UCSF

This dissertation presents findings from a qualitative study of hospitals and social activisms aimed at hospital transformation in San Francisco. Research questions address how hospitals have been geographically and socially placed in the city over time, and how this placement may have set up hospital administrators’, local government’s, and community groups’ more recent actions around hospital social construction and geographic placement. Data include documentary and archival evidence as well as qualitative interviews. Findings are divided into two parts: the first follows the historical development of the city’s hospitals from c. 1848 to 2001; the second explores the redevelopment of California Pacific Medical Center hospitals from 2001 to 2013. Key findings are as follows: Historically there have been few hospitals in the city’s southern/southeastern corridor, relative to government constructions of area need and to distribution of hospitals in the city. This disparity has been produced in tandem with structural racism and classism in the city’s urban development. Federal healthcare policy development and implementation over time in part exacerbated this healthcare inequity. In more recent years, hospital administrators, local government officials and members of community organizations have oriented to hospitals according to diverse constructions of the efficiency of care, healthcare disparities, and hospitals’ relationships to communities. However, through a variety of social-structural and cultural contingencies, social movements have produced changes in hospital social boundaries and placement.