100% single room accommodation: an evaluation of ward layout on the delivery of care.
Space Syntax was commissioned by the Department of Health and the National Patient Safety Agency to join an interdisciplinary research team investigating the impact of 100% single room accommodation in hospital wards on patient care and specifically to evaluate the effect of spatial layout and room configuration on staff working practices
Built as a temporary structure in the car park of Hillingdon Hospital, the Bevan Ward research project offered a unique opportunity to test examples of best practice in ward design. The 24 bed T shaped ward has three en suite 8-bed clusters that share a central support zone with reception, kitchen and social areas. Each of the three wings has been designed to test different room configurations based on the location of en suite facilities: standardised, courtyard and outboard.
The analytic process included:
– observation of occupation and interaction patterns of patients, visitors and staff
– nurses’ travel paths and interaction patterns
– spatial accessibility analysis
– room and bed-head visibility
– walking distances
– natural surveillance & visual field analysis
– structured interviews and questionnaires with key members of staff.
In order to establish a comparative baseline, the first part of the research used four existing wards of various configurations and accommodation types as a case study. These case studies included two wards within Hillingdon hospital, one of which was then relocated to the newly built Bevan ward. The second stage applied the same methodology to the Bevan ward, with two observations studies. The first undertaken in February 2009, a month after the Bevan ward was commissioned as a working ward, with a second follow-up on site surveys in December 2009 and January 2010.
Findings and outcome
Single-room accommodation is likely to provide a better patient experience than that offered in multi-bed wards as long as key conditions are achieved. These refer firstly to the design of the layout and secondly to the fundamental requirement for staff to adapt their practices to the new layout. The success of the Bevan ward was only possible after the charge nurse re organised certain routines that, while successful in multi-bed bays, were inefficient in a single-room environment.