Providing Care Quality By Design: A New Measure to Assess Hospital Ward Layouts

Rosica Pachilova & Dr Kerstin Sailer, University College London

Awards 2019 RIBA President's Awards for Research
Category Building in Quality (Annual Theme)

This research was the winner for the Annual Theme: 'Building in Quality' category in the 2019 RIBA President's Awards for Research.

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 their time spent with 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, collecting detailed information about movement and communication patterns of healthcare workers. On this basis the index was developed. Then 31 NHS wards were selected based on their quality of care rating – these were used to test the index. Each ward was analysed with a method called Space Syntax, 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 and thus accrue more communication opportunities by virtue of the layout. Statistical analysis was 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 highlight 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.