The influence of ward layout on everyday communications between healthcare workers: an evidence based study

The importance of communication for healthcare workers within a hospital ward has always been huge. And, as a recent BBC TV News report about the night shift at the Royal London Hospital in the middle of the COVID pandemic peak shows, in times like this communication is even more important not only to exchange patient information, but also to show solidarity, to go to someone and say that they’ve done a great job. The aim of this blog post is to generate greater insight into the everyday life of hospital wards and to more accurately describe and depict the role of the layout in shaping communication patterns within them. My research shows how walking around hospital wards is a contributing factor to informal face-to-face interactions and that the hospital ward corridor plays a key role in shaping these types of conversations. The other space that I found was key in bringing multidisciplinary teams together and contributing to integrated care, was the nursing station, which was not only used by nurses but all healthcare workers. The discussion here is based on observational data that was collected pre-COVID and was used for the development of the Spaces for Communication Index which is a new metric I developed to measure the effectiveness of a ward layout to maximise communication opportunities and was discussed in a previous blog post.

The hospital ward corridor as a key space for impromptu interactions between healthcare workers. Source: https://www.piqsels.com/

Let me first begin with describing the six hospital wards where I conducted my observations. I selected one intensive care unit and one nursing ward from three London based NHS hospitals. The wards varied in terms of size between 470 sqm and 1500 sqm and number of patient beds between 9 and 43. To understand the work processes of the healthcare workers in each ward, I shadowed a total of 102 different professionals during their everyday work. I was recording how much time each healthcare worker spent in walking, talking, computer work, patient care, electronic communication, paper documentation and support activities such as changing bed linen and cleaning patient trays and also recorded where these activities took place. 

Additionally, to understand how frequently and for how long healthcare workers communicated with each other, I used wearable devices that participants were asked to wear around their neck throughout the duration of their shift. The devices, also called sociometric badges, were developed by MIT and resemble a typical staff ID card. When a badge wearer had a conversation with another badge wearer, the devices sensed the vibrations of the body from the vocal cords and also recognised that the two participants were in close proximity, so the two badges sent signals to each other. I should note that the sensors didn’t record the actual content of the conversation, just the tone of voice of the participants. 

While conducting observations, I noticed how dynamic the workplace environment was, with nurses and doctors moving up and down the ward corridor going from one patient room to another, to the nursing station and medicine cabinet. An analysis of the collected data confirmed my initial observations. Healthcare workers walked on average between 2.61 km and 6.58 km and spent half of their time in face-to-face conversations. A lot of these conversations were unplanned, happening on the go where two people bumped into one another which explains the high proportion of conversations in pairs (77% on average) and high percentage of conversations that were less than a minute long (86% on average). A great proportion of these unplanned conversations happened in the corridor (19% on average) and the nursing station (22% on average) which made me realise how important these two spaces were for all healthcare workers. 

Walking distances and patterns in the observed hospital wards. Source: author

My observations pointed to the importance of the hospital ward corridor which has often been considered as wasted space and designers have sought to minimise the area to make the hospital more efficient. However, healthcare workers spend a good proportion of their time in the corridor and it is a place that brings different disciplines together and contributes to informal encounters that are important for both information exchange and also socialisation. The nursing station was used by different healthcare professionals which poses a question on the ongoing debate about the typology of the nursing station i.e. centralised vs decentralised. A centralised nursing station is usually a large single working area on a ward that act as a focal point for all nurses. A decentralised nursing station is a smaller workstation located immediately outside or inside the patient room with a direct visibility towards the patient, arguably better for monitoring but possibly affecting teamwork negatively. However, my observations showed that the nursing station is a place used by different healthcare professionals, not only nurses. This was also discussed by Julie Zook and her colleagues who, based on their findings, suggested that key work zones in each ward, namely centralised or decentralised nurse stations, should provide good awareness and visibility of the environment but also with the capacity to act as hubs for information sharing and social interactions between different professional roles.  

The observations of this study depicted the importance of the hospital ward corridor and the nursing station in shaping interactions between different healthcare workers. This information can be used by architects and healthcare planners in the design of hospitals to maximise communication opportunities which in turn render better teamwork.

A nursing station used by different healthcare workers and bringing together multidisciplinary teams. Source: author

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