Ocean Medical Center, a community hospital part of Hackensack Meridian Health, in Brick Township, N.J., saw favorable and unfavorable results after moving from a centralized nurses station to a decentralized nurses station in the inpatient unit of its adult medical-surgical and elective surgery department.
The findings of the post-occupancy evaluation, “Lessons Learned from Decentralization of an Elective Surgery Medical-Surgical Unit,” were published in the journal Health Environments Research & Design.
The purpose of the study was to document changes in the nurses’ and patient care associates’ perception of supportiveness in the physical environment after the changes in design. The previous nurses station featured a racetrack-style design surrounding a centralized nurses station with support spaces located within the core. Seventy-eight percent of the patient rooms were double occupancy, with one inboard toilet shared between two patients. Four decentralized documentation alcoves and workstations on wheels provided charting options.
The new unit, which was completed in 2018, is composed of decentralized nurses stations, three separate neighborhoods, curved corridors for improved patient visibility and single-occupancy patient rooms with nested toilets. The new unit catered to the same patient population, and the neighborhood unit configuration is a hybrid of centralized and decentralized operational functions, physically distributed into three 12-bed, private patient room clusters.
The design intent was to provide proximal access to spaces and things necessary to carry out all tasks associated with daily care delivery. The three neighborhoods were designed to operate as one unit where teamwork and cross-communication might occur.
The designers performed a post-occupancy evaluation one year and nine months after the move and found that out of 41 survey items measuring health care workers’ perspective, 12 showed statistically significant differences after the redesign.
Positive measurements included an increase in satisfaction with current unit design, with many nurses highlighting the spaciousness of the new unit. Another perceived efficiency was the storage room location; many of the patient care associates noted that it helped to streamline care processes.
The research, however, also revealed some unfavorable changes in perception. For instance, nurses reported a decrease of audibility of alarms from assigned patient rooms and an increase in perceived walking distances.
In discussions with the surveyed health care workers, the researchers found that work processes such as traveling to other units to find medical supplies may contribute to some of the unfavorable results in the workers’ perception of the design.
The authors write, “success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture and the physical design.”
