× You are not currently logged in. To receive all the benefits our site has to offer, we encourage you to log in now.

Balancing the Human Touch with the Need for Integrating Technology in Ambulatory Surgical Environments: Barriers and Facilitators to Nursing Work and Care Team Interactions

May 2023
The Center For Health Design

Why does this study matter?
Major advances in medical technology - paired with changes in Medicare reimbursement policy - have led to rapid growth in outpatient surgery. While many of these advances are beneficial for healthcare organizations and patients, there are challenges in that there is still very little research focused on how the design of ambulatory surgery centers affects nursing work or the critical interactions between staff, patients, and families. And there is even less research that helps us understand these issues from the nurse’s perspective.

How was the study done?
In this study, researchers explored the relationship between the physical environment in pre-op and post-op areas of two ambulatory surgery centers (one built in 1990; one built in 2000). The team took a multimethod approach, using behavior mapping, shadowing, spatial analysis, and semi-structured interviews with staff. They focused on the interactions among staff, patients, and their families, and on how the spatial layout and configuration affected the integration of new technology, especially electronic medical records (EMRs).

So what do we learn from the study?
The most common nurse activity observed was face-to-face communication, which included nurses listening and talking with each other, with patients, and with family members. Face-to-face communication was seen in one-third to nearly one-half of all observations.

Another major finding in this study is a distinct ebb and flow of activities and space usage, which leaves the post-op areas underutilized during the morning and the pre-op areas underutilized in the afternoon. The authors of this study suggest that locating the pre-op and post-op areas in close proximity could enable more flexibility in the use of bays during off-peak times.

Regarding technology integration, the majority of time spent by nurses in direct patient care involved charting by the bedside, seen in nearly half of the observations at site 1 and one-third of the observations at the newer site. The findings include several points about the difficulty in integrating workstations on wheels (WoWs) into spaces that were not originally designed to support computerized charting. Despite the potential ergonomic advantage these WoWs offer in height adjustment and portability, the space constraints and nature of nurses’ work did not allow for nurses to sit while charting, and nurses shared their frustration in finding and reaching power outlets to plug the stations in.

Can we say the results are definitive?
This study included only two sites, both of which were part of the same healthcare organization. Additional research will be required to tell if these findings can be generalized to other facilities. Additionally, while this study aimed to clarify the role of technology in the relationship between design and nurse work, the study took place only two weeks after the organizations had transitioned to electronic records, and staff was likely still getting used to the new process. A good rule of thumb is to wait at least six to 12 months after integrating a new system in order to understand the impact.

What’s the takeaway?
This study highlights the vital importance of a systems view to understanding the healthcare environment. Architects and interior designers should consider the complexities at play to support the critical tasks and interactions, the range of activities, people, technologies, processes, and culture in a healthcare setting. Taking a close look at the results, design teams may see opportunities to support better workflow through innovative design, including ways to locate pre-op and post-op areas to increase efficient use of the space at all times, not just at peak times.


Summary of:
Joseph, A., D. Wingler, and Z. Zamani. “Balancing the Human Touch with the Need for Integrating Technology in Ambulatory Surgical Environments: Barriers and Facilitators to Nursing Work and Care Team Interactions.” Journal of Interior Design, 42(1), 39–65. https://doi.org/10.1111/joid.12089



Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.



Learn more about this research paper in our Knowledge Repository