ARTICLE
Pati, D., Harvey, T., Redden, P., & Summers, B. (2015). An empirical examination of the impacts of decentralized nursing unit design. Health Environments Research & Design Journal, 8(2), 56-70
Abstract
Objective: The objective of the study was to examine the impact of decentralization on operational
efficiency, staff well-being, and teamwork on three inpatient units.
Background: Decentralized unit operations and the corresponding physical design solution were hypothesized to positively affect several concerns—productive use of nursing time, staff stress, walking distances, and teamwork, among others. With a wide adoption of the concept, empirical evidence on the impact of decentralization was warranted.
Methods: A multimethod, before-and-after, quasi-experimental design was adopted for the
study, focusing on five issues, namely, (1) how nurses spend their time, (2) walking distance, (3) acute
stress, (4) productivity, and (5) teamwork. Data on all five issues were collected on three older units
with centralized operational model (before move). The same set of data, with identical tools and
measures, were collected on the same units after move in to new physical units with decentralized
operational model. Data were collected during spring and fall of 2011.
Results: Documentation, nurse station use, medication room use, and supplies room use showed consistent change across the three units. Walking distance increased (statistically significant) on two of the three units. Self-reported level of collaboration decreased, although assessment of the physical facility for collaboration increased.
Conclusions: Decentralized nursing and physical design models potentially result in quality of work
improvements associated with documentation, medication, and supplies. However, there are unexpected consequences associated with walking, and staff collaboration and teamwork. The solution to the unexpected consequences may lie in operational interventions and greater emphasis on culture change.
Keywords: decentralized nursing, acute care, collaboration, nurse walking, inpatient unit design
Experts
Dr. Debajyoti Pati is Professor and Rockwell Endowment Chair in the Department of Design, Texas Tech University, Lubbock, TX. He has researched, published and presented extensively on healthcare design, internationally. He was twice voted among the 25 most influential people in healthcare design, by the Healthcare Design Magazine. He has received over ten research awards, including three-time recipient of the best international research award by the International Academy of Design and Health. He serves on the board of directors of the AIA-NIBS BRIK program, is on the editorial board of the HERD journal, and is a Fellow of the Indian Institute of Architects.
Tom has invested his career of 35+ years as an architect, operations consultant, educator and researcher in design for healthcare facilities. He is a Fellow of the American Institute of Architect a Fellow of the American College of Healthcare Architects and is EDAC certified. His leadership and ideas have influenced an extensive array of environments for healthcare-related missions within settings ranging from rural to urban academic teaching enterprises. He holds the distinct honor, among these accomplishments, of leading the naval design team design for our nation’s two hospital ships, the USS Mercy and Comfort.
His passion focuses on optimal performance of the buildings that emerge from his practice. He organized and is a member of the HKS’ Knox Advisors (business consulting), and is the President and Managing Principal of HKS’ Center for Advanced Design Research & Evaluation (CADRE), a non-profit organization dedicated to rigorously distilling and disseminating quality research evidence relevant to the improvement of design. This focus has led to an innovative design approach intent upon informing design by operational discoveries and evidence from rigorous research in practice.