Decentralized design may not be the hospital of the future

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Are the centralized nursing stations most nurses are accustomed to on their hospital floors creating congestion and diminishing efficiency, leading to worse patient care? Is there a better hospital design?

For many years, some have been arguing for decentralized nurse stations, asking for numerous smaller stations around a hospital floor rather than one large primary station. But a new study indicates that the expected positive effects may not quite live up to the hopes designers had of a revolutionary hospital design.

Healthcare Design Magazine looks at “Centralized vs. Decentralized Nurses’ Stations: The Impact on Staff Perception, Communication, Teamwork, and Quality of Care,” a report by researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago presented at the 2014 Healthcare Design Conference.

The Decentralized Design

The research was done at a new unit that moved a centralized nurses’ station to a number of smaller individual workspaces (called porches) throughout the floor, closer to patient rooms. There also were “consultation zones” and “care team stations” (which contained both open and private spaces) at various points on the floor.

It should be noted that the redesigned unit was more than twice as big as the one it replaced, and combined what had been two units into one. This also likely affected the work habits of nurses accustomed to working with fewer coworkers in a smaller space.

The Bad

Despite what was expected by the design improvements, nurses reported less satisfaction with their jobs, as well as a lowered sense of teamwork. Perhaps surprisingly, the report showed that nurses walked half a mile more than they had in the previous space.

Additionally, nurses tended to form their own centralized stations, even in the absence of a formal meeting place. “Within the decentralized design, the staff created their own centralized model,” researchers said.

The Good

However, the news was not all bad for the new design. Researchers reported that the perception of noise was decreased, and so was the number of distractions presented to workers on the unit.

The Future

Moving forward, the hospital will continue to adapt its workflow while more research is done on the unit. For example, Healthcare Design points out that the current research “didn’t study the effect on patient interactions or measure how much time nurses actually spent at the porches.”

What do you think? Do you believe decentralized nurse stations would improve your work experience? Are there other improvements you would make? Or do you think centralized nurse stations work just fine? Let us know in the comments!

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