Fourth in a series on Kaiser Permanente’s 70th anniversary
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.
– Henry J. Kaiser
"Problems are only opportunities in work clothes.”
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.
[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.