Barriers, Facilitators, and Strategies for Sustaining the Hospital-Wide “One Bed” Model in China: A Single-Centre Descriptive Qualitative Study of Healthcare Professionals’ Perspectives

Background: Hospital-wide centralized bed allocation, known in China as the “one-bed-for-the-whole-hospital” model, aims to improve inpatient access by pooling beds across specialties. Existing studies have mainly examined operational outcomes, process risks, or staff competence. Less is known about how bed redistribution interacts with clinical responsibility, professional roles, functional support, and shared governance. Objectives: This study explored healthcare professionals’ perspectives on the barriers, facilitators, and strategies for sustaining the hospital-wide “One Bed” model. It also examined how bed integration and care integration aligned or diverged across the dimensions of the Rainbow Model of Integrated Care. Methods: A single-center descriptive qualitative study was conducted in a Grade A tertiary hospital in Shanghai, China, where the model had operated across 11 pilot wards for approximately 48 months. Between December 2024 and March 2025, 25 healthcare professionals, including 14 clinical nurses, eight head nurses, and three physicians, completed face-to-face semi-structured interviews. Data were analyzed using inductive qualitative content analysis. After themes and subthemes were developed from participants’ accounts, the Rainbow Model of Integrated Care was used as an interpretive framework to map the findings across clinical, professional, organizational, system, functional, and normative integration. Results: Five themes were generated. Participants perceived centralized bed allocation as shortening waiting time and improving bed use, but also as intensifying ward workload and making single efficiency indicators insufficient. Patients could move to available wards before medical response, responsibility, and physician visibility were fully aligned. Cross-specialty case mixes exceeded what nurses could manage through temporary learning alone. Information, logistics, space, equipment, and supplies did not always move with patients, leaving nurses to maintain workflow through manual and often invisible coordination. Sustained bed sharing also depended on clearer boundaries for patient selection, specialty fit, severity, nursing workload, leadership authority, resources, and incentives. Together, these themes showed that bed resources were integrated faster than care processes, professional capability, functional support, and shared governance. Conclusions: Hospital-wide centralized bed allocation should be understood as an uneven process of integration rather than only as a bed-management strategy. These findings primarily reflect the perceptions and experiences of nurses and nursing managers, supplemented by limited physician input. The distinctive finding of this study is that beds may be pooled, and patients may move rapidly, while medical response, nursing competence, functional support, workload recognition, and governance arrangements do not always move at the same pace. Safe and sustainable implementation therefore requires bounded flexibility: bed allocation should be guided not only by bed vacancy but also by clinical suitability, specialty fit, nursing workload, timely medical response, functional systems that move with patients, and shared accountability.