Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.

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Argues that the concept of the total workplace goes beyond physical facilities to take account of the whole network of social, organisational, and design elements that constitute the context in which we spend our working lives. Uses the Steelcase Corporate Development Centre, in Grand Rapids, Michigan, as an example of a total workplace, and to show the effectiveness of teamwork and the critical need for communication in advanced work culture. Discusses a number of key social process areas that represent an integral part of the workplace. Finally, considers the application of the total workplace concept to other organisations and contexts.

While considerable attention has been paid to how the design of nursing units can help reduce nurse fatigue, improve safety, and reduce nosocomial infection rates, much less attention has been paid to how nursing unit design influences informal communication patterns, on-the-job learning, and job stress and satisfaction. Yet the literature consistently cites communication among diverse caregivers as a critical component for improving quality of care. This paper reviews relevant literature related to nursing unit design and communication patterns, and suggests an evidence-based design research agenda grounded in the concept of "organizational ecology" for increasing our understanding of how hospital design can contribute to improved quality of care.Key Words Evidence-based design, physical design, communication, job stress, nurses.

Purpose-Drawing on recent research related to hospital facilities, this paper aims to discuss the role of evidence-based design in facility planning and design as a key element in helping the field of facility planning and management continue to strengthen professional practice. Design/methodology/approach-The discussion draws on relevant literature and recent research. Findings-Evidence-based design is having a major impact on planning and design of hospital facilities, and can play a similar role for other facility types. Originality/value-Calls for evidence-based design for healthcare facilities abound. This paper discusses important issues surrounding the implementation of an evidence-based design approach that need to be considered for this approach to be successful in all types of facilities.