Providing care quality by design: a new measure to assess hospital ward layouts

Abstract

Which hospital ward layout works best? In the past, one response to this question has been to design layouts that minimise walking distances of healthcare workers, and increase the time spent with their patients. However, new research suggests that good face-to-face communication between doctors and nurses crucially impacts the health and safety of patients. Taking this into account, this research proposes a new single measure called Spaces for Communication Index (SCI). It assesses communication opportunities arising from the layout, and shows that a high index is associated with the provision of good healthcare. Six NHS wards were first studied in depth by collecting detailed information about movement and communication patterns of healthcare workers. The index was developed on this basis. Thirty-one NHS wards were then selected, based on their quality of care rating. These were used to test the index. Each ward was analysed with the Space Syntax method, which investigated the size of visual fields of healthcare workers on everyday movement paths through the ward. Large viewsheds provide good visibility and awareness of the environment. As a result, they accrue more communication opportunities by virtue of the layout. Statistical analysis was also used to test if the index can predict care quality. Other factors such as distances between key areas, number of patient beds or ward size were tested, too. Results showed that the higher the index, the better the quality of care. The other factors were not related to healthcare quality. In terms of design, these results high-light the importance of the openness of spaces that healthcare workers traverse to get from one key area to another. This research contributes to the development of an objective method that designers can use to compare different nursing unit designs, and anticipate the care quality that would be provided to patients.

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

“…There were, however, important exceptions to these trends. In addition to the Blennerhassett et al (2018) pre and post ward redesign study, there were other targeted studies with quantitative observation data that similarly did not produce specific conclusions about the environment from their observation methods (Anåker et al, 2018; Broom et al, 2019; Edgerton et al, 2010; Lu & Zimring, 2012; Miller & Keith, 1973; Newall et al, 1997; Pachilova & Sailer, 2020; Scrivener et al, 2019; Shannon et al, 2019; Shepley, 2002; Stahler et al, 1984), and there were some notable examples of exploratory studies with qualitative observation data which did produce specific conclusions (Eriksson et al, 2010; Hamilton, 2019; Karlsson et al, 2019; Kelley et al, 2011; O’Hara et al, 2018). The conclusions drawn from these exploratory studies tended to be layered, with multiple implications for hospital design.…”

“…Overall, 37% of the included publications were classified as drawing specific conclusions from their observation data (n ¼ 25), 43% were classified as drawing nonspecific findings (n ¼ 29), and 19% could not be determined (n ¼ 13). Of the 29 studies with nonspecific findings, 59% were unspecific about both the environment and behavior in their results (n ¼ 17), while 41% were specific regarding particular aspects of behavior but provided limited information in regard to the environment (n ¼ 12), as in the Blennerhassett et al (2018) observation data that similarly did not produce specific conclusions about the environment from their observation methods (Ana ˚ker et al, 2018;Broom et al, 2019;Edgerton et al, 2010;Lu & Zimring, 2012;Miller & Keith, 1973;Newall et al, 1997;Pachilova & Sailer, 2020;Scrivener et al, 2019;Shannon et al, 2019;Shepley, 2002;Stahler et al, 1984), and there were some notable examples of exploratory studies with qualitative observation data which did produce specific conclusions (Eriksson et al, 2010;Hamilton, 2019;Karlsson et al, 2019;Kelley et al, 2011;O'Hara et al, 2018). The conclusions drawn from these exploratory studies tended to be layered, with multiple implications for hospital design.…”

Health Building Information Modeling (HBIM)-Based Facility Management: A Conceptual Framework

“…Additionally, it is suggested that spatial configuration can also influence the health performance of the building (Pachilova and Sailer, 2020). A recent study, for example, reported that higher visibility and accessibility led to a higher frequency of healthcare worker's hand-hygiene behaviours in hospitals (Cai et al, 2021).…”

Investigations into the impact of nursing unit layout on critical care nurses

“…The evidence-based design literature established connections between the physical environment and the experience of healthcare providers ( Ulrich et al., 2014 ). The available research on this connection focuses on the dynamics of movement patterns at the hospital level in general ( Choi, 2011 ; Yi and Seo, 2012 ), as well as within specialized units such as critical care units ( Cai and Zimring, 2012 ; Ossmann et al., 2019 ; Zadeh et al., 2012 ), medical-nursing units ( Pachilova and Sailer, 2020 ; Xuan et al., 2020 ), operating rooms ( Bayramzadeh et al., 2018 ), and the emergency department ( Rismanchian and Lee, 2017 ). At the unit level, research indicates that excessive and unnecessary movement caused by lengthy travel routes can result in fatigue, cause delayed task completion, or impair overall performance ( Zadeh et al., 2012 ).…”

“…This resulted in study on certain building styles that were suggested for staffing efficiency, decreased traveling distances for staff, and increased opportunities for patient observation, among other benefits ( Trites et al., 1970 ; Verderber and Fine, 2000 ). Radial corridor hospitals were popular in the 1960s ( Jaco, 1972 ; Pachilova and Sailer, 2020 ). Verderber and Fine (2000) also identified a variety of issues that have marked the transition of health care in their broad examination of the development of efficient health care architecture.…”