THE UNIVERSITY HOSPITAL
The profound developments of the past thirty years in biological research, both basic and clinical, in medical education, and in health care delivery patterns have affected deeply the physical features and the operational procedures of the University Hospital. Throughout virtually the entire thirty-year period the Hospital's administration was the responsibility of Dr. Albert Kerlikowske, who retired on June 30, 1969. He was succeeded by Edward Connors. Upon the retirement of Dr. Harley Haynes, the director who preceded Dr. Kerlikowske, the University administration created a Hospital Board-in-Control to which the Hospital director was immediately responsible. This Board originally consisted of the Vice-President for Academic Affairs, the Vice-President for Finance, the Dean of the Medical School, and the Director of the University Hospital. Subsequently, one member of the professional medical staff of the Hospital served on that Board. In 1969, when Connors came to the University, another major administrative change occurred. A new position had been created known as the Dean-Directorship of the Medical School and Medical Center. Dr. William Hubbard became the first incumbent. Under this new arrangement the Board-in-Control was modified considerably to include broader representation of the medical staff and non-University members representing the public at large. The new plan was developed in order to unify the direction of all activities within the Medical Center, which included the Medical School and the Hospital. The Hospital professional staff was given a larger role in the administrative affairs of the Hospital, under the leadership of a chief-of-staff.
The Main Hospital, under construction for six years, was finally occupied in August of 1925. By the mid-40s, having undergone many internal modifications to meet rapidly changing needs, the Hospital had begun to show signs of increasing obsolescence. It was finding itself unable to cope with modern patient service demands and medical advances quite different than those it was designed to meet originally. In 1953 Dr. Kerlikowske, after lengthy diplomatic contacts with members of the legislature and with the Regents, succeeded in obtaining legislative approval for an ongoing program of modernization to be approved and supported on a yearly basis.
In addition, a combination of federal funds, private philanthropy, and funding from University Hospital operations was necessary to meet capital building and Page 213modernization demands to keep pace with new medical advances, patient expectations, and the greatly expanded clinical teaching program for health-care professionals. Between 1950 and 1970, new hospital building construction and modernization of the University Hospital from all sources of funding amounted to $40,555,000 during the twenty-year period. The teaching and research facilities related to the Medical School during this period also involved new construction and modernization totaling $35,667,000 in the Medical Center. Of the total capital and modernization funds, 51.3 percent was provided by the state, 22.3 percent by gifts or private philanthropy, 12 percent from federal sources, 8.9 percent from University Hospital operations, and 5.5 percent from University sources.
Major new hospital buildings were added shortly after World War II. In 1950, the Women's Hospital was built at a cost of $1,725,000. The seven-story Outpatient Building in 1952 expanded programs for ambulatory treatment and teaching, involving $3,837,000 for the new facility. The Children's Psychiatric Hospital was opened in 1955 with a construction cost of $2,153,000. In 1969, with a generous gift of $6,777,000 from the C. S. Mott Foundation, the Charles S. Mott Children's Hospital came to fruition, with added federal and University Hospital funds for a total construction cost of $9,555,500. In 1967 the University Hospital acquired the Parkview Medical facility on Wall Street in Ann Arbor for $1,100,000. It is used for hospitalized patients needing less intensive care than in the main hospital, for patients requiring rehabilitation from physical disabilities, and for special ophthalmological surgery procedures. These were the major new Hospital building additions from 1960 to 1970.
In this same period, the modernization demands of University Hospital to meet new techniques in medicine, expanded student and training needs, and support services, required considerable changes from the original 1925 Main Hospital structure. In 1954 the Alice Crocker Lloyd Radiation Laboratory was established with donor gifts of $148,300 toward an installation cost of $259,423. With the new knowledge in treatment of those handicapped with physical disabilities, and the need for expanded training of physiatrists and physical therapists, a remodeled unit for the Department of Physical Medicine and Rehabilitation, supported by state and federal funds, in 1961 offered greatly improved facilities. In 1962 a former cafeteria was converted into a model patient-care unit for Clinical Research within the hospital as a "branch" of the National Page 214Institutes of Health. Federal support of $492,000 provided for this renovation. The greatly-expanded utilization of drugs for treatment and diagnostic laboratory examinations, as well as education of pharmacists and clinical laboratory professionals, established the need for replacement of crowded and outmoded Pharmacy and Central Laboratory facilities in 1964 and 1965, at a renovation cost of $1,125,000.
By 1960 patient accommodations in the 1925 Main Hospital building required major changes to meet public expectations and an improved patient environment. The single-room pavilion rooms on the top three levels of the surgical wing were completely remodeled, air-conditioned, and re-decorated at a cost of $650,000. Throughout the hospital, lighting was greatly improved and color began to be used in place of the hospital grey walls in corridors and rooms. Planning was also begun to convert the large open 18-bed wards to semiprivate accommodations. Because of original building constraints, it posed major reconstruction problems. In 1967, at a cost of $575,000, one patient unit was converted to semiprivate accommodations. In 1970 the major ward wings were included in a five-year program of reconversion to semiprivate rooms, and the current expanded needs for support or training facilities. The first 18-bed unit was renovated in 1970 at a cost of $500,000 in this program.
When the new seven-story Outpatient Clinic, with its connecting corridor, was completed to the east of the Main Hospital in 1952, it had been anticipated that space vacated by outpatient activities in the Main Hospital would allow the over-all bed capacity to be increased. This was not the case. Length of patient stay had been reduced, allowing for more patients to be treated without lengthy hospital convalescence. New services and treatment programs developed by advancing medical knowledge required additional space commitments formerly provided to bed areas. Highly specialized care units, with sophisticated equipment and supporting facilities, utilized broader areas previously occupied only with beds. Newly-developed space needs for greatly increased clinical laboratory activities, blood bank, inhalation therapy services, a surgical and cardiac recovery room, intensive care units for both surgical and medical patients, a special burn unit, a coronary unit, a well-baby clinic, a cardiovascular study center, and a renal dialysis facility, to mention but a few, quickly absorbed all the vacated space and more. The over-all hospital capacity, 1,238 beds in 1941, fell to 1,059 in 1970-71. Additional emphasis was also placed on ambulatory-care programs.
Page 215There had been a virtually continuous process, also, of remodeling and auxiliary construction to meet supportive needs for receiving and storage of medical supply materials, bedside distribution of oxygen, for expanding food service needs, modern patient safety and comfort requirements, and appropriate building transport needs for patients, students, staff, and supplies.
In 1958, 3,000 cafeteria meals were served to patients daily and 5,000 to staff members. This service load required a hospital food facility remodeling program involving $3,077,000. A hospital chapel, built by a private donor in 1958 within University Hospital, began to serve the religious and pastoral care requirements of patients and hospital staff or students. An $800,000 electrical renovation program in 1965 required re-wiring of the entire Main Hospital building and the construction of multiple-power stations to correct seriously overloaded circuits for diagnostic equipment, lighting, elevators, and electrical devices of all sorts. To meet new patient safety codes, the state fire marshall, long unhappy with the antiquated fire-escape system, demanded and assisted in funding the construction of steel staircases at the end of every wing of the thirteen-level structure, fully enclosed with brick walls and supplied with fire doors to the interior. This patient-safety program involved renovations from 1964 to 1969 at a total cost of $597,000. To further meet patient safety and comfort needs, the eleven Main Hospital operating rooms and 96 single-room accommodations were air-conditioned for $2,300,000 in 1968. Increased students, staff, patient transportation, and supply movement taxed the old 1925 vertical transportation system. Four new elevators were ingeniously constructed on outside walls of the Hospital in 1970, at a construction cost of $1,620,000. Included in the project, a multiple ambulance entrance was created in a cul-de-sac of the original main building. To cope with structural deterioration, the front entrance steps were removed entirely in 1958 and replaced by a newly-lighted and all-weather canopied entrance way. Central sterilization and supply facilities, with large-volume processing equipment, were installed in 1961 in a renovation program contiguous with the Physical Medicine and Rehabilitation Department expansion, for a project cost of $1,835,500. During the thirty-year period of 1940-70, multiple smaller modernization programs were carried out each year.
To meet urgent needs for instruction, the Department of Postgraduate Medicine, with the cooperation and assistance of the Hospital Director, found space for and Page 216conducted the necessary remodeling and equipping to provide four lecture rooms, in addition to those that had been made available on almost every level in the Outpatient Building constructed in 1952. The Main Hospital amphitheatre, seating 200, was repeatedly refurbished and refinished, and to some extent redesigned over the years until the final major renovation in the mid-60s, which included the installation of closed-circuit color television monitors for teaching purposes. The increase in clinical faculty established need for faculty office accomodations. The original Intern's Quarters building, constructed in 1939 to house 75 interns, was utilized for these faculty offices.
The growth of services for treatment of patients, the expanding teaching facility needs with a large student group, and the limitations within the original University Hospital had created further outward movement. Supporting services, such as the purchasing, accounting, housekeeping, and central functions, were moved to University housing units on the periphery of the Medical Center. Valuable hospital space vacated was then converted by 1970 to more direct patient-care functions.
Because of the increased numbers of students, faculty, staff, and patients in the Medical Center, the parking situation in the Hospital vicinity had been a growing problem since 1940. To meet this, a 400-capacity parking structure was originally built on Catherine Street, augmented by a 100-car structure directly south of Women's Hospital, and additional areas for a total of 2,800 automobiles in 1970.
The admitting, information, and administrative support of the Hospital has been repeatedly modified and modernized during the 1940-70 period. The senior administrative staff of the Hospital has grown from five members in 1940 to a total of ten in 1970 in order to deal with the complex management activities of the University Hospital. Twenty-seven functional units support the patient-care activities of the clinical staff, ranging from the Nursing Department to a Data Systems or Computer Department. During the 30-year period, the growth of voluntary, prepaid insurance for hospitalization, as well as government reimbursed hospital care, had made increasing demands for added business and supporting personnel. New para-professionals, such as clinical nursing specialists, inhalation therapists, licensed practical nurses, and trained aides in operating rooms, nursing, laboratories, and pharmacy, have made University Hospital a leader in progressive programs. Page 217During this period collective bargaining for some groups of employees became a new factor in the hospital field. Financial support and characteristics of patients served at University Hospital has changed from a preponderance of patients supported from welfare and indigent health programs to those whose hospital care is supported through voluntary, prepaid insurance.
The combined hospital facilities of the Medical Center in 1940-41 totaled 17,559 hospital admissions, with 303,757 patient days, and 29,303 outpatient visits. The volume of services to patients increased to 21,768 admissions, with 300,500 patient days and 305,600 outpatient clinic visits in 1969-70.