Talk for seminar 'Building Blocks for Clinicians', 8 June 2018, held at Murphy Philips architects, London

1. How design affects communication Sailer, June 2018@kerstinsailer
How Design Affects Communication
and Clinical Workflows
Dr Kerstin Sailer
Reader in Social and Spatial Networks
Bartlett School of Architecture, UCL
Building Blocks for Clinicians, Murphy Philipps Architects, London, 8 June 2018

2. How design affects communication Sailer, June 2018
The Relationship between Architecture and Human Behaviour
Embedded and embodied experience

3. How design affects communication Sailer, June 2018
The Role of the Built Environment
What we see
Where we go
Who we meet
Who we interact with
How we perceive the world
Embedded and embodied experience

4. How design affects communication Sailer, June 2018
Space Syntax: Analysis of layouts and experience
Spatial configuration:
The way in which spatial elements are
put together to form an interconnected
system of spaces
(Hillier1996)

5. How design affects communication Sailer, June 2018
Space Syntax: Analysis of layouts and experience
Different overall configurations create different experiences
Sequence Grid
Tate Modern British Museum

6. How design affects communication Sailer, June 2018
text
Regular grid to create isovists
Floor plan Syntax model:
Strategic visibility
IntegratedSegregated
Space Syntax: Analysis of layouts and experience

7. How design affects communication Sailer, June 2018
Example 1
Hospital in Netherlands
(and Canada)

8. How design affects communication Sailer, June 2018
Example 1: Hospital in Netherlands
Newly built hospital in 2010: “integration of new technologies that put the patient first”;
building that supports new care concept and general sense of wellbeing

9. How design affects communication Sailer, June 2018
A Tale of Two Hospitals
Hospital A: small town in Netherlands;
new built hospital (2010), open
layout, ‘knowledge centre’
Hospital B: large city in Canada;
built in phases (since 1912);
tower; corridor layout

10. How design affects communication Sailer, June 2018
Hospital A – Knowledge Centre
Entrance lobby Waiting Exam rooms

11. How design affects communication Sailer, June 2018
Entrance lobby Exam Rooms
Hospital B – Corridor Layout
WaitingReception

12. How design affects communication Sailer, June 2018
Research Questions
How are spatial practices
embedded in and shaped
by the layout?
What affordance does the
layout provide for care
processes?
How much do work activities
in out-patient clinics
resemble each other or
differ?
Can potential differences be
explained by spatial
configuration?

13. How design affects communication Sailer, June 2018
Data: Shadowing Caregivers
12 different caregivers (6 doctors, 4 nurses, 2 clerks) shadowed in each clinic; total time
of 90 hours in hospital A (activities n=5350) and 85 hours in hospital B (n=2890)

14. How design affects communication Sailer, June 2018
The Spatial Layout of the Clinics
HOSPITAL B [CA]
Av CONN: 140
Av MD: 2.99
HOSPITAL A [NL]
Av CONN: 491, av MD: 2.19
5 out-patient clinics investigated in
each case; example: Cardiology

15. How design affects communication Sailer, June 2018
Differences in Care ProcessesHOSPITALA[NL]HOSPITALB[CA]
Cardiology Orthopedics
Immunodeficiency
Internal Medicine Pulmonology Surgery
Care processes differ from clinic to clinic, but more similarity within hospital than within
speciality

16. How design affects communication Sailer, June 2018
Differences in Care Processes
Mean duration of all activities
Hospital A Hospital B
Mean duration of communication among caregivers
Hospital A Hospital B
All differences highly significant in t-test / ANOVA (p<0.0001**)
61.2 sec 106.2 sec
47.8 sec 81.6 sec
Cardiology 58.1 sec
69.2 sec
34.9 sec
57.7 sec
40.0 sec
90.8 sec
96.6 sec
97.2 sec
57.3 sec
60.6 sec
Internal Medicine
Orthopedics
Pulmonology
Surgery
Cardiology
Internal Medicine
Immunodeficiency
Pulmonology
Surgery

17. How design affects communication Sailer, June 2018
Activities Embedded in Spatial Layouts
Clinics with highest integration tend to have shorter duration of activities (R2=0.52, p<0.0183*)
→ dynamic work processes supported by configuration
In
PuCa
Su
Or
In
Im Ca
Su
Pu

18. How design affects communication Sailer, June 2018
Hospital A
Space creates opportunities for communication
HOSPITALB[NL]
64%
31%
26%
36%
69%
74%
0% 20% 40% 60% 80% 100%
Charting Galley
Corridor
Exam
unintentional intentional
Location of
communication
Unintentional= 44%
Intentional= 56%
Intentional
Unintentional
Physicians
Nurses
Clerks

19. How design affects communication Sailer, June 2018
Example 2
Comparative study of
three NHS hospital ICUs
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture

20. How design affects communication Sailer, June 2018
Example 2: Study of three NHS ICU wards
UCLH NHNN CW
Racetrack layout
Max: 5.1 Ave: 3.3 Min: 2.1 SD: 0.59
Duplex layout
Max: 5.1 Ave: 3.3 Min: 2.3 SD: 0.48
Corridor layout
Max: 4.2 Ave: 2.5 Min: 1.7 SD: 0.57
MeanDepth(strategicvisibility)
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture
Connectivity(localvisibility)

21. How design affects communication Sailer, June 2018
Example 2: Study of three NHS ICU wards
UCLH NHNN CW
Racetrack layout
Max: 5.1 Ave: 3.3 Min: 2.1 SD: 0.59
Duplex layout
Max: 5.1 Ave: 3.3 Min: 2.3 SD: 0.48
Corridor layout
Max: 4.2 Ave: 2.5 Min: 1.7 SD: 0.57
MeanDepth(strategicvisibility)
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture
Connectivity(localvisibility)

22. How design affects communication Sailer, June 2018
Example 2: Study of three NHS ICU wards
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture
Racetrack layout Duplex layout Corridor layout
time is spent in f2f conversations
Racetrack
53%
Duplex
55%
Corridor
39%
f2f conversations less than a minute long 81% 81% 89%
conversations in pairs 76% 73% 78%
Face-to-face conversations

23. How design affects communication Sailer, June 2018
Example 2: Study of three NHS ICU wards
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture
Racetrack layout Duplex layout Corridor layout
Connections between room types – from observations
linkweight - number of times the healthcare
professionals went from one space to the other
node size - time spent in the space

24. How design affects communication Sailer, June 2018
Example 2: Study of three NHS ICU wards
Work by Rosica Pachilova, PhD candidate at Bartlett School of Architecture
Comparison between layout types
RACETRACK DUPLEX CORRIDOR

25. How design affects communication Sailer, June 2018
Robin
Evans
“If anything is described
by an architectural plan,
it is the nature of human
relationships.”
Evans (1997): Figures, Doors and Passages

26. How design affects communication Sailer, June 2018
Dr Kerstin Sailer
Reader in Social and Spatial Networks
Space Syntax Laboratory
Bartlett School of Architecture, UCL
22 Gordon Street
London WC1H 0QB
United Kingdom
Thank you!
k.sailer@ucl.ac.uk
@kerstinsailer
http://spaceandorganisation.org/
http://tinyurl.com/ksailer