Hospital design: Understanding implications for work practices, care quality and patient safety

New hospital developments claim to be anchored in ‘evidence based’ design yet the evidence is often conflicting; little is understood about the implications of hospital design for staff efficiency and quality of care, and there is limited research applying a ‘whole system’ approach to the patient care environment. This paper argues that work practices, care quality and patient safety on acute hospital wards are influenced by more than ward design alone. Ward design is one component in a complex system also comprising operational and social processes, culture, leadership, teamwork and equipment and technology. In order to understand how potential design benefits are realised (for example, surveillance capability in Nightingale wards), it is important to understand all elements of the system within which the ward is situated.