Improving Staff Outcomes in Inpatient Units—A Canadian Context

As reported in the CHD Research Report in the June 2012 issue of HEALTHCARE DESIGN, the design features of the new wing at Trillium Health Centre-Mississauga site, which include decentralized nurses’ stations, larger patient rooms, and wireless technology, were evaluated for their impact on patient safety, staff outcomes, cost effectiveness, and improvements in overall patient and staff satisfaction.

Trillium wanted to test the improvements in the quality of nurses’ work life by ensuring they had access to frequently used supplies, communication devices, and quiet spaces for medication dispensing and documentation. The new wing was built on the premise that the average age of the nursing staff will become increasingly older, based on demographic projections by human resources.

Ergonomic considerations such as large uncluttered rooms and ergonomically placed electrical outlets (waist high)—virtually stopping the need for kneeling and crawling—were critical to ensure enhanced staff safety and satisfaction.

The quality of the nursing environment was tested using qualitative interviews, retention rates, and reported sick time. The study measured the impacts of the new environment on staff safety, satisfaction, and turnover. A comparison of data from the traditional patient unit with data from the new decentralized units found statistically significant changes in pre and post measures for staff outcomes, including:

• A decrease in nurse walking time and trips to obtain supplies;
• A decrease in nurse call-response times; and
• An increase in nursing availability and direct patient care time.

Studies have shown that poorly designed workspaces can often lead to inefficient patient care as clinicians’ time is spent “hunting and gathering” information (Hendrich 2006, Ulrich et al. 2008). There are correlations between the work environment and nurse satisfaction. Nursing satisfaction, in turn, directly impacts patient outcomes (Hendrich, 2006). In hospitals where nurses experience high job satisfaction, patient outcomes such as quality care and patient satisfaction scores are often positive (Hendrich, 2006).

In the new wing’s decentralized nursing environment, process inefficiencies such as response times should be minimized because nurses are closer to their patients. Clinicians are able to update patient records right at the bedside and communicate directly with their patients and colleagues in a timely manner. In decentralized environments where nurses can work in stations placed closer to their patients, one finds that patient care is enhanced and staff satisfaction is increased (Ulrich et al., 2008).

Nurses are able to spend more time caring for their patients and are in a position to respond in a timelier manner to their patients’ needs. The decentralized environment has also been correlated with improved patient satisfaction. In their study that compared the benefits of decentralized environments over centralized environments, Howard and Malloch found that patient perception of response to calls was more favorable in a decentralized medical surgical unit (Howard and Malloch, 2007).

Staff safety and physical demands
Nurses have the highest number of lost work days and the highest percentage of lost time attributed to illness and injury. Most of these injures are musculoskeletal. Causes of musculoskeletal injuries include awkward postures for sustained periods of time and repetitive loading or lifting. For musculoskeletal disorder (MSK) cases involving patient handling, almost all (99%) were the result of overexertion. Sprain, strain, or tear was the type of injury incurred in 83% of the MSK cases involving patient handling (U.S. Bureau of Labor Statistics, 2011).