Study On Decentralized Nurses’ Stations Yields Surprising Results
The researchers from Ann & Robert H. Lurie Children’s Hospital of Chicago unpacked their story in a straightforward, methodical manner during the team’s presentation at the 2014 Healthcare Design Conference, titled “Centralized vs. Decentralized Nurses’ Stations: The Impact On Staff Perception, Communication, Teamwork, and Quality of Care.” The goals of the study, they explained, were to explore staff satisfaction, camaraderie, and stress; nurse movement, interactions, and noise level; and lessons that leaders might glean from this transition in order to facilitate successful transitions in other settings. The study’s methodology was carefully laid out for the attendees’ understanding.
The unit had moved from a centralized nurses’ station with a racetrack design and two smaller workstations to one that got rid of the central station in favor of individual workstations (“porches”) throughout the unit, located closer to patient rooms. “Consultation zones” outside patient rooms were created through strategically angled walls. A couple of “care team stations”—multiuse work spaces with both open and private areas, designed to be used by anyone at any time, as needed—were included in the new space, as well.
Anticipated benefits of the new layout included improved communication and collaboration among care team members, efficiency in service delivery, more privacy, and reduced noise levels.
But the findings don’t paint quite a rosy picture. Staff reported less satisfaction with their jobs in the new setup, and a weakened sense of teamwork. They found workflow to be less efficient and face-to-face communication has decreased.
The researchers suggested that these kinds of findings may be due to the increased size of the unit (it’s more than twice as big as the old one), the fact that the new hospital combines two units into one (which means many more unfamiliar team members), and the feeling of increased isolation that comes naturally with a switch to individual workstations. On the positive side, the perception of noise was decreased, as was the number of distractions for workers.
And there was one finding that had the session attendees sitting up straighter in their seats: Somehow, even though caregiver stations were decentralized and moved much closer to patients, nurses in the new unit walked half a mile more than they had in the previous space. The researchers didn’t offer a direct explanation for this, but they did shed some light on the culture in the new space, which might be worth considering as a potential factor.
Apparently, the caregivers in the new space tended to gravitate toward the bigger care team stations to (in part) reclaim the camaraderie and support they were missing. As one of the presenters said, “Within the decentralized design, the staff created their own centralized model.” In addition, the physicians and technicians coming into the unit, rather that working in whatever care team station was available or convenient, instead staked a more-or-less permanent claim on spaces within these stations during the very first month of operation.
Lurie Children’s continues to adapt its workflow and operations to create the right balance between staff needs and improved access to patients. More study is needed in the industry as a whole to get a better sense of the feasibility and desirability of centralized versus decentralized nurses’ station, too: This particular research, for instance, didn’t study the effect on patient interactions or measure how much time nurses actually spent at the porches. But this is certainly a good reminder of the power of culture over process, and the need to study workflows and involve clinicians in design planning as early as possible.