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.