Posts Tagged ‘Dream Hospitals’

60 years ago: Kaiser Permanente’s first LA medical center opens

posted on June 21, 2013

KP Sunset Hospital in Los Angeles, built in 1953, was one of Dr. Garfield’s “dream” hospitals.

By Lincoln Cushing, Heritage writer

Garfield’s design of ‘dream hospital’ features unconventional and efficient layout

1953 was a big year for expansion in Kaiser Permanente. The fledgling Health plan opened state-of-the-art hospitals in three communities – Los Angeles and Fontana in Southern California and Walnut Creek in Northern California.

The Los Angeles Medical Center (on Sunset Boulevard) was the first to open, on June 16, 1953. The dream hospital design was inspired by Kaiser Permanente founding physician Sidney Garfield who worked with architect of record George M. Wolff.

The new hospitals debuted the concept 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.

Garfield’s design called for decentralized nursing stations with one for every four rooms (one nurse per eight patients) instead of one per floor. Patient rooms had an individual lavatory with hot, cold, and iced water.

The futuristic concept of the “baby in a drawer” – a sliding bassinet that let a tired mom pass her newborn through for care in the nursery – was also introduced in the 1953 dream hospitals.

LA Times touted new medical center

The Los Angeles Times gushed about the $3 million facility, describing it as “sorely needed.” It also noted: “The Kaiser Hospital, operated by the non-profit Foundation, is open to the public, a fact not generally known. In addition to Health Plan patients, it also accepts private patients and charity patients referred by social welfare agencies.”

But that public aspect did not sit well with the Southern California medical establishment whose members resisted the arrival of prepaid, group practice medicine. The next month the Los Angeles County Medical Association sent out a questionnaire to its members with the header caption “This is the most important notice ever sent to you by the LACMA.”

Medical association resisted group practice

The cover page made clear the medical association’s concerns:

“Points have been raised as to whether this (Kaiser Permanente) is really a corporation practicing medicine, whether the ‘captive’ patients of the plan forced to join by their union is good for the welfare of the people, whether the patients receive adequate medical care, whether it is proper for a layman to control physicians, etc.”

Opposition reached a fever pitch in August 1953 when Paul Foster, MD, president of the medical association, condemned the Kaiser Permanente program as “unethical.”

These were difficult times for the fledgling Permanente group. The successful practice of high-quality medicine in gleaming new facilities like Sunset eventually wore down the opposition.  By 1960, the local medical society attacks on the program had come to an end.






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Creating the ultimate patient experience

posted on October 26, 2011

By Laura Thomas

Heritage correspondent

Second of two articles

KP Bellflower Hospital built in 1965 in Southern California

In the beginning, Sidney Garfield and Henry Kaiser, promoters of the fledging Kaiser Permanente Health Plan, didn’t have to think: do we build a big hospital, or a small hospital? With only a few thousand members in 1945, they only had to consider “where, and how quick?

The first clinics were primitive and small, often in space adapted from an office building, storefront, old home, or automobile dealership. Atmosphere and aesthetics didn’t figure into the mix.

But that was to change phenomenally over the next few decades. In 1950, KP Northern California membership, with the recent addition of the longshoremen’s union and some government employers, was 120,000. In Southern California, with longshoremen and retail clerks, the number was smaller: 20,000.

By 1990, KP Northern California boasted more than 2 million members; Southern California had about the same. Where hospitals in Los Angeles, Fontana, and Harbor City had sufficed in the 1950s, by 1990 there were seven more: San Diego, Bellflower, Anaheim, Woodland Hills, Riverside, West Los Angeles, and Panorama City.

Downey Medical Center replaced the Bellflower hospital in 2009.

Where Oakland, Richmond, San Francisco, South San Francisco, and Walnut Creek had been enough for the north in the 1950s, by 1990 there were eight more: San Rafael, Hayward, Santa Clara, Redwood City, Santa Teresa, Sacramento, South Sacramento, and Martinez.

Big hospitals draw from satellite clinics

These hospitals, varying in size from 100 beds to over 500, played the role of kingpin to a network of medical office buildings (MOBs) in communities within a reasonable distance. If patients needed emergency care, surgery, or had to be hospitalized for any reason, they were taken to the hub hospital.

Generally, KP has grown by establishing satellite offices in areas where membership numbers can support an MOB. Then when membership grows in an area and overwhelms established MOBs, another clinic is built in a nearby area. When the MOBs start to overwhelm the designated hospital, another hospital is built to take the overflow. This has been the trend.

For example, when membership in the San Jose area outgrew the Santa Clara Medical Center, built in 1964, KP purchased a community hospital and established a second medical center, Santa Teresa in 1976. Similarly, when the Fairfield-Vacaville area membership outgrew Vallejo Medical Center, a Vacaville Medical Center was built in 2009. When Los Angeles Medical Center became stuffed with too many patients, Baldwin Park Medical Center was established nearby in 1995.

Facility planners get a workout

Another view of Downey Medical Center.

By now, membership in both regions has soared to more than 8 million, and that means more hospitals and MOBs. By last count, KP has 35 medical centers (including Ontario to open later this year) and about 430 MOBs in California. All this growth and construction has given KP facilities planners plenty of experience, and caused them to spend a bucketful of money.

So in the late 1980s and early 1990s, planners began to “plan” for a more efficient way of meeting the demand for more medical office and hospital space. Taking best practices and design success stories, they developed a template that could be used to build new buildings with a minimum of effort, lead time, and government review. Gateway was the first template developed in the 1990s and was used in part to design and build the Fresno Medical Center, Roseville Medical Center, and others.

Vacaville Medical Center, built in 2009, serves members formerly part of Vallejo Medical Center area.

Today’s flexible template calls for efficiency, sustainability, and beauty

The current version of the template calls for the combination of hospital and medical offices in one structure with a common entrance. However, the template is flexible and constantly evolving to address specific needs of each KP service area. The template ideas have been garnered from many sources and have been reviewed by a wide array of stakeholders, including labor, medical staff, and other employees. The functionality has been tested in mocked-up clinical situations, and designs have been validated by leading health care designers.

Modesto Medical Center in Modesto, showcase of modern, green hospital design, 2008

Throughout the years, KP architects have retained many of Sidney Garfield’s innovative ideas and incorporated them into updated hospital designs. Garfield’s idea of decentralizing nursing by creating “circles of service” survives to the present day in the triangular towers built in gateway and template model Kaiser Permanente facilities from the late 1980s onward. With the nursing station at the center and patient rooms surrounding, nurses save steps and are closer to their patients, thus they’re able to provide better care.

Garfield and architect Clarence Mayhew pioneered the design in 1962 with the construction of the first “binocular” hospital in Panorama City. It was used again for Santa Clara hospital built in 1964, but this time the circular towers were enclosed in rectangles. Garfield’s early hospital designs also called for the latest available technology. (See previous blog: “What’s the Big Idea?” posted Oct.18.)

Coincident with the idea to streamline the construction process, KP was also becoming aware of the need to make facilities “warmer” and for the configuration of structures to support a positive experience for the patient and visitors. Also, new technology spurred thinking about how a medical center could most efficiently function.

The current iteration of the hospital template informs future construction in functionality, as well as sustainability, patient comfort, efficiency for staff, accommodation of the latest technology, effective use of light, and more. In 2008, KP opened the exquisitely designed Modesto Medical Center, a showplace for the newly evolved template and for accompanying green initiatives.

Architects vie for best small hospital design

The latest KP hospital design calls for lots of natural light, as in the Ontario Medical Center lobby.

Meanwhile, this year KP asked architects around the world to design a new prototype for a small hospital, one that challenged the status quo way of thinking about health care delivery.  The Small Hospital, Big Idea competition, with three finalists still in the running, will conclude with the presentation of final designs in late January. If the stars are happily aligned, the new small hospital design may offer a viable alternative for KP to move into new areas with a self-contained, integrated medical facility.

In the competition, KP asked all contenders to think about how to make the hospital an inviting place associated with “health,” rather than “health care,” according to John Kouletsis, vice president of facilities planning. “It should be a ‘wow’ experience,” he said, “where people come out of it and say, ‘this was difficult in terms of the clinical things, but it was such a great experience. The facility was beautiful. It supported me in every way’.”

Snooping for a glimpse at the “Big Idea” design

Submissions from six semi-finalists offer a picture of what the new facility might be like. Many responded to the mandate for stressing wellness by seeing the new hospital as a place for patient health education where members can come to use a fitness center or attend classes in a facility designed to be attractive and welcoming.

In Kaiser Permanente’s new small hospital, telecommunicating expertise will help staff expand their ability to offer a range of acute, diagnostic, and surgical services as well as emergency and, perhaps, maternity care. There are numerous visions of making the facility blend both functionally and physically with the community with the possibility for storefront clinics in nearby neighborhoods or a farmers market, vegetable garden, or community park on the site.

The gadgetry so favored by Garfield in patient rooms will be ever more sophisticated and will also move into the hands of members in the guise of mobile devices that monitor their health, connect them to medical staff, and provide education and advice in the hopes of keeping them away from the hospital.

No doubt the design or designs accepted for the small hospital will incorporate the concepts so important to creating the “total health” experience in all KP’s facilities. Also, Garfield’s ideas of keeping patients healthy through illness prevention and health education will come through in plans for the compact hospital to be a pleasant place where support for healthy lifestyles and learning is paramount.

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