Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation.

Maben, J. and Griffiths, P. and Penfold, C. and Simon, M. and Pizzo, E. and Anderson, J. and Barlow, J.. (2015) Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Health Services Delivery Research, 3 (3). p. 254.

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Official URL: https://edoc.unibas.ch/62566/

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BACKGROUND: New  hospital design includes more  single room accommodation but there is scant and ambiguous evidence relating to the  impact on  patient safety and  staff and  patient experiences . OBJECTIVES: To explore the  impact of the move to a newly built acute  hospital with all  single rooms on care delivery, working practices,  staff and  patient experience, safety outcomes and costs. DESIGN : (1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a  single hospital , (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with  single rooms. SETTING: Four nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new  hospital with all  single rooms. Matched wards in two control hospitals formed the comparator group. DATA SOURCES: Twenty-one stakeholder interviews; 250 hours of observation, 24  staff interviews, 32  patient interviews,  staff survey ( n = 55) and  staff pedometer data ( n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with  hospital design (e.g. cleaning and staffing) in the new  hospital . RESULTS: (1) There was no significant change to the proportion of time spent by nursing  staff on different activities.  Staff perceived improvements ( patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each  patient , locating other  staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for  single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation.  Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with  single rooms, although  staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘ single room ’ factor that prevents infection. (3) Building an all  single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher. CONCLUSIONS: The nature of tasks undertaken by nurses did not change, but  staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant  implications for the nature of teamwork in the longer term.  Staff preference remained for a mix of  single rooms and bays. Patients preferred  single rooms. There was no strong evidence that  single rooms had any  impact on  patient safety but housekeeping and cleaning costs are higher. In terms of future work,  patient experience and preferences in hospitals with different proportions of  single rooms/designs need to be explored with a larger  patient sample. The long-term  impact of  single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored. FUNDING: The National Institute for Health Research Health Services and Delivery Research programme.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Institut für Pflegewissenschaft
UniBasel Contributors:Simon, Michael
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Dec 2018 11:46
Deposited On:08 Dec 2018 11:46

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