Providing care quality by design: a new measure to assess hospital ward layouts

Which hospital ward layout works best? In the past, one response to this question has been to design layouts that minimise walking distances of healthcare workers, and increase the time spent with their patients. However, new research suggests that good face-to-face communication between doctors and nurses crucially impacts the health and safety of patients. Taking this into account, this research proposes a new single measure called Spaces for Communication Index (SCI). It assesses communication opportunities arising from the layout, and shows that a high index is associated with the provision of good healthcare. Six NHS wards were first studied in depth by collecting detailed information about movement and communication patterns of healthcare workers. The index was developed on this basis. Thirty-one NHS wards were then selected, based on their quality of care rating. These were used to test the index. Each ward was analysed with the Space Syntax method, which investigated the size of visual fields of healthcare workers on everyday movement paths through the ward. Large viewsheds provide good visibility and awareness of the environment. As a result, they accrue more communication opportunities by virtue of the layout. Statistical analysis was also used to test if the index can predict care quality. Other factors such as distances between key areas, number of patient beds or ward size were tested, too. Results showed that the higher the index, the better the quality of care. The other factors were not related to healthcare quality. In terms of design, these results highlight the importance of the openness of spaces that healthcare workers traverse to get from one key area to another. This research contributes to the development of an objective method that designers can use to compare different nursing unit designs, and anticipate the care quality that would be provided to patients

The dynamic nature of caregiver communication networks and spatialised work processes in hospital wards

This paper presents an empirical study of four hospital wards in two UK hospitals. Of interest are caregiver communication networks and behaviours because they form an important part of care provision. Space syntax research argues that the spatial configuration of buildings has an effect on social behaviours. However, only few notable studies investigate how inpatient wards influence work processes and relationships amongst caregivers. The dynamic nature of this work environment is particularly challenging to observe. Therefore, this study focuses on spatial layouts and dynamically evolving communication networks and behaviours adopting a set of complimentary methods to disentangle the complex and dynamic social processes in hospital wards. The two case studies are situated in London and were specifically selected to contrast in their setup and spatial organisation. Two corresponding inpatient departments in each hospital were chosen for a comparison – the intensive care unit and one medical ward. Space syntax was used alongside a staff survey including social network analysis to assess communication networks amongst caregivers. The survey was carried out for four consecutive days and asked about communication partners on each particular day to capture snapshots of everyday communication that could explain the dynamics of social networks. Sociometric sensors developed at MIT were run for eight consecutive days and provided information about frequency and duration of conversations. The dynamic nature of the workflow was captured by shadowing caregivers and recording digitally type and durations of sequential activities and locations. The study offers several contributions by bringing together spatial analysis, observational data, self-reported surveys and sensor data. Results indicate that the structure of communication networks of doctors and nurses became less hierarchical to keep the network stable when a key role was missing. It was also shown that distance influence the frequency and duration of conversations in the intensive care unit assuming that caregivers are fixed to their assigned beds. However, for the general nursing ward, a different methodology to model distance is required as one caregiver takes care of several physically dispersed patients. Finally, it was shown that nurses spent a great proportion of their time in various activities in different locations pointing towards the dynamic nature of the workplace. The outcome of this study generates insights into everyday life in hospital wards and how spatial practices play out

Use of an online interactive space analysis tool to understand student perceptions of four secondary schools

With the sheer complexity of the built environment, understanding the aspects of the building that directly impact the occupants can be prohibitively difficult. Previous methods have been largely split between low-number, high-detail methods (photo-surveys or interviews), or high-number, low-detail methods (questionnaires). This study presents an alternative to these methods; creating an online tool that represents a navigable building, enabling the occupants to freely identify any aspect of the building that they feel is important. This online tool deliberately works in a manner similar to Google Street View, taking advantage of this familiarity to reduce the learning curve and maximise immersion. Using spherical images captured with a special camera or smartphone, each space in the building is captured and then uploaded into the online tool. Whilst in the online version of their building, the respondent can navigate through the building, make unguided comments about any part of the building. Using this tool, four recently built secondary schools were imaged and online versions created. In each school, students from three ICT lessons aged between 11 and 14 explored the online version of their school and marked parts of the building that were important to them. The students were asked to follow a typical day in the school, moving from lesson to lesson and to the spaces they use at breaks. The tool collected both the movement data and the comments, allowing analysis of not just the occupant attitudes, but also the route the students take through the building. The movement data for each school was compared to the visual graph analysis of the building, showing that the movement of the students within the tool resembles patterns seen elsewhere; configurational logic with attractors. The rich data that is generated in parallel with the movement data allowed insights into the way in which the students moved through the space and what was important to them

Recalculation of an artificially released avalanche with SAMOS and validation with measurements from a pulsed Doppler radar

A joint experiment was carried out on 10 February 1999 by the Swiss Federal Institute for Snow and Avalanche Research (SFISAR) and the Austrian Institute for Avalanche and Torrent Research (AIATR, of the Federal Office and Re-search Centre for Forests, BFW) to measure forces and velocities at the full scale experimental site CRÊTA BESSE in VALLÉE DE LA SIONNE, Canton du Valais, Switzerland. A huge avalanche could be released artificially, which permitted extensive investigations (dynamic measurements, im-provement of measurement systems, simulation model verification, design of protective measures, etc.). The results of the velocity measurements from the dual frequency pulsed Doppler avalanche radar of the AIATR and the recalculation with the numerical simulation model SAMOS are explained in this paper

Differential perceptions of teamwork, focused work and perceived productivity as an effect of desk characteristics within a workplace layout

The impact of the physical workplace on behaviors and attitudes at work is a much-studied topic. Major research streams over the last decades investigated either satisfaction with offices in relation to physical comfort, or how layout decisions influenced interaction and collaboration in the workplace with a focus on open-plan offices. Rather little is known on the effect a workplace layout (such as its openness) has on perceptions of staff regarding teamwork, focused work and perceived productivity. We aim to close this gap by taking a differential approach which appreciates detailed variations within open-plan offices. Not every corner of an office is the same, so the question arises whether satisfaction with workspace differs depending on where someone is sitting. Bringing results of a staff survey in the UK headquarters of a global technology company together with a detailed analysis of spatial qualities at desks based on isovist and visual field analysis, we find that staff are less likely to rate their workplace environment favorably when they have higher numbers of desks within their own field of vision; and when they are facing away from the room with a relatively larger area behind their back compared to the area surrounding them. Aspects of teamwork that are negatively affected include sharing information with others, as well as team identity and cohesion. Focused work (concentration) and working productively are impacted even more so with the largest effect sizes throughout. These findings highlight the relevance of investigating detailed spatial qualities of micro-locations in workplace layouts. Our results also raise important questions regarding the current popular practice in workplace design of providing large open-plan offices for technology companies

Travel Concentration: The effects of attractor-bound movement on workplace activity

PURPOSE: The purpose of this paper is to explore the effects of office attractors on workplace activity. First, it aims to describe how movement towards different attractors such as canteens and entrances can be approximated in a 2D spatial model, and second, to show how those simulated effects relate to actual observations of movement and interaction. THEORY: Human activity in physical workspace is typically examined from the perspective of the purely geometric properties of the space (i.e. in the field of space syntax), or by other properties of workspaces, such as barriers and distance between workers. Movement in offices however is an activity that is driven by both geometric and non-geometric properties. The non-geometric properties relate to the functional configuration of space (where seats/canteens/meeting rooms are) but the activity itself happens in the real space and it is thus bound by spatial configuration.Furthermore, while the driver for movement is the need to travel to specific attractors, it is the actual space that allows for secondary effects such as serendipitous interactions to emerge. Thus, it can be expected that a successful approximation of workplace movement will also contribute to understanding interaction, especially that which happens away from spaces programmed for it such as meeting rooms. This paper examines the two activities of movement and interaction under the hypothesis that a spatial model that properly simulates attractor-bound movement can successfully identify the locations where movement happens, but also provide relevant hints for serendipitous interaction. DESIGN/METHODOLOGY/APPROACH: To study this hypothesis, we constructed paths from each seat to a set of three types of attractors, specifically the building entrance, the closest canteen or kitchen and the closest WC. These paths were then transformed to zones of visibility to take into account the surrounding space as well as to allow for interaction to be examined as that activity is unlikely to happen directly on the path. The final result is a metric of travel concentration that measures how likely is it that a space will be seen from those generated paths. The metric is validated against actual observations of movement and interaction in a linear model, tested initially against a large sample of different workplaces (216 floors), but also against two sets of floors, one with high and one with low seat density. FINDINGS: The new metric fares well against both movement and interaction on the whole sample, but on the two sets of floors the effects are less robust. In high-density floors the main driver of attractor movement is the one generated from outside the floor and to a lesser extent the one that comes from within the floor. In low density floors only interaction is somewhat predictable albeit with a weak effect and only in relation to travel from within the floor. Travel concentration was found to be less effective than the existing Visual Mean Depth metric, however combinations of the two were found, in some cases to yield the best results. ORIGINALITY/VALUE: The new metric presented here is a useful simulation of movement in office spaces which can be applied to the analysis of existing spaces, but also provide a way for designers to test against floor plans of new buildings

The Innovation Deficit: The importance of the physical office post-COVID-19

After more than a year of dealing with the fallout from COVID-19, much has been learnt about the benefits of working from home. There is plenty of evidence for people wishing to retain at least some of the flexibility that working from home has brought post-pandemic. However, what has also been shown is that a well-designed office is more often better than home at supporting some types of activity, especially those involving socialisation and collaboration with others. This paper takes stock of what the office is good for and argues that without opportunities to meet in unplanned ways face-to-face, innovation, the life blood of many businesses, is at risk. In so doing a different way to think about the post-pandemic office is proffered; one that is designed to realise the benefits that being physically co-present can bring and thus avoid the so-called innovation deficit. By using this way of thinking, this paper concludes with an evaluation of how some organisations are already ‘re-imagining’ their post-pandemic workplaces

Macroscopic limit cycle via pure noise-induced phase transition

Bistability generated via a pure noise-induced phase transition is reexamined from the view of bifurcations in macroscopic cumulant dynamics. It allows an analytical study of the phase diagram in more general cases than previous methods. In addition using this approach we investigate patially-extended systems with two degrees of freedom per site. For this system, the analytic solution of the stationary Fokker-Planck equation is not available and a standard mean field approach cannot be used to find noise induced phase transitions. A new approach based on cumulant dynamics predicts a noise-induced phase transition through a Hopf bifurcation leading to a macroscopic limit cycle motion, which is confirmed by numerical simulation.Comment: 8 pages, 8 figure

A total Lagrangian, objective and intrinsically locking-free Petrov-Galerkin SE(3) Cosserat rod finite element formulation

Based on more than three decades of rod finite element theory, this publication unifies all the successful contributions found in literature and eradicates the arising drawbacks like loss of objectivity, locking, path-dependence and redundant coordinates. Specifically, the idea of interpolating the nodal orientations using relative rotation vectors, proposed by Crisfield and Jeleni\'c in 1999, is extended to the interpolation of nodal Euclidean transformation matrices with the aid of relative twists; a strategy that arises from the SE(3)-structure of the Cosserat rod kinematics. Applying a Petrov-Galerkin projection method, we propose a novel rod finite element formulation where the virtual displacements and rotations as well as the translational and angular velocities are interpolated instead of using the consistent variations and time-derivatives of the introduced interpolation formula. Properties such as the intrinsic absence of locking, preservation of objectivity after discretization and parametrization in terms of a minimal number of nodal unknowns are demonstrated by conclusive numerical examples in both statics and dynamics