Pachilova, Rosica; (2020) Exploring Quality of Care in Hospital Wards: The Effect of Spatial Layout, Staff Work Activities and Communication Patterns. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A body of research studies showed that the spatial configurations of hospital wards had an effect on work processes and communication patterns of healthcare providers. Some of these studies aimed at developing measures for ward efficiency to minimise walking distances between functional areas. Others intended to identify the best ward typology. However, none of these studies connected their findings to healthcare quality. Moreover, most of the research focused on the positive effect of space on communication and did not investigate potential negative social network structures. This thesis investigates how the layout of hospital wards influences work processes and communication patterns of healthcare providers and how this affects healthcare quality. Six NHS wards were selected as case studies including three intensive care units, two nursing wards and one labour ward. Space syntax was used to investigate their spatial configurations. Data on communication patterns were collected with wearable devices and surveys, and social network analysis was used to describe the resulting networks of relationships. The workflow of care providers was captured by shadowing members of staff and recording digital type and durations of activities and locations. A staff survey to evaluate teamwork and communication as a proxy for healthcare quality was used alongside official quality of care ratings. Finally, semi-structured interviews with healthcare providers were conducted to get an in-depth understanding of the work environment and culture of the ward. Results indicated that the size of the ward was not a predictor of care quality. What was more important was the presence of large and open spaces that provided doctors and nurses with good local visibility combined with a main spine corridor to connect the spatial system. Of even higher importance was the openness of spaces that healthcare providers had to traverse to get from one key area to another. These findings were used to develop a new measure to allow for a systematic comparison of hospital wards with the aim to maximise communication opportunities via large viewsheds and thus increase the likelihood of providing better quality of care. The thesis provides insights into the relationship between the spatial layouts, work processes and communication patterns of healthcare providers and care quality and has contributed to the development of a new measure for ward effectiveness that designers can use to compare different nursing unit designs and plan for maximising the chances of good healthcare provision.

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