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 health-care service. Therefore, a range of factors that facilitate this service (i.e. healthcare) need to be considered when speaking of improving the productivity in a hospital ward. 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 (e.g. Joseph and Ulrich, 2007). 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. Thus, the need to design ward layouts that benefit from the most effective circulation system cannot be over-emphasised. The study presented in this thesis 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. Findings of the study included: further empirical and analytical support for the impact of the ward design on nursing staff s performance; a ranking of the suitability of different design layouts for minimising staff s unnecessary walking in wards similar to the case study; the importance of considering different staff members needs in such analyses; and a ranking of the criticality of different routes within a ward