The healthcare workspace: Understanding the role of decentralized nursing stations, corridors, and huddle spaces as locations for teamwork in a neonatal intensive care unit

Why does this study matter?
While it’s known that decentralization improves caregiving efficiency, it has also negatively influenced teamwork among caregivers. The authors of this study leveraged the transition of a NICU from an open-bay to single-family rooms to evaluate the room design, note differences in collaboration among caregivers between the two layouts, and evaluate the use of decentralized nursing stations, corridors, and huddle stations on multidisciplinary care activities in the new unit. 

Generally speaking, the original unit was an open bay layout with nine multi-bed pods and the new NICU had six 12-room neighborhoods. The original unit had a single centralized nursing station and no designated huddle stations and the new unit was equipped with 36 decentralized nursing stations and six designated huddle stations.

How was the study done?
All NICU service line staff were invited to complete surveys both before and after the move to the new unit. Survey data were analyzed to identify differences in perceptions of teamwork stress well-being job satisfaction and design satisfaction before and after the move. Descriptive analyses were conducted to summarize individual item results. 

One year after the move, researchers used six trained observers to record face-to-face communication at the decentralized nursing stations, huddle stations and corridors. Observers noted communication participants by role (MD/residents, nurses, technicians, therapists, family members, and other badged staff), but the content of the conversations was not considered pertinent for the purposes of this study. Observational data were initially assessed regarding communication: specifically, the frequency of conversations and which professions participated in them. Secondly, the data was assessed to figure out who used which spaces the most. Finally, observations were assessed to determine the use across locations and among professions.      

So what do we learn from the study?
In general, survey respondents demonstrated statistically significant improvements in their perceptions of job satisfaction, well-being, and design satisfaction in the new unit but they had lower perceptions of teamwork albeit not statistically significant. 

Analysis of 40-hours of observations in the new unit indicated 54% of communication occurred at the decentralized nursing stations, 46% in corridors and 18% in huddle stations with some interactions crossing locations. Interestingly, when two or more professions were involved in the conversation,   37% of communication occurred at the decentralized nursing stations, 44% in corridors and 51% in huddle stations suggesting that huddle stations contribute to multidisciplinary collaboration. Communication in huddle stations averaged 2-3 individuals, but sometimes included as many as 12. Further, nursing staff were involved in conversations 80% of the time and frequently engaged in cross-location conversations between the decentralized nursing station and the corridor. In this study, corridors were important areas for collaboration and as such should be intentionally designed to support care collaboration as well as care delivery, but in such a way as to support patient confidentiality.

Can we say the results are definitive?
There are a few limitations for consideration. First, there were no statistical details on the survey or observational tools used despite both being described as piloted to ensure reliability and validity. Secondly, it was not clear if the post-move survey was 1-year after the move or just the observations. Additionally, no information about the shifts observed or surveyed was included, and there was no indication of how many individuals from different professions responded to the survey. Finally, this was limited to a NICU transition within a single academic facility.

What’s the takeaway?
Professional collaboration is an essential component of comprehensive patient care, especially in critical care units such as NICUs. This study demonstrates that when a NICU transitioned to a new unit layout, multiple disciplines made use of the decentralized nursing stations, huddle spaces and larger corridors provided. Although the authors did not include information on how specific disciplines perceived or used the different areas, this work informs the industry on the importance of supporting multidisciplinary collaboration through design. Studies to better understand the impact of various decentralized and collaboration spaces specific to registered nurses who typically spend over 12-hours on the units would be informative as would information regarding the impact on the work of other distinct professions.   

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Summary of:
Fay, L., Real, K., & Haynes, S. (2022). The Healthcare Workspace: Understanding the Role of Decentralized Nursing Stations, Corridors, and Huddle Spaces as Locations for Teamwork in a Neonatal Intensive Care Unit. HERD: Health Environments Research & Design Journal, 15(4), 270–282. https://doi.org/10.1177/19375867221106503

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