November 4, 2016

Race, gender, and infection — the case for private hospital rooms

Two-bed ward, The Southern Permanente Hospital (Fontana), 1944-08-25

When Kaiser Permanente opened its showcase modern Oakland hospital in 2014, news releases boasted that it had “all private rooms.” Which caused me to wonder — what is the history of private rooms in our facilities?

The first facilities expansion built for our flagship hospital in Oakland in 1943, which served the Kaiser Richmond shipyard workers, included single, double, and quadruple bedrooms. Similarly, the 1943 hospital at the Fontana, Calif., steel mill had rooms for one, two, and four patients.

It’s a logical assumption that the main reason for single rooms is medical.

“To isolate: to separate; to protect; to prevent.” This has long been the industry rationale given for single-patient rooms to reduce “nosocomial infections,” those acquired within a hospital by patients and personnel because of contamination or infection.

But there are other, non-medical reasons as well.

Detail of floor plan, Southern Permanente hospital at Fontana, February 1943

When the original Fontana steel mill hospital became inadequate for the increased volume of patients, a 1952 prospectus for moving the Kaiser hospital to the city of Fontana specifically called out for private rooms:

Rationale for plans to build all 25 “general beds” as private rooms:

With 2 bedrooms, beds are wasted because some people need single occupancy.

  1. Demand (executives, private rich, etc.)
  2. Very ill and dying patients need privacy.
  3. Wrong sex in one of the beds, so can’t admit other sex.
  4. Racial problems — some colored and white people refuse to share rooms.

In an oral history, staff pediatrician Alice Friedman, MD, described the brand-new 1953 Kaiser Permanente Walnut Creek hospital, and revealed yet another reason :

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Detail of floor plan, Oakland Permanente Foundation hospital expansion, April 1943

The rooms were designed for one person only, one bed in other words. There were a few two-bed rooms and otherwise, it was all one. The only reason for the two-bed rooms was because of Blue Cross coverage [for non-Kaiser Permanente patients] at that time. It covered two beds in a room and not a private room.

Adrienne Alcantara, principal media architect planner for Kaiser Permanente’s National Facilities Services organization, explains some of the issues that confronted hospital design during that period:

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Detail, floorplan of Redwood City, 1968

Dr. Sidney Garfield’s main contribution in hospital design was the creation of separate corridors for visitors and staff. Visitors could enter a patient room from an outside walkway, staying out of the way of busy medical staff moving along the interior corridor.

But not all of the rooms in the new hospitals were private. A “mini-pod” served by a nursing station would be based on a 4-room cluster, with two private rooms and two semi-private rooms. The Kaiser Permanente hospital design template from the 1960s tried to achieve this ratio of 50 percent private room space.

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Detail, floorplan of South Sacramento, 1985

As needs changed, so did designs:

In the 1970s more configurations were chosen based on local needs. For example, South Sacramento was built with a 30/70 private to semiprivate ratio, while nearby Roseville was 80/20. This was known as the “gateways hospital.”

In the late 1990s some nursing units — such as Perinatal and ICU — found that they needed more private rooms.

One factor in the room design equation was the cost and inconvenience of having to move patients in shared rooms when situations changed (such as one patient became more ill). Sometimes a shared room was untenable because of patient behavior — the most common complaint in shared rooms is snoring. Also, health care competitors were moving toward more single rooms.

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Detail, floorplan of Roseville, 1995

In 2002, the “template hospital” model was initiated, with similar plans serving several new facilities. The first three hospitals included Modesto, Antioch, and Irvine, which were designed with 100 percent private rooms. This became the standard ratio for all new hospitals or nursing unit remodels to follow. Some facilities have had to incorporate a few semiprivate rooms to compensate for variable peak bed capacity demands.

From gender privacy to nonmember insurance to snoring — so many reasons that private rooms make sense.

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Detail, floorplan of Antioch, 2007.

All modern floorplans courtesy Adrienne Alcantara.