Spatial Layout and Face-to-Face Interaction in Offices—A Study of the Mechanisms of Spatial Effects on Face-to-Face Interaction

Methodological considerations in the open-plan office paradox: A systematic literature review

BACKGROUND: Several recent reports conclude that open-plan offices negatively impact workers across a variety of outcome measures. This contrasts to a corporate trend to move from cellular to open-plan layouts, often justified by the same outcomes. Two explanations for this paradox are proposed: (1) the results are more complicated than critical reports suggest, and (2) methodological biases make open-plan layouts look more negative than they are. OBJECTIVE: To evaluate the proposed explanations using a systematic literature review. METHODS: Google Scholar was used to find original research on the relationship between office openness and worker outcomes. 89 articles were coded for the variables and methods they used, and conclusions about the relationship between layout and outcomes were evaluated. RESULTS: The proposed explanations were partly supported. The relationship between layout openness and worker outcomes depends on the variables considered and the methods used, and a small subset of methods was used far more often than others. That said, more research is needed to evaluate impact of open-plan offices on worker outcomes. CONCLUSIONS: The relationship between office openness and worker outcomes varies widely depending on how it is measured. Several promising areas for future research may help clarify this relationship.

How social context impacts the emergence of leadership structures

In leadership research, it has proven useful to understand leadership as a relational phenomenon and to conceptualize leadership structures as networks of leader-member ties. Currently, research further highlights the dynamic nature of these structures and examines their emergence in more detail to uncover the underlying mechanisms. In this literature, emergence is conceptualized as social exchange in teams and investigated experimentally. This paper argues that by doing so, the influence of social context has been neglected. I draw on findings from broader tie-formation research to substantiate the influence of social context and to tackle the conceptual shortcoming. Drawing on this rich literature, I identify eight mechanisms that explain in detail how four dimensions of social context ( Culture, Social Networks, Population Characteristics, and Opportunity Patterns) shape the formation of leader-member ties. Finally, I derive 13 propositions based on these mechanisms. These propositions, on the one hand, provide solid starting points for further empirical research. On the other hand, they indicate that the underexposure of social context has led to an overly positive picture of emergent leadership in the current literature. They suggest that much more often than assumed so far, the wrong people become and remain leaders.

Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study

Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations.

The role of shared study space in shaping graduate students’ social networks

Purpose

The purpose of this paper is to study whether the use of a shared study space played a role in shaping graduate students’ social networks by exploring how the copresence in space was related to the structure of friendship and advice networks. The authors first proposed two concepts of spatial copresence: measured spatial-temporal copresence and perceived copresence. The authors then examined the role of copresence through a case study of a shared study space occupied by 27 graduate students in the same department.

Design/methodology/approach

Copresence relations were first constructed through a six-month room access history data set and self-reported data to examine whether measured spatial-temporal copresence was consistent with perceived copresence. Friendship and advice network relations were then analyzed with copresence, social media connections, class project collaboration relations and social homophily (nationality, gender, cohort) through quadratic assignment procedure (QAP) and MQAP analysis.

Findings

The authors found that students who used the shared study space more often reported more friendship and advice ties. The perceived copresence and the measured spatial-temporal copresence were highly correlated. Copresence relations, as measured by survey and room access history, were both significantly correlated with advice relation, which was associated with perceived social support.

Originality/value

This study contributes to the debate about whether “space” continues to play significant roles in graduate students’ social networks in the context of flexible learning environments. The results also reveal new directions for research methods in studying spatial proximity in flexible settings.

Associations of Device-Measured Sitting, Standing, and Stepping Time With Informal Face-to-Face Interactions at Work

OBJECTIVE

This cross-sectional study examined the interrelationships between workplace movement (sitting, standing, and stepping), availability of discussion space, and face-to-face (FTF) interactions between workers.

METHODS

Desk-based workers (n = 221) wore an activity monitor for 7 days and self-reported their weekly frequency of FTF interactions and discussion space availability. Negative binomial regression models examined behavioral and spatial factors associated with the frequency of FTF interactions.

RESULTS

Adjusted for potential confounders, each one standard deviation increment in time spent sitting, standing, stepping, and discussion space availability was associated with 20% lower (P = 0.004), 19% higher (P = 0.003), 6% higher (P = 0.16), and 11% higher (P = 0.26) frequency of FTF interactions, respectively CONCLUSIONS:: Lower workplace sitting was often linked to reduced risk of chronic diseases. Our findings suggest that less sitting at work may have additional benefits of increasing informal interactions between office workers.

Balancing Support for Staff and Patient Centeredness Through the Design of Immediate and Relational Space: A Case Study of Ambulatory Care Center Layouts

PURPOSE

This descriptive case study of ambulatory care center typologies builds a layout-based approach to patient-centered care and care team work using theory and methods from space syntax and a recently developed approach to floorplan analysis focused on visibility.

BACKGROUND

Calibrating support for care team work and patient centeredness is a persistent dilemma in ambulatory care settings.

METHOD

A review of literature and floorplan layout analysis are used.

RESULTS

The center-stage layout more strongly integrates staff and patients, while the onstage-offstage layout provides greater privacy to the care team. The integration values for exam rooms in each layout were roughly equivalent. Analysis of variations on each floor plan demonstrates ways relatively small variations can modulate visibility conditions without altering integration patterns.

CONCLUSION

Decoupling design of immediate visual properties and relational layout properties can act as a strategy to address competing demands.

User preferences for coworking spaces; a comparison between the Netherlands, Germany and the Czech Republic

Coworking spaces have become a central component of new work environments, with large international chains. The purpose of this study is to investigate whether user preferences for the physical workspace design are consistent across countries, which the uniformity of such chains seems to suggest. A comparison between the user preferences of coworking spaces between the Netherlands (n = 219), Germany (n = 98) and the Czech Republic (n = 79) is performed using a mixed multinomial logic model for each country. Besides statistical utility of attributes, also motivations for working in coworking spaces are analysed. The findings show that there are some consistencies in preferences across countries. Typical real estate characteristics like accessibility and contract options came forward to be the most important attributes in choosing which coworking space to work at in all three countries. However, significant differences in the desired quality levels of specifically these attributes were found between the countries as well, and only the less important attributes showed similar preferences internationally. This suggests that identical world-wide implementations of the same concept, might serve multi-nationals but possibly will not attract local users. The identified differences in preferences can help to position more specific, dedicated coworking spaces within local markets.

The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork

OBJECTIVE

This study empirically investigates the relationships between visibility attributes and both patients' and staff members' teamwork experiences.

BACKGROUND

Teamwork among healthcare professionals is critical for the safety and quality of patient care. While a patient-centered, team-based care approach is promoted in primary care clinics, little is known about how clinic layouts can support the teamwork experiences of staff and patients in team-based primary clinics.

METHODS

This article measured teamwork perceptions of staff members and patients at four primary care clinics providing team-based care. Visual access to staff workstations from both staff and patient perspectives was analyzed using VisualPower tool(version 21). The relationships between teamwork perception and visibility attributes were analyzed for each entity: staff members and patients.

RESULTS

The results showed that the visual relationships among staff members and those between staff members and patients have significant associations with overall perceptions of teamwork. While clinics providing more visual connections between staff workstations reported higher teamwork perception of staff members, patient perceptions of staff teamwork were inversely related to the number of visual connections between patients and staff workstations.

CONCLUSIONS

The findings of the study provide implications for designing team-based primary care clinics to enhance the teamwork experience of both staff members and patients, which is also applicable to teamwork perceptions in other settings where both inhabitants and visitors are main user groups of the spaces. This study illustrates the representational function of space: Organizations can emphasize their values via layout design by regulating what they show to inhabitants or visitors.

Understanding knowledge exchange processes among diverse users of coworking-spaces

Purpose

Coworking spaces use the idea of spatial co-location that improves communication and knowledge sharing among independent knowledge professionals. Fluid work structures and a sense of community can facilitate work satisfaction, creativity and entrepreneurship. Fundamentals to those positive outcomes are the knowledge sharing processes between users of coworking spaces. The purpose of this study is to explore the knowledge sharing processes in this setting where researchers still have very little understanding.

Design/methodology/approach

Based on an inductive research methodology, qualitative data were collected through observations and interviews with a variety of users (including freelancers, entrepreneurs and firms) incumbent in various coworking spaces in Germany.

Findings

Co-location of individuals in coworking spaces is first about physical proximity and second about socialization and collaboration opportunities, which then advance cognitive proximity. Thus, co-location can facilitate tacit knowledge exchange, ignite the social disembodiment of ideas, synthesize domain-related knowledge sharing and promote inter-domain learning. The institutionalization of knowledge management services will allow coworking spaces to increase these positive outcomes.

Practical implications

Findings of this study are interesting for managers of shared spaces and traditional firms that use spatial co-location. The authors propose institutionalized knowledge management services to enable multifaceted and multidisciplinary knowledge creation in organizations.

Originality/value

This paper sheds light on the role of spatial co-location in knowledge sharing processes among independent knowledge professionals in shared office spaces. Thereby, this study provides valuable insights into a phenomenon that has received little attention even though its practical importance is high.

The Influence of Visibility on Medical Teamwork in Emergency Departments: A Mixed-Methods Study

AIM

This mixed-methods study delivers empirical evidence on the influence of visibility on healthcare teamwork in Emergency Departments (EDs). This study researchers hypothesized that with changes of visibility in EDs, teamwork among medical staff members will be impacted.

BACKGROUND

Prior research results suggest that visibility can influence health-setting efficacy. Teamwork is one of the components of each healthcare system that can be supported by environmental design.

METHOD

Visibility in four subject sites from the same healthcare system was objectively measured by morphology plan analyses. Teamwork among medical staff members was the behavioral variable of interest and explored through field observations, interviews, and surveys.

RESULTS

The qualitative outcomes demonstrated that teamwork can be enhanced by improved visibility, while the quantitative findings supported the idea that some specific measures of visibility were correlated with teamwork.

CONCLUSION

This study provides a model for future research on the association between healthcare staff behavior and ED plan configuration. The enhancement of ED design, considering the significance of visibility, enhances the perceptions of nurses and physicians in terms of teamwork.

Location choices of face-to-face interactions in academic buildings: an experience sampling approach

Although it is recognised that face-to-face interactions are important for sharing interests and (new) knowledge, it remains unknown how and where students and university employees interact in academic buildings. Therefore, the aim of this study is to analyse the location choice for face-to-face interactions in an academic building, including several personal- and interaction characteristics. An Experience Sampling Method (ESM) was used to collect data on 643 face-to-face interactions during two weeks in the Flux building at Eindhoven University of Technology, the Netherlands. In general, students more often interacted in meeting rooms than teaching staff, and support staff interacted less in eat/drink areas and the hallways than other users. Unexpectedly, some of the lectures took place outside of traditional project-/lecture space. Real estate managers of university campuses could use these results to create better interactive work environments that stimulate face-to-face interactions among employees and students of different departments. Practitioner Summary: Based on longitudinal data of ftf interactions among students and employees in an academic building, results showed that ftf interaction characteristics, compared to personal characteristics, are most important for explaining the location choice of interactions. These insights could help to design academic work environments that optimise the support of interactions. Abbreviation: ABO: activity-based office; ANOVA: analyses of variance; ESM: experience sampling method; FTF: face-to-face; HR: human resources; MMNL: mixed multinomial logit model; NewWoW: new ways of working.

Activity-based flexible office

Purpose

Corporations balancing real estate holding (CRE) costs with recruitment-retention increasingly use activity-based flexible offices (AFO) to right-size environments for a mobile workforce. In this layout, workers have the option to select between a mix of unassigned workstations and alternative work settings (AWS) that support autonomy and mobility. The open layout encourages visibility and access to colleagues to enhance communication and collaboration. Nevertheless, studies into the effects of AFO environment attribute effects on worker needs and work outcome are sparse. Therefore, this study aims to focus on understanding how environmental features and psychological or job needs impact observed and perceived satisfaction, communication, collaboration and perceived productivity.

Design/methodology/approach

Data were collected in a case organization piloting an AFO before implementation across their CRE portfolio. A mixed-methods approach was used, including systematic observations, space syntax and surveys collecting information on the observed and perceived satisfaction, communication, collaboration and productivity.

Findings

Collaboration instances were higher in AWS, especially more visible and accessible open areas, supporting higher impromptu interactions and enhanced perceptions of productivity of team members and cross-team members. Privacy requirements linked to a greater demand for enclosed AWS. Team communication satisfaction depended on how easily teams were located. Almost half of the user teams clustered within workstation zones corresponding to territoriality needs. Job autonomy satisfaction depended on the availability of preferred workstation or AWS, enabling private, uninterrupted work that enhanced perceived productivity.

Practical implications

The case study findings indicated a correlation between the AFO environment and worker needs impacting workplace satisfaction, communication, collaboration and perceived productivity.

Originality/value

The findings form this case study indicated that a fit between the AFO environment and needs impacted workplace satisfaction, communication, collaboration and perceived productivity.

Measuring Interpersonal Visual Relationships in Healthcare Facilities: The Agent Visibility Model and SAVisualPower Tool

Visibility has a significant impact on health-related outcomes and experiences of users in healthcare settings. Built environments determine interpersonal visual relationships between users and control their ability to see (or be seen by) others. Despite this importance, metrics that fully and precisely describe these interpersonal visual relationships are lacking. In this article, we introduce the Agent Visibility Analysis Model and the SAVisualPower software, which enable person-centric visibility analysis for quantifying visual relationships both among users and between users and visual targets. The model precisely captures users' visibility by reflecting the orientation of users and by differentiating visual contents of the users-space, other users, and targets. By providing practical examples of the new model using layouts from previous studies, this article describes specific visibility metrics that can be analyzed by the new tool and how the tool can be applied to design and research in healthcare settings for improved user experiences.

Visitors’ use of corridors in internal medicine wards

Purpose

This paper aims to analyze visitors’ waiting behavior in corridors of an internal medicine ward in relation to concepts of territoriality and privacy.

Design/methodology/approach

Waiting activities, visitors’ room numbers and duration of activities were recorded on a floor plan. Results were tallied according to behavioral and architectural zones in which the activity took place.

Findings

Locations that are near patient rooms that provide visual and auditory access are largely used as territorial areas for non-privacy-required activities. Ends of corridors, secondary corridors and staircases were mainly used for activities that required some level of privacy such as grieving.

Research limitations/implications

As is true with post-occupancy evaluations in other single buildings, this research may not be generalizable to all internal medicine wards. Future research could measure whether responding to visitors’ spatial needs could result in lower density and sense of crowding in the corridors, as well as reduce stress and task interruptions and increase efficiency of patient-check rounds.

Practical implications

The findings indicate that internal medicine wards should include waiting areas near the patient rooms for visitors to be able to keep visual and auditory connection with their patients, as well as areas that provide privacy. This may help lower density, sense of crowding, distraction of medical staff, stress and burn-out and errors, as well as increase the efficiency of patient checks.

Originality/value

The ways in which architectural design of internal medicine corridors can support visitors’ activities and environmental needs such as territoriality and privacy is an issue that is rarely examined. This paper also adds an example from a non-Western culture, to a literature that is dominated by examples from Western cultures.

Who talks to whom about what? How interdisciplinary communication and knowledge of expertise distribution improve in integrated R&D labs

Although several studies have examined the impact of open workspaces, there is still an on-going debate about its advantages and disadvantages. Our paper contributes to this debate by shedding light on three issues: the effect of open workspaces on (1) the flow of communication along and across hierarchical lines; (2) the content of communication; and (3) the specificities of open integrated laboratories. Our findings derive from a longitudinal case in a large pharmaceutical company that has relocated some R&D teams from enclosed to multi-space offices and labs. The relocation has resulted in (a) increased interdisciplinary communication, particularly at lower hierarchical levels, (b) a shift of the location of discussions and the content of conversations and (c) an improved knowledge about expertise distribution. Practitioner Summary: Communication is essential in knowledge-driven organisations. This article examines the impact of a relocation of R&D employees from enclosed to multi-space offices and labs on communication patterns. We explain how the new environment fosters interdisciplinary communication, shifts the location of discussions and increases the knowledge of expertise distribution.

Ecological Influences on Employees' Workplace Sedentary Behavior: A Cross-Sectional Study

PURPOSE

The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB).

DESIGN

Cross-sectional online survey.

SETTING

Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016.

PARTICIPANTS

The final sample included 527 (56% response rate) employees.

MEASURES

Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate.

ANALYSIS

One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB.

RESULTS

Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model.

CONCLUSION

Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.

The Impact of Environmental Design on Teamwork and Communication in Healthcare Facilities: A Systematic Literature Review

The purpose of this systematic review is to investigate the current knowledge about the impact of healthcare facility design on teamwork and communication by exploring the relevant literature. Teamwork and communication are behavioral factors that are impacted by physical design. However, the effects of environmental factors on teamwork and communication have not been investigated extensively in healthcare design literature. There are no published systematic reviews on the current topic. Searches were conducted in PubMed and Google Scholar databases in addition to targeted design journals including Health Environmental Research & Design, Environment and Behavior, Environmental Psychology, and Applied Ergonomics. Inclusion criteria were (a) full-text English language articles related to teamwork and communication and (b) involving any healthcare built environment and space design published in peer-reviewed journals between 1984 and 2017. Studies were extracted using defined inclusion and exclusion criteria. In the first phase, 26 of the 195 articles most relevant to teamwork and 19 studies of the 147 were identified and reviewed to understand the impact of communication in healthcare facilities. The literature regarding the impact of built environment on teamwork and communication were reviewed and explored in detail. Eighteen studies were selected and succinctly summarized as the final product of this review. Environmental design, which involves nurses, support staff, and physicians, is one of the critical factors that promotes the efficiency of teamwork and collaborative communication. Layout design, visibility, and accessibility levels are the most cited aspects of design which can affect the level of communication and teamwork in healthcare facilities.

Social ecological correlates of workplace sedentary behavior

Background

To identify social ecological correlates of objectively measured workplace sedentary behavior.

Methods

Participants from 24 worksites - across academic, industrial, and government sectors - wore an activPAL-micro accelerometer for 7-days (Jan-Nov 2016). Work time was segmented using daily logs. Sedentary behavior outcomes included time spent sitting, standing, in light intensity physical activity (LPA, stepping cadence <100 steps/min), and in prolonged sitting bouts (>30 min). Outcomes were standardized to an 8 h work day. Two electronic surveys were completed to derive individual (job type and work engagement), cultural (lunch away from the desk, walking at lunch and face-to-face interaction), physical (personal printer and office type) and organizational (sector) factors. Mixed-model analyses with worksite-level clustering were performed to examine multi-level associations. Secondary analyses examined job type and sector as moderators of these associations. All models were adjusted for age, race/ethnicity and gender.

Results

Participants (N = 478; 72% female; age: 45.0 ± 11.3 years; 77.8% non-Hispanic white) wore the activPAL-micro for 90.2 ± 15.5% of the reported workday. Walking at lunch was positively associated with LPA (5.0 ± 0.5 min/8 h, P < 0.001). Regular face-to-face interaction was negatively associated with prolonged sitting (−11.3 ± 4.8 min/8 h, P < 0.05). Individuals in private offices sat more (20.1 ± 9.1 min/8 h, P < 0.05), stood less (−21.5 ± 8.8 min/8 h, P < 0.05), and engaged in more prolonged sitting (40.9 ± 11.2 min/8 h, P < 0.001) than those in public office space. These associations were further modified by job type and sector.

Conclusions

Work-specific individual, cultural, physical and organizational factors are associated with workplace sedentary behavior. Associations vary by job type and sector and should be considered in the design of workplace interventions to reduce sedentary behavior.

Trial registration

Clinical trial No. NCT02566317; Registered Sept 22nd 2015.

Patient visibility and ICU mortality: a conceptual replication

OBJECTIVE

This study reanalyzes the data from a study by Leaf, Homel, and Factor (2010) titled "Relationship between ICU Design and Mortality" by adopting and developing objective visibility measures.

BACKGROUND

Various studies attribute healthcare outcomes (patient falls, satisfaction) to a vague notion of patient room visibility. The study by Leaf and colleagues was the first to draw an independent association between patient mortality and patient room visibility, however "visibility" remains imprecise.

METHODS

The original patient dataset was obtained from Dr. Leaf. The 664 patient sample assigned across 12 rooms at the medical ICU at Columbia University Medical Center was reanalyzed in terms of targeted visibility; the unit of analysis was the room, n = 12. Several computer-based visibility measures of patient rooms were used: patient head visibility, patient room visibility, and field of view to nursing station. Patient head visibility was defined as the percentage of area within the central nursing station from which the patient head could be seen; patient room visibility was defined as the percentage of area within the central nursing station that could see the patient room (average value of all patient room grids); field of view was defined as the maximum viewing angle from the patient head to the central nursing station.

RESULTS

Among the sickest patients (those with Acute Physiology and Chronic Health Evaluation II > 30), field of view accounted for 33.5% of the variance in ICU mortality, p = 0.049.

CONCLUSIONS

Subtle differences in patient room visibility may have important effects on clinical outcomes.

KEYWORDS

Case study, critical care/intensive care, methodology, outcomes.

Attending a workplace: its contribution to volume and intensity of physical activity

Understanding the contribution that attending a workplace has in accumulating physical activity (PA) may help inform strategies used to increase PA. This study explores the influence that attending work has on the total number of steps taken and the time spent in moderate to vigorous activity (MVPA). A global position system (GPS) was used to identify the geographical domain of the participant. An activity monitor (activPAL, PALtechnologies Ltd, Glasgow, UK) was employed to measure the number of steps taken and the cadence of those steps. Both devices were worn for seven consectutive days and 5 work days extracted post data collection. The data from the two devices were synchronised allowing domain, volume and intensity of PA to be explored. The distance from the home domain to the workplace was used to establish if there was any relationship between commute distance and number of steps accumulated and time in MVPA. Twenty-six office workers (17F; mean age 38 (range 23-65)) were recruited. The number of steps taken per day on average for the group was 11 008 (SD  ±  2999) with time spent in MVPA per day being 32.7 (SD  ±  17.1) min. The commute accounted for 32% or 3550 (SD  ±1664) of the steps taken and 68% or 22.0 (SD  ±14.1) min of MVPA. No statistically significant correlations with distance from home to the workplace for either variable were found. This work explores the contribution that attending work makes to PA, combining data from a GPS system and an objective activity monitor. The commute to works accounts for more than two-thirds of the MVPA accumulated per day. This provides meaningful in sight into the volume and intensity of individuals' activity and also its context.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature

Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.

The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff

BACKGROUND

Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members.

METHODS

A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemar's tests were used to analyze changes in survey indices and interview data were coded for themes.

RESULTS

The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features.

CONCLUSIONS

We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space.

Developing nurse and physician questionnaires to assess primary work areas in intensive care units

The objective of the study was to develop instruments for describing and assessing some aspects of design of the primary work areas of nurses and physicians in intensive care units (ICUs). Separate questionnaires for ICU physicians and nurses were developed. Items related to individual- and unit-level design features of the primary work areas of nurses and physicians were organized using constructs found in the literature. Items related to staff satisfaction and staff use of time in relation to primary work area design were also included. All items and constructs were reviewed by experts for content validity and were modified as needed before use. The final questionnaires were administered to a convenience sample of 4 ICUs in 2 large urban hospitals. A total of 55 nurses and 29 physicians completed the survey. The Cronbach α was used to measure internal consistency, and factor analysis was used to provide construct-related validity. Convergent and discriminant validity were assessed through examining bivariate correlations between relevant scales/items. Analysis of variance was used to identify whether the between-group member responses were significant among the 4 units. The Cronbach α values for all except 3 preliminary scales indicated acceptable reliability. Factor analysis indicated that some preliminary scales could be partitioned into subscales for finer descriptions of the primary work areas. Correlational analysis provided strong evidence of convergent and discriminant validity of all the scales and subscales. The significance level of F-statistics showed that the units were significantly different from each other, providing evidence of more between-unit variance than within-unit variance. Therefore, the questionnaires developed in the study offer a promising departure point for rigorous description and evaluation of the primary work areas in relation to staff satisfaction and use of time in ICUs at a time when the importance of such studies is growing.

Field observations into the environmental soul: spatial configuration and social life for people experiencing dementia

This article focuses on the important, facilitating role architectural design plays in social interaction within long-term care facilities (LTCFs) serving people with dementia. Here, we apply space syntax, a set of theories and techniques for the analysis of spatial configurations, as an objective measure of environmental characteristics. Almost 150 rounds of behavioral observations were collected in the social spaces of 3 LTCFs. Using the visibility and proximity metrics of space syntax, the locations of occurrence of various social activities in relation to the furniture and spatial layout on architectural floor plans have been identified. The results did not confirm the space syntax hypothesis that spaces with greater visibility and proximity promote more social interaction. Further analysis revealed that when in settings with better visibility and accessibility, the residents were more likely to engage in low levels of interaction. High-level social interactions actually were more likely to occur in settings providing greater privacy (eg, less visibility and accessibility). The findings suggest an important nuance that architectural configuration factors impact not only the likelihood but also the type of conversations likely to occur in certain locations. This would have implications for both design and staff training on how best to utilize social spaces for therapeutic effect, particularly within the context of person-centered care.

Hospital design and face-to-face interaction among clinicians: a theoretical model

A growing body of literature suggests that face-to-face interaction among clinicians in hospitals affects patient outcomes. How can face-to-face interaction among clinicians be influenced positively to improve patient outcomes in hospitals? So far, most strategies for improving face-to-face interaction in hospitals have focused on changing organizational culture. In contrast, this paper proposes a theoretical model that shows how spatial program and structure can help face-to-face interaction fulfill its purposes in hospitals by controlling the interfaces among different communities of clinicians.

Application of Space Syntax Theory in the Study of Medical-Surgical Nursing Units in Urban Hospitals

Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals.

Background:

The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes ( Bureau of Labor Statistics, 2009 ; Clarke, 2007 ; Clarke & Donaldson, 2008 ; Institute of Medicine, 2000 ; Institute of Medicine, 2004 ). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication.

Methods:

This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users.

Results:

The use of space syntax theory for analyzing medical-surgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs.

Conclusions:

Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare. The findings of this study suggest that further exploration is needed to confirm this theory's application to healthcare environments.

Lost in Translation: Bridging Gaps between Design and Evidence-Based Design

The healthcare design community is adopting evidence-based design (EBD) at a startling rate. However, the role of research within an architectural practice is unclear. Reasons for the lack of clarity include multiple connotations of EBD, the tension between a research-driven market and market-driven research, and the competing expectations and standards of design practitioners and researchers. Research as part of EBD should be integral with the design process so that research directly contributes to building projects. Characteristics of a comprehensive programming methodology to close the gap between design and EBD are suggested.