Alumnus Helped Redesign San Francisco General Hospital from the Ground Up

May 2012Diana Austin

San Francisco General Hospital and Trauma Center (SFGH) has served as the city’s primary public hospital since 1872 and is still San Francisco’s only trauma center; its emergency department receives about 30 percent of all San Francisco ambulance traffic. But when California passed a law requiring all acute care hospitals to meet specific seismic safety standards, the San Francisco Department of Public Health discovered it would need a new facility.

Thanks to a 2008 ballot measure approved by a record 84 percent of San Francisco voters, that new facility will become a reality in 2015, when a nine-story hospital opens on what is now the main lawn of the current campus. The new hospital will meet the latest standards for seismic safety and help SFGH better meet the city’s increasing health care needs.

From 2008 through 2011, Christina Foushee was the project’s transition planner, responsible for coordination and oversight of such things as design, workflow and patient safety. Though she recently relocated to Washington, DC, where she now works with McKesson Health Solutions to create evidence-based decisionmaking tools for health care organizations, Foushee remains passionate about the SFGH project.

A nontraditional nursing research path at UCSF School of Nursing – where she received her master’s degree in 2005 and doctorate in 2010 – helped prepare her for the transition planning role.

Supporting Nursing Practice and Patient Health

After getting her master’s in health policy, Foushee worked as a clinical research nurse at UCSF Medical Center, while beginning work on her PhD in occupational and environmental health nursing. Under the guidance of professors Marion Gillen and Julia Faucett, Foushee’s research program married organizational decisionmaking, patient safety, health policy and occupational and environmental health outcomes.

The skills and knowledge she acquired turned out to be a strong match for the complex SFGH project, which not only encompassed the logistical and managerial necessities of building a large public hospital, but also incorporated occupational and environmental health concepts and patient safety considerations. Foushee relished the challenges, as well as the opportunity to work under the leadership of the former CEO of SFGH, Gene Marie O’Connell (MS 1989). “She exemplified nursing excellence, and I knew I wanted to be in close proximity to her brand of leadership, which continues today with [current CEO] Sue Currin [MS 1993],” Foushee says.

One of Foushee’s top priorities was to help ensure that the design “supports the reality of the way we practice,” she says. “In the new hospital, we’re designing for efficiencies and an improved experience for both patients and staff.… [We believe] staff will be better able to perform if the building itself performs.”

To that end, designers sat down with staff and patient advisory groups during every phase of the design process. The project also incorporates evidence-based design: the use of data to determine how the physical design of the facility can help positively affect patient outcomes, as well as staff satisfaction and retention. This resulted in a number of innovative features:

  • The facility maximizes the use of natural sunlight.
  • It is built in an oval, giving clinical staff improved visibility into patient rooms.
  • Some units will have the ability to meet varying patient acuities, reducing the need to move patients as their care needs change.
  • Each patient room will have a standardized work environment for clinical staff.
  • The number of single-patient rooms will increase, reducing the spread of infection and encouraging family members to stay with patients. Research has shown that family members often are an effective second set of eyes for preventing medical errors.
  • Restrooms will be located so that patients can use handrails for the entire trip from bed to restroom, reducing one of the most common causes of patient falls.

Environmental Health Too

The environmental and safety aspects of the new design also inspire Foushee. Sustainability efforts include using environmentally friendly materials, reducing waste and cutting operating energy consumption. Water-saving devices will reduce potable water use to below 40 percent of current building code standards.

In addition, the foundation design, known as triple pendulum base-isolated, requires 30 percent less steel than traditional foundations and represents only 1 percent of the total embodied energy going into the building, while meeting all state standards for earthquake resistance.

Finally, before she moved on, Foushee and her colleagues also prepared drills for staff at all levels to ensure that the transition from one working facility to another happens as smoothly and safely as possible. “Most of us have never done this before,” she says, “and we only have one chance to get it right.”

For more information on the SFGH Rebuild Project, and to see videos and images of the new design, go to