The Impact of Visibility on Teamwork, Collaborative Communication, and Security in Emergency Departments

This dissertation provides empirical evidence on the effects of visibility for promoting better healthcare delivery in hospital emergency departments (EDs). Visibility is defined as the level of visual connectivity among different points within a defined and closed environment. The researcher hypothesized better visibility in EDs would promote teamwork and collaborative communication among medical staff members, while reducing the frequency of security incidents. Visibility in the ED environment was objectively measured as the level of visual connectivity among different points within the ED. Teamwork and collaborative communication among medical staff members were treated as behavioral variables and were measured through direct observation, interviews, and surveys. Security incidents were defined as any type of aggressive behavior in the ED; this factor was measured using hospital incident records. All of the aforementioned factors were evaluated at four different emergency departments (after a pilot study) within the same hospital system. The methods included computerized floor-plan analysis, direct observation in the EDs, interviews and surveys of medical staff members, and textual analysis of interview transcripts. The researcher found a significant association between ED visibility and collaborative communication among the medical staff members. However, the findings about visibility’s relationship to teamwork and security were inconclusive. Based on the qualitative outcomes, teamwork can be enhanced and the rate of security issues would decrease by improvement of visibility. As one of the first studies to measure visibility in EDs and relate this factor to behavioral variables, this dissertation provides a model for future research to analyze the effect of hospital design strategies. It also provides valuable knowledge about the observed reactions and subjective perceptions of medical staff in relation to environmental variables