Prevention of worker injuries a Kaiser Permanente tradition

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 20 ^th 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 Kaiser Permanente 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 Kaiser Permanente 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]

Kaiser Permanente 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 Kaiser Permanente 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 Kaiser Permanente’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, Kaiser Permanente Employee Safety), Helen Archer-Duste (executive director, Kaiser Permanente Workplace Safety and Care Experience), Patricia Hansen (Kaiser Permanente regional workplace safety practice leader), and Maureen Anderson (Coalition of Kaiser Permanente Unions) for contributing to this article.

[i] California Wire, “Workplace Safety Initiative: KP and Labor Partners Put Safety First,” Aug. 6, 2001.

[ii] California Wire, “U.S. Labor Leader, KP CEO, Employees, and Managers Launch Programwide LMP Workplace Safety Plans,” Nov. 4, 2002

[ii] California Wire, “Labor Management Partnership Reaches Staff in Workplace Safety ‘Walk-throughs’,” Nov. 11, 2002.

[iv] California Wire, “Safety Is Key in KP HealthConnect ® Deployment,” July 19, 2004.

[v] California Wire, “Los Angeles Lift Team Wins LMP Award,” July 26, 2004.

[vi] “Workplace Injuries Plummet,” Inside KP, Nov. 8, 2011.