate its own projects, but selects them from submitted project proposals from client groups across the organization. They work with groups at the national, regional and medical-center level, at three levels of engagement: use of the space and tools for project exploration, coaching/guidance through a project, and — for strategic initiatives — a hands-on role in driving the project. According to Lieberman, “Our projects represent a combination of those that are aligned with organizational goals and those that are off the strategic radar enough to push boundaries or be game-changers.”

Imagining the future of health care

In ten years, the Garfield Center has evolved from a testing lab to a place that provokes people to think about the future. This is how those “game-changers” happen. For example, Imagining Care Anywhere (ICA), a groundbreaking approach developed in 2012, stretches teams to think about the future and bring in provocative outside trends. Combining telemedicine, smart technology and an entirely new model that lets members access personalized care anytime, anywhere, ICA is taking care delivery to the next level.

Serene Lau, innovation storyteller at the Center said, “I lead a lot of tours at the Center, and I always love seeing peoples’ minds open up to the possibilities of the future. Sometimes it takes being in a physical space where innovations are tangibly explored to really drive out-of-box thinking.”

The greater good

The Garfield Center is mission-driven to help launch health care innovations that benefit members, patients and care teams throughout Kaiser Permanente — and ideally, ones that impact health care on a larger scale. Their mission goes one step further, by cultivating and spreading the idea of innovation itself. The Center offers innovation coaching services and supports employees throughout Kaiser Permanente with training, toolkits and abundant resources. And by hosting tours to outside organizations, its reach and influence is even greater: more than 75,000 people from hospitals, health plans and academic institutions from 44 countries have visited the Center to learn more about health care innovation.

Some of Dr. Sidney Garfield’s pioneering ideas for the future of health care were perhaps too early to actualize in his time, but through the work of contemporary innovators and the Garfield Center, they are gaining ground and taking shape in this new frontier of health care.