A Single-occupancy.. A Right for Every Patient

A recently republished paper called, “A Scandalous Impromptu”, originally written in 1976 by Evan JR Burrough, provided a strong view against multi-bed wards and advocates that a person who is sick and already not feeling well should not be put in an environment which will make their condition worse.  The question is why an already unwell person has to put up with a noisy, uncomfortable, crowded and impersonal environment?  A quote from the paper by Sir Rupert Vaughn Hudson in 1960 reads: “It is the custom for the sick horse to be segregated to a loose box, an orphaned lamb to the kitchen, a sick dog at times to the best bedroom, but our patients are put in large dormitories and obliged to adjust themselves to endure, sometimes for the very first time, an intensely public life with many discomforts, which are now essential for the investigational treatment.” Sir Hudson’s views were not only based on the need for single bed rooms to combat infections, but from humanitarian point of view to provide both the rich and the poor an equal chance of the right treatment.

Hundreds of years before that,  many historians wrote of the way hospitals were built in Spain (Cordoba) where single private rooms and creating the healing environment was a significant factor of patient’s medical treatment.

In 1997, during the designing of the International Medical Center, I was asked a strategic question by the USA based design firm:  “What is the percentage of single bed rooms to multi-bed wards?  My answer then was an intuitive one and remains the same until today, “Of course each and every room MUST be a single bed room.” Definitely that was not the case then in 1997 and until today many hospitals still put more than one person in a room. I am glad that Dr. Sami Engawi, the leading architect at that time, fully supported that view from the “Healing by Design” concept which I will describe later in my article.

 I explained then to the architects a principle we learned from the teachings of the Prophet Mohammad which you also find in all of the divine religions which translates as this, “I swear you will not become a believer until you love for your fellow human being what you love for yourself.” Who loves to share a room or be on a multi-bed ward when sick?  To make my point, I gave many scenarios in which multi- bed wards would have a negative effect (i.e. spread of infection, noise, lack of sleep, embarrassment, lack of privacy and many more) on patients. Years later in 2003, I came back to Saudi Arabia with the design of the hospital, investors carefully selected, company formed and the construction work started the same year.   In 2006, the hospital opened its doors (soft opening) under the honor of our beloved King Abdullah bin Abdulaziz Al Saud.

In the same year 2006-2007, many of the Western countries started to put new standards for the design and construction of Health Care Facilities and one to mention is The Facility Guidelines Institute (FGI). Looking at section 2.2 of the new specific requirements for General Hospitals it says, “The maximum number of beds per room shall be one unless the functional program demonstrates the necessity of a two-bed arrangement. Approval of a two-bed arrangement shall be obtained from the licensing authority.”

The new standards are the results of accumulated data over the last decade on the importance of a single bed per room arrangement for better patient care.

An increasing number of studies and articles emphasizing the importance of a single bed per room arrangement for patient care and for patient safety, less medical errors especially giving the wrong medication, reducing hospital-acquired infections, better environment for the patient, the family as well as the health care providers as well as increasing health care providers efficiency, improving patient privacy and control and providing greater flexibility in operation.

In a review of more than 600 articles, researchers found that there was a clear link between the physical environment (such as the single bed vs. the multiple-bed patient rooms arrangements) and patient outcome (such as fewer adverse events and better health care quality) as well as the staff outcomes (such as reducing stress and fatigue and increasing efficiency and effectiveness in delivering care).

The benefits of a single-occupancy versus multiple-occupancy applied to a public health care sector as well as the private sector. It was found that single-occupancy reduces the overall cost by decreasing the operating cost, increasing the occupancy rates, decreasing the length of stay, medication errors and costs. The single-occupancy room improved infection control by decreasing the rate of nosocomial infections, decreasing patient transfer and decreasing patient length of stay among other reasons.

Therefore, the new guidelines in the USA and many other European countries dictate single-occupancy and very soon many other countries will only have single occupancy patient rooms. In a commentary published in the Journal of the American Medical Association (08/27/08) Vol. 300, No. 8, P. 954 titled “Single-Patient Rooms for Safe Patient-Centered Hospital”, a result of 16 studies on the impact single-patient rooms have on infection control, researchers found reduction in both airborne-related and contact related nosocomial infections; ” Single patient rooms are easier to clean and decontaminate than multi-bed rooms.  Healthcare workers may be more likely to adhere to hand-hygiene procedures when moving between rooms rather than between beds…Other arguments in support of single- patient hospital planning include the enhancement of patient flow and increases in patient satisfaction and privacy due to various aesthetic and safety features”.

I believe I have provided so far enough evidences and justifications to prove the necessity to make a single-occupancy arrangement to be the norm in the designing of hospitals. Not surprising that it is considered now by many to be a patient’s right since it has direct impact on patient safety and healthcare quality.

Today, after many years of accumulating data and statistics regarding this issue, many hospitals in the Arab world continue to apply the multiple-occupancy arrangements in their hospitals. Even though, I don’t have a single doubt that all hospitals worldwide sooner or later will be obligated to apply the single-occupancy, I feel the responsibility to be an agent for expediting that change in our beloved country.

I do realize that the change is difficult and it requires the combined efforts of many private and public healthcare institutions.  One example of the positive impact Saudi Aramco had on the healthcare in the country when they applied a differential pricing for institutions which had received the Joint Commission International (JCI) accreditation for quality (around a 20% higher compensations for JCI accredited hospitals for the same service offered in any other healthcare facility which had no JCI accreditation). That was a good incentive for many hospitals to pursue the JCI when they had no interest to pursue it prior to that which had a positive impact on quality of healthcare in the country. Another example is the positive impact of the quality improvement national programs such as the Mecca Region Quality Program (MRQP) on the quality of care in the country.  I am very glad as well to learn that the Ministry of Health is moving towards the single-occupancy arrangement and conditioning the new license approval for new hospitals to a single-occupancy arrangement designs, which is the first of its kind decision in the region.

However, I am still wondering about Saudi Aramco’s position in supporting the single-occupancy bed arrangements as they have a tract history of always being the leader in pushing healthcare in the right direction and implementing the highest standards of quality in all life’s fields and especially when it comes to the health and safety of people.  The current system only compensates for a shared room and does not compensate for single–occupancy rooms, when this is the right thing to do.  As a matter of fact, Saudi Aramco’s unintentional position of only compensating for a shared room (double-occupancy) is indirectly not recognizing hospitals which are doing the right thing and rewarding the non compliant hospitals.

It is easy for any hospital to accommodate two patients in one room if the objective is purely financial; however, I always say, there is a price to be paid by those who want to do the right thing and be an agent of a positive change in their societies rather than choosing the easy route to go with the flow.

I do appeal to Saudi Aramco decision makers through this article to continue to be a leader of positive change and be the example and the model to other healthcare institutions.  That would be consistent with the tract history of Saudi Aramco in improving the quality of healthcare in this county and doing the right thing for its staff.

I do also appeal to the Ministry of Health and all public and private healthcare institutions  to expedite the change to the single- occupancy patient room arrangement since this issue is no longer considered a luxury or complementary hospitality,  instead it is considered a recognized and well researched and studied factor in providing optimal patient safety and quality healthcare.

Therefore, I view it as a right for all and every patient.