Posts Tagged ‘“Dream” hospital’

Clarence Mayhew – early Kaiser Permanente architect

posted on May 31, 2016

Lincoln Cushing
Heritage writer

Part one of two parts – Walnut Creek, Dragerton, and Fontana


 “Hospital design is sort of a hobby of mine.”
—Sidney Garfield, MD, New York Times Magazine, April 28, 1974.

Sidney Garfield and architect Clarence Mahew, looking at drawing of planned Panorama City hospital, 1965 [circa]

Dr. Sidney Garfield and architect Clarence Mayhew looking at illustration of planned Panorama City hospital, circa 1965

Although Kaiser Permanente’s founding physician certainly had a passion for hospital design, and often served as a consultant, professionals were hired when it came to actually bringing these complex structures into being. One of the organization’s most significant architects was Clarence William Whitehead Mayhew (1906-1994).

Mayhew’s career began in 1922 as a draftsman at the San Francisco firm of Arthur Brown, Jr.. He traveled abroad to study at Paris’ Ecole des Beaux-Arts between 1922 and 1925, and returned to the Francisco Bay Area, where he graduated from the University of California at Berkeley School of Architecture in 1927.

He remained in the Bay Area began a long and distinguished career. Mayhew designed homes, including two in scenic Big Sur and Los Angeles for Lucille and David Packard (co-founder of the multinational information technology company Hewlett-Packard). Among his institutional commissions were the Aurelia Henry Reinhardt Alumnae House at Mills College (Oakland, Calif.), the Alumni House at U.C. Berkeley, and a racetrack in Lima, Peru.

But it was his design of early Permanente Foundation hospitals that is the foundation of his legacy.

Planning for Health newsletter  1952-10

Sketch of future Walnut Creek Medical Center, Planning for Health newsletter October, 1952

Mayhew’s first Permanente hospital was the 76-bed Walnut Creek Medical Center, which opened in April, 1953, one year after the flagship Kaiser Permanente Los Angeles hospital. Dr. Garfield was listed as “functional designer and medical consultant.” It, and the subsequent Kaiser Permanente Fontana Hospital, were part of a “small city” hospital movement; the larger and more urban Kaiser Permanente hospitals in San Francisco and Los Angeles were called “dream hospitals.”

Walnut Creek, along with Los Angeles and San Francisco (opened August 1953), were considered marvels of hospital design. Kaiser Permanente’s member newsletter Planning for Health of October 1952 gushed about its charms:

"Today's Most Talked About Hospital..." article on Kaiser Walnut Creek hospital, Architectural Forum, 1954-07. [Also source tiff files saved separately] [TPMG P1288]

“Today’s Most Talked About Hospital…” detail from article on Kaiser Walnut Creek Medical Center, Architectural Forum, July, 1954.

Many unusual innovations have been incorporated to make the hospital outstanding in the service it will render. The usual central corridor has been converted into a private corridor for nurse, doctor and employees, with a nurse’s station located for approximately each eight beds. This keeps the public away from the service area and bring the nurse, supplies and equipment in close proximity to the patient for more efficient care. Visitors reach the rooms via an outer corridor. Each patient enjoys a private or semiprivate room enclosed on one side with glass, affording the patient a pleasant view of landscaped grounds and trees.

Another progressive feature is the maternity wing. Here the central nursery has been eliminated and replaced with an individual nursery behind the bed-wall. At any time the mother, or visitors, can view the baby through a glass window beside the bed while the baby is actually attended by the nurse. Whenever the mother wants her baby beside her, she need only pull out the bassinet and her baby is there.

Even more impressively, the hospital was featured in an eight-page article in the July 1954 issue of Architectural Forum. It was titled “Today’s Most Talked-About Hospital…for four good reasons,” which it articulated:

1: Its architecture is part of the cure
2: Its corridors are actually long workrooms
3: Its bedrooms are designed for patient self-help, and
4: Its economics make it self-supporting at low rates.

Although many of those functional features were Dr. Garfield’s ideas, the aesthetics of the design were credited to Mayhew: “Note the easygoing grace with which Architect Mayhew has imbued a necessarily machinelike plan.”

Immediately on the heels of Walnut Creek were two smaller facilities built in 1954, one at a remote World War II Kaiser Steel coal mining location in Dragerton, Utah, and the other as a civic expansion of the hospital in the city of Fontana, Calif., where Henry J, Kaiser’s wartime steel mill was located.

Detail from blueprint for alterations and additions to Dragerton, Utah hospital, lot bounded by Center Street, Third Street, and Whitmore Drive. Original hospital built 1952. 1953-02-25. [TPMG P2640]

Detail, 1953 alterations and additions to Dragerton, Utah hospital, (Center Street, Third Street, and Whitmore Drive.)

The War Production Board had built a hospital at Dragerton (now called East Carbon City), which was later purchased by a physician who soon afterwards was charged with medical and fiscal mismanagement. United States Steel asked Henry J. Kaiser to take over the hospital in early 1952. Miners were desperate for proper care, and the team of Permanente physicians – which included shipyard doctor Wallace “Wally” Cook – was swamped. Mayhew designed a simple hospital, for which Dr. Garfield was listed as “consultant.”

Although a Permanente health plan was never established in the region, the hospital remained as Utah Permanente Hospital until 1966. However, this commitment to serving working people would eventually re-emerge as a plea for expansion from stakeholders in Colorado, which Kaiser Permanente began to do in 1969.

Architectural drawing, Fontana Kaiser Foundation Hospital, 9961 Sierra Ave., completed 1954. Clarence Mayhew, architect. Plans 1953 [circa]. [TPMG P1479]

Architectural drawing, Fontana Kaiser Foundation Hospital, 9961 Sierra Ave., completed 1954. Clarence Mayhew, architect.

In Fontana, a wartime hospital existed on the steel mill site, but once the Permanente Health Plan was opened to the public after the war it made more sense to locate a hospital in town. At first Dr. Garfield considered simply expanding the hospital at the steel plant, but in late 1953 Kaiser Steel Corporation Vice-president and General Manager Jack L. Ashby wrote to Dr. Garfield and told him:

I am advised that last month alone some 9,000 to 10,000 people visited the existing clinic now at the steel plant. The overcrowded condition is constantly a problem… In our opinion, not to build the clinic in the City of Fontana would be like building a beautiful automobile without an engine.

The San Bernardino County Sun published an article August 19, 1954, announcing a three-day open house:

The Kaiser Foundation’s newest “hospital of the future,” bringing to the Fontana area the last word in comfort and efficiency for patients and the hospital staff, will be introduced to the public next week.

The new medical facilities, initially containing 42 beds, are located on a 15-acre site at 9961 Sierra Ave., corner of Marygold Ave. They will complement the existing 88-bed Foundation hospital at the nearby steel mill of Kaiser Steel Corp., which donated $300,000 to help finance the new structure. The hospital, in the center of the expanding Fontana-Bloomington-Rialto-Etiwanda area of 60,000 population, is a community hospital open to the general public and to all qualified physicians and their patients, as well as Kaiser Foundation Health Plan members.

The one-story, “T” shaped building, of steel construction and utilizing vast amounts of glass, is the second of the Foundation’s concept of the ideal “small city” hospital.

Three hospitals in two years – that’s a pretty remarkable pace. But Mayhew was just getting started.


Next: More California hospitals 1955-1973: Harbor City, Panorama City, and San Rafael.


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What’s the big idea? Designing the small hospital of the future

posted on October 18, 2011

By Laura Thomas

Heritage correspondent

First of two articles

Inpatient ward at Garfield's Contractors General Hospital at Desert Center, circa 1933

When the winner of Kaiser Permanente’s “Small Hospital, Big Idea” design contest is announced in February, at first glance it may appear the 65-year-old health plan is taking a major turn off the road it followed for decades: building large hospitals as hubs for satellite medical clinics in surrounding communities.

But, actually, a fuller story lies in Kaiser Permanente’s genesis in the small hospitals that founding physician Sidney Garfield built in the early part of his career.

In the competition, architects have been asked to dream up a model for a community health center with many of the features of a larger KP hospital, including surgery, emergency, laboratory, and pharmacy. The small hospital will leverage the newest diagnostic, treatment, and communications tools for outpatient and inpatient basic and acute care — all in one cutting edge hospital.

KP Sunset Hospital in Los Angeles, built in 1953, was one of Dr. Garfield's "dream" hospitals.

The key for planners is to find a set of design concepts that will balance the latest in technology with a humanistic approach in providing efficient, affordable, and high quality care. The “hospital” will create a place to encourage and nurture a healthy lifestyle for KP’s members and the community at large.

Of over 100 contest submissions, three made the final cut in May: Aditazz of Palo Alto; Gresham, Smith and Partners of Nashville, Tenn.; and San Francisco engineering firm Mazzetti Nash Lipsey Burch, working with Perkins+Will of New York. They each received a grant to refine and concretize their plans over several months.

Garfield's idea for a "small city" hospital featured plenty of natural light. This is the innovative Walnut Creek hospital built in 1953.

The winning design will be used to wildly modernize and perfect the self-sufficient hospital design pioneered by Garfield on construction sites in the Southern California desert and the Grand Coulee Dam in Washington State in the 1930s and 1940s.

The plans, promising to be ingenious, will be the blueprint for construction of the “best of the best” small KP hospital, likely to be built in the High Desert northeast of Los Angeles. Rather than being a major departure from tradition, the Small Hospital, Big Idea concept will bring the medical plan’s legacy of hospital building full circle.

Ironically, the setting for the early Garfield hospital designs, as well as the imminent creation of the KP futuristic “Big Idea” small hospital, was and is the Southern California Mojave Desert.

Ingenious health care for Garfield’s time

Garfield’s ability to keep 11,000 Los Angeles Aqueduct workers healthy improved greatly as the men came in for routine checkups instead of waiting until they were really sick. His other initial foray into prevention was direct: To reduce head injuries and nail punctures, he went to the job sites and lectured the workers about pounding down nails and then inspected tunnels for dangerous shoring.

Visitors to the early Walnut Creek hospital (1953) could access patient rooms from an outside walkway, leaving the central corridor of the nursing wing free for nurses.

Garfield eventually built three hospitals in the desert, equipping them with air conditioning — the latest technology — and newly invented venetian blinds. He furnished the wards with soothing color schemes, flower containers, and personal radios to elevate patients’ moods.

Garfield’s three hospitals were far flung — the first at Desert Center, another at the east end of the aqueduct at Parker Dam, and the third at the Imperial Dam near Yuma, Arizona. He staffed each with a physician, and he zipped back and forth by car across 100-mile stretches of desert to perform surgery.

Garfield’s next project was to refurbish and outfit a rundown 35-bed facility for Henry Kaiser’s workers on the Grand Coulee Dam project in Mason City, Washington. The union was excited when Garfield promised air conditioning, but Kaiser’s son Edgar, who was running the project, said no. (Garfield installed it anyway, paying for it out of his pocket; a slightly annoyed Kaiser reimbursed him).

That small hospital, with its early team of group practice doctors, went full bore into preventive care for the 15,000 residents (workers and their families) in the company town.

“They saw simple acute appendicitis instead of peritonitis; earaches instead of mastoiditis; upper respiratory infections and less pneumonia; early lumps in the breast instead of metastatic carcinoma,” writes Dr. John Smillie in his history of the Permanente Medical Group. “The Coulee physicians were capable of handling just about any case that came their way, including serious cancer surgeries. Only one patient, a suspected brain tumor, had to be referred to Spokane.”

They also established a satellite community service: Millie Cutting, a nurse and wife of job site physician Cecil Cutting, solicited funds door-to-door — and received generous contributions from the brothel madams — to set up a well baby clinic in a local church.

Bigger challenges on the Home Front

The urgent need for quality health care for Kaiser West Coast Shipyards workers during World War II dictated the facilities Henry Kaiser and Sidney Garfield could establish for their often sick, weak, and injured patients. The Richmond Field Hospital, later serving the community at large, was thrown up in a hurry and opened with 10 beds in August of 1942.

Garfield carefully designed the modern 70-bed Oakland Medical Center, although it was the hurried resurrection of the surviving maternity wing of the Victorian Fabiola hospital, which had been torn down years before. The Oakland hospital, also opening in August of 1942, expanded twice (to 145 beds) before the end of the war and its successor structures remain the hub of East Bay facilities to this day.

The Panorama City Hospital in Southern California, built in 1962, featured two circular towers. Within the towers, the concept of "circles of service" was born. Later KP hospitals retained the basic design but the "binocular" towers were enclosed in rectangles.

With World War II behind him and the Kaiser Permanente medical plan beginning to grow, Sidney Garfield was able to experiment with various ways of using architecture and design to improve both the efficiency of staff and services and patient comfort as well. In the early 1950s, Garfield, whose boyhood dream was to become an architect, designed his first two large “dream” hospitals in San Francisco and Los Angeles and his last two “small city” hospitals in Walnut Creek and Fontana.

Innovative, efficient mid-century designs

He designed them all around principles he held dear: efficiency, economy, and patient comfort. Renowned architect Clarence Mayhew designed Walnut Creek and Fontana to echo the mid-century desire to have the indoors and the outdoors meld. Each was Y-shaped with two wings of rooms that opened to the natural environment to both soothe the patient and give visitors access while nurses, doctors, and orderlies circulated freely down an interior corridor.

Despite being small, they incorporated the features of the larger hospitals. The central work area was abolished in favor of stations distributed along the corridor so each nurse would be a few steps from her patients with records and supplies shelved nearby.

Santa Clara Medical Center, built in 1964, featured the decentralized interior corridor dictated by the circular design debuted in Panorama City.

And the mostly private patient rooms were equipped with all manner of modern convenience with power-drawn curtains and bed adjustments operated by push buttons, a built-in lavatory, toilet, closets, oxygen outlet, plus phonograph outlet and radio.

Garfield received national attention for his rooming-in maternity section where babies were kept close to their mothers, but also within reach of the nurses through a bassinet that slid between the room and nursery.

Architectural Forum magazine in July 1954 lauded all the new technology and design innovations in Walnut Creek: “For all its luxuries, care at Walnut Creek actually costs less than at older hospitals. The gadgets speed recuperation and encourage patients to care for their own minor needs.” Thus, the nurses’ time spent as errand girls would be reduced. He was a great believer in the power of human contact in the healing process.

Garfield said in the KP Reporter in 1963, “Over the years, we have been working for development of functional design in hospitals in which our staffs can serve patients with a minimum of wasted time and energy. They will then have more time to be with patients, and this human contact makes for happier patients, more stimulus to recovery.”

View a 1953 video about the Kaiser Permanente “dream” hospitals.DreamHospital

Next time: Kaiser Permanente member growth spurs new thinking on how to create the ultimate patient experience.


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