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The Case Against Hospital Beds

Two summers ago, I opened The New York Times Magazine and saw a startling centerfold ad that seemed to foretell the future: a sweeping panoramic image of people relaxing and strolling in Central Park, overlaid with large block text that read, “IF OUR BEDS ARE FILLED, IT MEANS WE’VE FAILED.” You could hardly have guessed it was a hospital ad. The logo for the Mount Sinai Health System was stamped in the upper corner, almost like an afterthought.

Around the same time, I was beginning a project funded by the Robert Wood Johnson Foundation to examine whether hospitals and health care facilities are well designed for their modern purposes—to produce more health, rather than just deliver more health care. And it became clear that one of the most important challenges for hospitals to address will be a simple one: the association of hospitals with beds.

When the health care industry talks about hospitals, it tends to use the language of facility planners—one in which “patients” and “beds” are equivalent. This is the legacy of a very different era in medicine. Modern hospitals are historically rooted in the sanatoria and asylums of the mid-19th century, originally conceived to isolate patients with conditions such as tuberculosis and lunacy from the community, not to protect their rights. The move from open wards to closed rooms was perhaps the first major reform in hospital design—motivated by a need for isolation as our understanding of communicable diseases and infection control became more sophisticated.