Healthcare Design - October 2015 - 57

effects of collaboration and teamwork on quality, efficiency, safety, and innovation, and in this
context, the reduction noted should be of major
concern.
As patient care increasingly moves to
outpatient locations, the inpatient acuity level
is increasing, requiring the ability for nurses to
consult on clinical problems, teach new nurses,
and rely on teamwork in acute situations.
Striking a balance
The key challenge that's emerged from this
review is how to retain the benefits of decentralization while improving on the areas of concern.
Does the solution lie in operational interventions
or in physical design? If a larger footprint is
one of the culprits, the solution may be to
reduce unit size and number of beds. However, that may pose a challenge to operational
efficiencies.
In addition to acuity-based patient assignment, higher patient-to-nurse ratios will affect
operations more on a decentralized unit, as
a higher number of patients assigned means
more walking and to multiple rooms. Both

of these factors could provide subjects for
new hypotheses related to centralized versus
decentralized design. Is the decentralized model
superior only with lower patient-to-nurse ratios
and higher patient acuity? What role does
geographic patient assignments play in the efficiency of unit operations?
Before pointing a finger at either physical
design or operations, it's crucial to underscore
that changes in the former or the latter alone
may not produce desired outcomes. Physical
design interventions must be accompanied with
a firm commitment to operational and cultural
changes. Regardless of the unit design, these
formalized processes must be implemented and
sustained to realize successful outcomes in any
model. HCD
Debajyoti Pati, PhD, FIIA, IDEC, LEED AP, is
a professor and Rockwell Endowment Chair,
Department of Design, Texas Tech University
(Lubbock, Texas). He can be reached at d.pati@
ttu.edu. Pamela Redden, MS, BSN, RN, EDAC, is
director of clinical operations development at
MD Anderson Cancer Center (Houston). She can
be reached at predden@mdanderson.org.

The six studies referenced
* "An Empirical Examination of the Impacts of Decentralized Nursing Unit Design," by Debajyoti Pati,
Thomas Harvey, Pamela Redden, Barbara Summers,
and Sipra Pati. In HERD, Volume 8, No. 2, 2015.
* "Centralized vs. Decentralized Nursing Stations-The
Impact on Staff Perception of Communication,
Teamwork, and Quality of Care," by Sherri Ewing,
Karen Richey, and Huong Mai. A paper presented
at the 2014 Healthcare Design Expo & Conference,
San Diego.
* "Effects of Nursing Unit Spatial Layout on Nursing
Team Communication Patterns, Quality of Care, and
Patient Safety," by Ying Hua, Franklin Becker, Teri
Wurmser, Jane Bliss-Holtz, and Christine Hedges. In
HERD, Volume 6, No. 1, 2012.
* "Impacts of Architectural Design on Communication
Among Hospital Staff," by Chia-Hui Wang. A paper
presented at the EDRA 42 Conference, Chicago, 2011.
* "Centralized Versus Decentralized Nursing Stations:
Effects of Nurses' Functional Use of Space and Work
Environment," by Terri Zborowsky, Lou BunkerHellmich, Agneta Morelli, and Mike O'Neill. In HERD,
Volume 3, No. 4, 2010.
* "Centralized and Decentralized Nurse Station
Design: An Examination of Caregiver Communication, Work Activities, and Technology," by Linda
Gurascio-Howard and Kathy Malloch. In HERD
Volume 1, No.1, 2007.

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Healthcare Design - October 2015

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