Our hospitals are under more pressure than ever, and making them efficient and effective is crucial. Ward layout is a big factor – for years the focus has been on a design that minimises the walking distances of healthcare workers and increases the time spent with their patients.
However, our new research suggests that good face-to-face communication between doctors and nurses crucially impacts the health and safety of patients. We analysed a selection of NHS wards to better understand how communication opportunities, and better nursing unit designs, could have a positive impact on the provision of healthcare. Here’s what we found.
Hospital wards are busy places. Nurses and doctors communicate face to face 45 times an hour, on average. Good communication and effective coordination are crucial to quality of care.
We found that the spatial design of a ward mattered. When healthcare workers walked through large and open areas (so-called viewsheds) on their everyday paths, they communicated more often with each other. This means open and visible space leads to communication opportunities.
Research has established that good communication in a ward can improve quality of care. Yet traditional approaches to evaluate wards, such as the Yale Traffic Index, were often based on efficiency and cost – for instance, seeking to optimise walking distances.
Based on observations, we established which were the most frequently traversed paths in a ward (from patient bed to patient bed, from bed to nursing station, from bed to medicine cabinet, from nursing station to medicine cabinet) and aggregated viewshed sizes along those paths. Walking from a patient bed to another patient bed, a healthcare worker has visual access to a series of spaces (shown in red, pink, green, yellow and orange).
We developed a metric, the Spaces for Communication Index (SCI), that estimates communication opportunities arising from everyday movement between key locations. The index sums up the size of all areas traversed by healthcare workers. Visible areas for each of the four most important connections between locations is weighed by a factor according to their frequency of use. Finally, the sum is divided by the number of beds, to take the size of a ward into account.
Comparing a larger sample of wards, we found that those with a higher SCI had higher ratings for quality of care. This means we can now analyse and design ward layouts differently with a focus on good communication, maximising opportunities for colleagues to see each other at work.