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Maben J, Griffiths P, Penfold C, et al. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Southampton (UK): NIHR Journals Library; 2015 Feb. (Health Services and Delivery Research, No. 3.3.)

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Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation.

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Chapter 5Case study quantitative data findings

Introduction

This chapter provides the results of the analysis of quantitative data from three different sources:

  1. Staff activity: task time distribution. Observations of staff activities were undertaken in each study ward to understand the types of tasks undertaken by staff and the proportion of time spent on each. Staff were shadowed by a researcher who logged their activities.
  2. Staff travel distances. These were collected by staff wearing pedometers. These data were collected before and after the shadowing sessions.
  3. Staff experience surveys. Staff surveys on each ward were conducted before and after the move to the new hospital and these data provide a comparison of perceptions of the ward environment in the old and new wards.

The survey probed perceptions of many aspects of the ward environment before and after the move. As discussed in Chapter 3, the trust, the designers and stakeholders held various expectations about the benefits of the 100% single room design. We examined whether or not these expectations (or hypotheses about the effect of the move) were fulfilled. Specifically, the new hospital was designed to increase patient comfort, prevent infections, reduce numbers of patient falls, reduce patient stress, increase patient-centred care and increase the time spent by nurses on direct care (see Appendix 16). Concerns were raised about the possible reduction in staff observing and monitoring patients, increased travel distances and patient isolation.

This chapter primarily addresses the following two research questions:

  1. What are the advantages and disadvantages of a move to all single rooms for staff?
  2. Does the move to all single rooms affect staff experience and well-being and their ability to deliver effective and high-quality care?

Staff activity: task time distribution results

Preliminary analysis showed that five activity categories accounted for 78% of observation data before the move and 83% of observation data after the move. This meant that numbers in the remaining categories were too low for analysis, so all subsequent analyses were confined to these five categories: direct care, indirect care, professional communication, medication tasks and ward-related activities. Proportion of time was derived by calculating the duration of each event from its start and end time, and then aggregating duration by activity for each observation session. The number of events for each activity was also counted (Table 23).

TABLE 23

TABLE 23

Observations (events) per session before and after new build

Proportion of time spent in each type of activity was analysed using a general linear model with proportion of time as the dependent variable. The first model consisted of a single independent variable for before and after the new build and was used to ascertain the effect of the move to a new build, prior to adjusting for other variables. To this model were added ward (maternity, surgical, older people, AAU), staff group (midwife, RN, HCA) and day of the week. This second model was used to ascertain the effect of the move to the new build having adjusted for these variables.

Events were defined as a switch of activity (either to a new activity or to continue a previously interrupted activity) and were captured by a new entry in the PDA. The number of events (new or continuation of a previous activity) per hour was modelled in the same way except that a generalised linear model with a Poisson distribution and shift length in hours specified as offset (equivalent to modelling the hourly rate) was fitted to the data. An unadjusted analysis (before and after the new build only) and adjusted analysis (before and after the new build, ward, staff group and day of week) were performed.

Analysis of medication tasks was confined to RNs only. The fact that RMs work only on the postnatal ward means that it would not be possible to interpret whether any obtained results were due to the effect of the professional group or the ward. Therefore, staff group (i.e. midwives) was dropped from this model. On average the number of events (either new or continuations of previous activities) observed per session was higher before the move than after (177 vs. 153).

However, the move to the new build did not result in a significant change to the proportion of time spent on different activities (Table 24). Although there was an increase in the proportion of direct care, indirect care, professional communication and medication tasks and a decrease in ward-related activities such as cleaning, bed making and stocking the utility room in adjusted analyses, none of these changes was statistically significant (see Table 24).

TABLE 24

TABLE 24

Mean proportion of time spent in each type of activity before and after move

Table 25 shows results for the analysis of the number of events per hour. The adjusted number of recorded events per hour decreased significantly for direct care (p = 0.039) and professional communication (p = 0.002), and increased significantly for medication tasks. A decrease in the number of events per hour for an activity, and no change in the proportion of time spent on that activity, suggests that there were fewer interruptions during these tasks and work was, therefore, less fragmented. This interpretation is supported by qualitative data showing that nurses could focus on direct care and communication tasks more easily in the single room environment. Staff had difficulty locating each other and also felt reluctant to interrupt a colleague providing direct care in a single room, and there were more frequent structured opportunities for professional communication within the small nursing teams.

TABLE 25

TABLE 25

Number of events per hour by type of activity before and after move

The number of events per hour increased significantly for medication tasks (p = 0.001), showing increased fragmentation for this task. Again, this interpretation is supported by the qualitative data showing that when staff entered a patient room to administer medication they were likely to engage in other direct care activities; thus medication administration was not carried out in a single medication round, but integrated into patient care activities generally.

We also assessed the changes in patients’ contact time per patient-day to check if nurses spent more time with the patient instead of doing other activities. The analysis draws on day shift observation data (based on 118.5 hours of staff shadowing before the move and 254.5 hours after the move). The proportion of contact time was applied to the total NHPPD to provide an estimate of the patients’ contact time per patient-day (see Table 26).

TABLE 26

TABLE 26

Patients’ contact time per patient-day before and after move in the case study wards

After the move, the contact time per patient-days increased in all units, apart from surgery, where there was a decrease in direct care and an increase in indirect care activities, for example medication activities and professional communication, and essential ward/patient care activities.

These changes are the result of a combination of two factors: a change in the proportion of care (i.e. an increase/decrease in the time spent with the patient) and a change in NHPPD (i.e. an increase/decrease in the number of nurses working full-time during a day).

Staff travel distances results

Statistical analysis

The data were analysed using a repeated measures general linear mixed model (GLMM) with steps per hour as the dependent variable and pre/post new build, ward (maternity, surgical, older people, AAU), observation session (repeated measure), staff group (midwife, RN, HCA) and day of the week as independent variables. The first GLMM analysis investigated the main effects of ward, pre/post move, staff group and day of the week. The second GLMM analysis investigated the interactions between pre/post move and ward, and between pre/post move and staff group. Because midwives were employed only on the maternity ward, there was potential confounding between the effects of ward and staff type. Initial analyses confirmed that removing maternity from the analyses improved the fit of the models. The first sensitivity analysis added a variable to the model that indicated whether or not a member of staff contributed to both the pre- and post-build samples. Only five staff contributed to both. The effect on the overall results was minor. A second sensitivity analysis fitted a model to first observation session data only, but allowed data to repeat across individual staff before and after the build. We report the results below, including where sensitivity analyses identified differences.

The data set contains information on 140 sessions collected on 53 staff (49%) prior to and 56 staff (51%) after the new build. A number of staff contributed more than one observation session: 85 provided one session, 18 provided two sessions, five provided three sessions and one provided four sessions. There were 73 sessions (52%) collected prior to the new build and 67 sessions (48%) after the new build. The average numbers of sessions per member of staff were 1.38 and 1.20, respectively. A small number of staff (n = 5, 4%) were observed at both times (one RN and four HCAs). Table 27 shows descriptive data for ward and staff group.

TABLE 27

TABLE 27

Steps per hour before and after new build

The unadjusted means (see Table 27) show an increase in the number of steps per hour for all wards and staff groups. Staff working on the older people’s ward (from 664 to 845) and RNs (from 639 to 827) have seen the biggest increases.

Table 28 shows results for the main effects of ward, pre/post move, staff group and day of the week. The number of steps per hour increased significantly from a mean of 715 before the move to a mean of 839 [F(1,83) = 10.36; p = 0.002] after the move. HCAs took significantly more steps per hour than nurses [F(1,83) = 8.01; p = 0.006]. There were also significant differences between days of the week [F(4,21) = 3.40; p = 0.027]. There was no significant difference between wards in the distances travelled (Table 29).

TABLE 28

TABLE 28

F-tests on main effects

TABLE 29

TABLE 29

Mean steps per hour by wards, pre-/post move, staff group and day of the week

Table 30 shows results for the interactions between pre/post move and ward, and between pre/post move and staff group. Neither of the two interactions was statistically significant.

TABLE 30

TABLE 30

F-tests on interaction effects

The estimated marginal means (Table 31) showed that there was an increase from pre to post build across all wards. Although the size of this increase did not differ significantly between wards, the increases in the surgical and older people’s wards were larger than for the AAU. RNs experienced a larger increase (from 624 to 811) in the number of steps per hour (from 3.74 to 4.86 miles) than HCAs (from 828 to 862 steps; from 4.96 to 5.17 miles).

TABLE 31

TABLE 31

Mean steps per hour for the interactions

The estimated marginal means from the second sensitivity analysis suggested a decrease in the number of steps per hour for the AAU from 901 to 836 and for HCAs from 876 to 855, rather than an increase as shown in Table 31. The change in means for the remaining two wards and for RNs, from pre to post build, were in the same direction, and of the same order of magnitude (see Table 31).

Staff experience survey

Results

Because of staff leave, shift patterns and staff turnover during the course of the study, it was not possible to use a completely within-subjects design, in which the pre- and post-move surveys were completed by the same people. Despite this, 19 participants did complete surveys at both times, which meant a mixed within- and between-subjects design. One potential problem with this is that the subgroup who completed both surveys could have been sensitised to the research questions and, therefore, could have been more likely to report differences after the move than those who completed only one survey; that would bias our results. We addressed this by treating the design as a between-subjects design and checking for bias by comparing the results of our analyses for the whole group with separate within-subjects analyses on the subgroup who completed both surveys. The results were identical except for a small difference: perceptions of the effect of the accommodation on the delivery of care approached significance (0.099) in the within-subjects analysis whereas for the whole group this effect was significant (0.011). This can be attributed to lack of power in the subsample of 19. On this basis we proceeded with the analysis by treating the ‘before’ and ‘after’ samples as independent groups.

There were 152 items in the staff survey. Our approach to analysis was multifaceted. First, we explored the potential for grouping questions into subscales that would summarise a topic area. We thematically analysed the questions to determine those that were likely to be measuring attitudes to related aspects of the ward design, and then tested these subscales using statistical reliability analysis. Where reliability was not adequate we revised the items in the subscales until we had identified coherent subscales. These were then analysed using independent sample t-tests to determine if post-move responses were significantly different from the pre-move scores for each subscale. Similar analyses were undertaken for the teamwork and safety climate scales. Qualitative open-ended questions were analysed thematically using a content analytic approach. The well-being and stress items were compared before and after the move using the Pearson chi-squared test and Fisher’s exact test when expected frequencies were less than 5.

One of the aims of the study was to investigate if there were differences between the case study wards in their perceptions of the positives and negatives of the new single room accommodation. However, the relatively small number of staff in each of the case study wards meant that it was not possible to explore this question statistically. We therefore used correspondence analysis and perceptual mapping to examine the interaction between ward attributes and case study wards. Correspondence analysis is an exploratory mapping tool that allows visualisation of relationships in the data that would be difficult to identify if presented in a table.114 It is related to other techniques such as factor analysis and multidimensional scaling. It does not rely on significance testing and is best viewed as an exploratory technique that provides insights into the similarities and differences between two variables.115 Correspondence analysis does not address questions of whether or not there were differences in ratings between the attributes (e.g. whether or not privacy for patients was rated more highly than staff teamwork). Instead, it focuses on the differences between case study wards and the interaction between ratings and wards. It allows an examination of to what extent which wards are associated with particular ratings. In this way it allows us to qualitatively explore the quantitative data.

Ward environment survey subscales

Ten reliable subscales were formed. Table 32 shows the subscales and example items from each.

TABLE 32

TABLE 32

Description of subscales

Appendix 19 contains a complete list of all items used for each subscale.

Table 33 summarises the statistical analysis of the subscales showing means, Cronbach’s alpha and the number of items for each subscale before and after the move. According to accepted criteria,115 alpha above 0.60 is acceptable for exploratory analyses, above 0.70 is acceptable for confirmatory purposes and above 0.80 is good for confirmatory purposes. Obtained coefficients were generally good, ranging mostly between 0.67 and 0.92. The lowest alpha, of 0.53, was obtained for the family/visitors subscale after the move, suggesting that this subscale is not internally consistent. However, the pre-move alpha was good (0.70), so it was decided to retain this subscale for exploratory purposes.

TABLE 33

TABLE 33

Mean subscale scores and reliability analysis before and after the move

Table 34 shows the results of independent sample t-tests comparing subscale scores before and after the move. Staff perceived significant improvements in the efficiency of the physical environment, the patient amenity, the effect of the environment on infection control, patient privacy, and family and visitors. The largest increases were found for perceptions of infection control and patient privacy. Perceptions of the effect of the ward environment on teamwork and care delivery were significantly more negative after the move. There were no significant differences in staff perceptions of staff facilities, patient safety and staff safety.

TABLE 34

TABLE 34

Results of t-tests comparing perceptions of the ward environment before and after the move

Although all subscales showed moderate to very good reliability, changes were not uniform for all items in every subscale; there were some exceptions to the overall trend. Overall ratings for the subscale ‘efficiency of physical environment’ increased, but ratings for the item ‘ward design/layout minimises walking distances for staff’ decreased. These perceptions were confirmed by our findings from the analysis of travel distances showing that staff took significantly more steps after than before the move. Some aspects of the design increased the amenity of the ward for staff but others did not. For example, staff toilet facilities, locker facilities and space at staff bases were rated more highly but ratings for social interaction and natural light decreased. These positive and negative aspects meant there was no significant difference in staff amenity before and after the move. The new ward was rated as much more positive for patients but there were reduced scores for three items after the move: social contact between patients, ability of patients to see staff and way finding. All aspects of teamwork and training were rated less positively, except for the item ‘discussing patient care with colleagues’, which increased. This finding is supported by our analysis of observation data showing that professional communication activities were less fragmented.

Although there were no significant differences in the effect of the ward layout on perceptions of patient safety, examination of the items showed that ratings for two items increased (‘minimising risk to patients of physical/verbal abuse from other patients/visitors’ and ‘minimising the risk of medication errors’) while ratings for two items decreased (‘responding to patient calls for assistance’ and ‘minimising the risk of falls/injury to patients’). This suggests that, although staff thought some risks to safety were reduced, they perceived an increased risk of falls and delays in responding to calls for assistance. Staff perceptions of a rise in risk of falls are detailed in Chapter 6. Staff also reported being unable to hear calls for assistance when in a single room with a patient.

There were five items that did not fit into any of the subscales. These items were analysed singly using Fisher’s exact test and the results are shown in Table 35. There was a significant relationship between the move and ratings for the number and location of hand basins, ease of keeping patient areas clean and quiet, and the overall comfort of patients, which all increased after the move. There was no relationship between the move and judgements of whether or not the location of the dirty utility room (where bedpans are stored and disposed of) reduces cross-contamination.

TABLE 35

TABLE 35

Results of single-item analyses

The distribution of responses for the four significant items showed that significantly more staff rated these aspects of single room accommodation as more positive after the move than before (Tables 3639).

TABLE 36

TABLE 36

Distribution of responses for the item ‘Number and location of CHWBs supports good hand hygiene’

TABLE 39

TABLE 39

Distribution of responses for the item ‘Easy to keep patient care areas clean’

TABLE 37

TABLE 37

Distribution of responses for the item ‘Overall comfort of patients’

TABLE 38

TABLE 38

Distribution of responses for the item ‘Easy to keep patient care areas quiet’

Expectations before the move and reality after the move

Before the move, staff were asked to rate on a five-point scale whether they thought single rooms would be better or worse for different aspects of clinical work (e.g. minimising the risk of patient falls, maintaining patient confidentiality, knowing when other staff might need help). After the move they again rated whether single rooms were better or worse for clinical work, thus providing a measure of whether or not their expectations about single rooms were met in reality. The questions were a subset of 23 questions from the first part of the survey and were analysed using Fisher’s exact test.

Results (Table 40) showed that staff perceptions of whether or not single rooms were better than multibedded wards changed after the move for five items. Staff perceptions of whether or not single rooms were better for responding to calls for assistance, knowing when other staff might need help and minimising walking distances were rated as worse or much worse by significantly more staff after than before the move. Staff rated single rooms as positive for patient sleep and rest and for interactions between patients and visitors after the move.

TABLE 40

TABLE 40

Relationship between expectations before the move and reality after the move

Tables 4145 show the distribution of significant responses.

TABLE 41

TABLE 41

Distribution of responses for the item ‘Responding to patient calls for assistance’

TABLE 45

TABLE 45

Distribution of responses for the item ‘Minimising staff walking distances’

TABLE 42

TABLE 42

Distribution of responses for the item ‘Patient sleep and rest’

TABLE 43

TABLE 43

Distribution of responses for the item ‘Knowing when other staff might need a helping hand’

TABLE 44

TABLE 44

Distribution of responses for the item ‘Patient interaction with visitors’

Teamwork and safety climate survey

To take into account our changes to the survey, we combined the four items about the quality of communication with doctors, nurses, nursing assistants and AHPs with the items in the information handover subscale to form a new subscale of seven items. Although this is different from the scales reported by Hutchinson et al.,98 reliability analysis confirmed the original factor structure of the survey. There were two teamwork subscales and three safety climate subscales with good to high reliability (Table 46). See Appendix 20 for a list of the items contained in each subscale.

TABLE 46

TABLE 46

Mean subscale scores and reliability analysis before and after the move

Mean scores for all subscales decreased following the move. Independent sample t-tests showed that ratings for information handover and communication decreased significantly following the move [t = 3.23, degrees of freedom (df) = 108, p = 0.002], indicating that information exchange and sharing within teams was perceived to be worse after the move. There were no other significant differences.

Correspondence analysis

Correspondence analysis transforms cross-tabulated data into a biplot showing distances between variables. In this study, case study ward was a column variable and mean questionnaire subscale score was a row variable (see Table 33). As appropriate when analysing mean scores, Euclidean distance was used and standardisation by removing row means was used.114,116 This means that differences between the subscale means were not represented in the perceptual map, as we were not interested in whether or not, for example, infection control was rated more highly than privacy. Differences between wards, contained in the columns, were of interest and are represented in the perceptual map. Separate analyses were conducted for before and after the move and for the ward attributes and teamwork/safety climate survey.

Figure 11 shows perceptual maps of the association between ward attributes and wards before and after the move. The pre-move map shows that the points on the map were dispersed, indicating that the ratings were not strongly associated with particular wards. There was one exception in that ratings for the efficiency of the physical environment, privacy and infection control were higher for the older people’s ward than for the other wards. The post-move map shows that the highest ratings for the efficiency of the physical environment, the delivery of care, the staff facilities and teamwork were obtained in the older people’s and surgical wards, indicated by proximity on the map. Ratings for patient amenity, infection control, privacy and family/visitors were highest for the surgical ward. High ratings for patient safety were obtained in maternity and the surgical ward. Ratings for staff safety were similar in the older people’s, surgical and maternity wards. The acute assessment ward was not associated with any particular ward attributes, as was the case before the move.

FIGURE 11. Perceptual maps of (a) pre- and (b) post-move ward attributes by ward.

FIGURE 11

Perceptual maps of (a) pre- and (b) post-move ward attributes by ward.

Figure 12 shows perceptual maps before and after the move of the association between teamwork/safety climate ratings and wards. The teamwork/safety climate survey consisted of two teamwork subscales – team input into decisions, and information handover and communication – and three safety climate subscales – attitudes to safety within own team, overall confidence in safety of organisation and perceptions of management attitudes to safety. The pre-move map shows that ratings of input into decisions, information and handover, and overall confidence in safety of the organisation were highest for the acute assessment ward. Ratings of safety attitudes within the team and management attitudes to safety were highest for the surgical ward. After the move, the surgical ward had the highest ratings for safety attitudes within the team, overall attitudes to safety and management; ratings for team input into decisions and information handover and communication were highest for the older people’s ward. Ratings for all safety climate subscales decreased in the acute assessment ward, which is indicated on the perceptual map by its location in a quadrant by itself. Maternity scores did not show a consistent pattern.

FIGURE 12. Perceptual map of (a) pre- and (b) post-move ratings of teamwork/safety climate by ward.

FIGURE 12

Perceptual map of (a) pre- and (b) post-move ratings of teamwork/safety climate by ward. Att., attitude; mgt., management.

These maps reveal some differences between wards in perceptions of the ward environment and show that perceptions were different before and after the move.

Staff ward preferences

Nursing staff were asked to indicate whether they would prefer single rooms, multibedded accommodation or a combination. There was a range of views (Figure 13). In each phase, fewer than 18% of staff indicated a preference for 100% single rooms. The most common preference in each phase was a combination of 50% of beds in single rooms and 50% in bays (see Figure 13). In the pre-move survey, more staff reported a preference for more beds in bays (n = 20) than in the post-move phase (n = 12).

FIGURE 13. Nurse preferences for single room or multibedded accommodation.

FIGURE 13

Nurse preferences for single room or multibedded accommodation.

Staff stress and well-being

There were five categorical questions about staff well-being that investigated whether or not they had experienced injuries and harassment in the previous 12 months (Table 47). There were three items about job stress that asked participants to rate their stress on a five-point Likert scale (Table 48). Results showed no differences in staff well-being and stress before and after the move.

TABLE 47

TABLE 47

Relationship between move and staff well-being

TABLE 48

TABLE 48

Relationship between move and staff stress

Staff were asked 10 questions about their satisfaction with their own performance of various tasks during their last shift, and one question about their overall job satisfaction. Results (Table 49) showed no significant effect for any of the job satisfaction items.

TABLE 49

TABLE 49

Relationship between job satisfaction and move

Qualitative survey data

Four open-ended questions were used to gain qualitative data about staff attitudes. The questions were:

  1. What two things do you think would most improve the current ward environment for staff?
  2. What two things do you think would most improve the current ward environment for patients?
  3. Before move:
    1. What two things are you most looking forward to in relation to the move to 100% single rooms in the new hospital?
    2. What two things are you most concerned about in relation to the move to 100% single rooms in the new hospital?
  4. After move:
    1. What two things do you like the most about single room wards in the new hospital?
    2. What two things do you dislike most about single room wards in the new hospital?

In the following sections we present the results of the thematic analysis with frequency data (almost equal numbers of staff responded before and after the move, n = 55 and n = 54 respectively) and examples from participants’ written responses where appropriate. Table 50 shows that staff identified a number of things that would improve the ward accommodation for patients. The need for more space, improved patient facilities, privacy, and rest and sleep were largely met, since there were fewer people identifying these as needs after the move. However, the need for improved patient–staff ratios and a day room to provide patient social interaction were still reported after the move.

TABLE 50

TABLE 50

What would improve the current ward environment for patients? Response frequencies

The need that staff perceived before the move for space around patient beds and staffing levels had decreased after the move (Table 51). However, ventilation/heating/lighting, access to equipment and supplies and facilities for staff, including staff bases, were identified as needing improvement after move. In addition there was a need for improvements in monitoring patients, keeping track of colleagues, reducing isolation and reducing walking distances. These have all been identified by other parts of our results (see Chapter 6).

TABLE 51

TABLE 51

What would improve the current ward environment for staff? Response frequencies

Staff were asked about the features of the ward they were most looking forward to in the pre-move phase, and most liked in the post-move phase (Table 52). Results showed that staff most liked the increased patient privacy, patient sleep and rest, increased space, working in a modern environment and improved patient bathroom facilities.

TABLE 52

TABLE 52

What are you most looking forward to/do you most like about 100% single room accommodation? Response frequencies

Table 53 shows that staff were most concerned about being able to monitor patients, patient isolation and the risk of falls. Being unable to find staff and increased walking distances also emerged as features staff disliked about single rooms.

TABLE 53

TABLE 53

What are you most concerned about/do you most dislike about 100% single room accommodation? Response frequencies

Summary

  • Most staff would prefer a mix of single rooms and multibedded rooms on wards.
  • Staff activity events observed per session were higher after the move and direct care and professional communication events per hour decreased significantly, suggesting fewer interruptions and less fragmented care.
  • A significant increase in medication tasks among recorded events suggests medication administration was integrated into patient care activities and was not undertaken as a medication ‘round’.
  • Travel distances increased for all staff, with highest increases for staff in the older people’s ward and surgical wards and for RNs/RMs.
  • Staff perceived that the new accommodation was better for:
    • efficiency in carrying out tasks
    • patient amenity, including comfort, space, sleep, light and ventilation
    • infection control
    • patient privacy
    • patient interaction with family/visitors and their involvement in care.
  • In open comments, staff most liked the increased patient privacy, working in a modern environment, improved patient sleep and rest, and space around the bedside.
  • Staff perceived that the new accommodation was worse for:
    • delivery of care, including factors such as spending time with patients, communication with patients, monitoring patients and remaining close to patients, responding to calls for assistance, minimising the risks to staff, minimising walking distances and staff spending time with patients
    • teamwork, including being able to locate staff, obtain assistance from colleagues, informal learning, keeping team members updated, discussing care with colleagues and knowing when other staff might need help.
  • In addition, in open comments staff were most concerned about patient isolation, the risk of falls and staff isolation.
  • There were no perceived differences in staff amenity and patient and staff safety.
  • Ratings for information handover and communication decreased significantly following the move. This suggests that information exchange and sharing within teams – and between professions – was perceived to be worse after the move.
  • Different wards valued different aspects of the ward environment.
  • Ratings for staff toilet facilities, locker facilities and space at staff bases were rated more highly but ratings for social interaction and natural light decreased.
  • No differences were found in staff job satisfaction, well-being or stress before and after the move.
  • The need for improved patient–staff ratios and a day room to provide patient social interaction was still reported after the move.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Maben et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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