Communication Patterns in Outpatient Clinics

The project aimed at understanding how different building layouts shape professional networks of face-to-face communication, mainly between doctors and nurses. This is against the background of an overall lack of research on how healthcare buildings could be configured to better support intra and inter-care team communication, despite the fact that communication breakdowns are generally blamed for more than half of all medical errors - with some claiming that miscommunication is ultimately attributable to as much as 90% of medical errors.

The studied hospitals differed significantly in their layout. In the Canadian case study hospital in Vancouver, British Columbia, outpatient clinics have been developed in isolated locations over time wherever space became available. In contrast, the second case study in the Netherlands purposefully configured its outpatient clinics to optimise the potential for face-to-face clinician communication, both within and between care teams. Clinicians in this case are served by an advanced and fully integrated Healthcare ICT (Information and Communication Technology) system.

The research combined a Space Syntax Analysis of floor plans, direct observation of the routines of selected caregivers and a survey-based Social Network Analysis to understand communication networks within knowledge organizations. Five outpatient clinics in each hospital were selected for the study.

Based on research insights in knowledge-intensive workplace environments, which highlighted the impact of physical proximity on communication frequency among colleagues, this study hypothesises that the spatial layout of the Netherlands hospital case study facilitates dense communication networks across the boundaries of care teams, whereas we would expect to find more disrupted and insular communication networks in the Canadian case.

People

This project was led by Dr Kerstin Sailer and supported by Rosica Pachilova as research assistant.

International collaborators were Ray Pradinuk (Stantec Architecture, Vancouver) and Darlene MacKinnon (Providence Healthcare, Vancouver).

The project was jointly funded by the EPSRC Platform Grant ‘Space Technologies and the Design of the Built Environment’ (EP/G02619X/1), Stantec’s internal research fund and a contribution by Providence Healthcare. 

Outputs

The research highlighted how differences in the spatial layout of hospital clinics resulted in differences in care routines and communication behaviours.

In summary, some of the most important insights included:

• Long lines of sight in workspace areas for caregivers increase visibility and chances for encounter and communication.
• Caregivers in the Netherlands case spent 68% of their time in shared workspaces, while caregivers in the Canadian case spent only 46% of their time in shared workspaces.
• Average conversations in the Netherlands case lasted only 44 seconds and were short, frequent and ubiquitous; large areas were reserved for caregiver access only, so conversations could not be overheard by patients or family. Average length of conversations in the Canadian case lasted almost twice as long (1 minute, 21 seconds) and tended to be more planned and less spontaneous. Only few areas were safe from being overheard.
• Doctors and nurses in the Netherlands case have a very similar activity pattern and spend comparable amounts of time in the same locations; the spatial layout acts integratively and brings caregivers together; in contrast, doctors and nurses in the Canadian case have different activity patterns, where the layout offers fewer chances for communication and presents a more disrupted interface.

For a more detailed account of research results, please refer to the following publications:

• Sailer, K; Pachilova, R; Kostopoulou, E; Pradinuk, R; MacKinnon, D; Hoofwijk, T; (2013) How Strongly Programmed is a Strong Programme Building? A Comparative Analysis of Outpatient Clinics in Two Hospitals. In: Ook Kim, Y and Tae Park, H and Wook Seo, K, (eds.) Proceedings of the 9th International Space Syntax Symposium. Sejong University Press: Seoul, South Korea. Read online via UCL Discovery
• Pachilova, R; Sailer, K; (2013) The Effect of Hospital Layout on Caregiver-Patient Communication Patterns. Presented at: Design4Health, Sheffield, UK. Read online via UCL Discovery

Impact

Insights from the research were not only published in academic papers but also presented at the Healthcare Design Conference 2013 in Orlando, FL, where a lot of interest from architects, designers and practitioners in the healthcare sector was generated. This was followed up by a Webinar presentation for the Healthcare Design Education Day in June 2014, which was organised by the Vendome Healthcare Media Group and attended by more than 200 professionals in the sector.

Most importantly, the results informed the re-design of a Vancouver hospital under the lead of Providence Healthcare and were therefore directly applied in practice.