Hospital nursing staff productivity- the role of layout and people circulation

As a facility that offers an important service to its users, a hospital can be considered as a ‘production unit’; a unit that provides healthcare service. Many factors that facilitate this service (i.e. healthcare) need to be considered when improving the hospital ward productivity. Evidence suggests that one of the main factors that affect the productivity level of a hospital ward is how the design of the hospital deals with access and circulation of the people inside the ward.

A productivity-oriented circulation system will need to: improve staff performance; enhance patients’ safety, privacy and rate of recovery; minimise the risk of cross-infection; reduce the delay time of external service delivery; create a more welcoming environment for visitors; and reduce the evacuation time in emergency situations. The need to design ward layouts that benefit from the most effective system cannot be over-emphasised.

This project focused on finding a method for identifying different systems of access and people circulation in hospital wards and how they could affect nursing staff productivity. The study comprised five main phases.

The first phase involved a literature review of existing healthcare environments to identify different types of access and people circulation requirements. In the second phase, data on nursing staff’s movements were collected from a case study. The third phase focused on categorising and modelling the existing approaches and layout design systems.

Phase four provided a comparative study of different categories of people circulation designs and contrasted their advantages and disadvantages to improve access and people circulation. In the fifth and final phase, the study concluded with proposing guidelines for choosing between different layout options in the design of new hospital wards or the refurbishment of the existing ones.

The research developed guidelines for understanding and implementing nursing staff productivity in the design of new-build wards and in the refurbishment plans of the existing ones. The guidelines comprise three main sections. The first section provides a theoretical basis for understanding the nature of staff productivity in the context of hospital ward functions. The second section offers details on the use of the data collection, cleansing and analysis method of the study. The third section summarises some of the lessons learnt from the exemplar study that have the potential to be generalised in form of recommendations to be used in similar designs.

The guidelines include recommendations for the positioning of different ward spaces (Nurse Station, Treatment Room, Staff Room, Ward Entrance and Patient Rooms) within the ward and in relation to each other with the goal of minimising the room to room walking of the nursing team. These guidelines, together with their enclosed Proximity Matrix of ward spaces have the potential to be used in the design of all wards with similar functions to those of the ward in the case study of this thesis.