Interaction of nursing efficiency and spatial design in different departments: An agent-based modeling approach

Abstract

The spatial design of nursing units can significantly enhance nurses' work efficiency. However, existing studies primarily focus on optimizing space for individual department, often overlooking the diverse spatial needs of different departments due to variations in work content. In this study, questionnaires were collected from 456 nurses across five departments of nursing units in 14 general hospitals, and semi-structured interviews and behavioral observations were conducted in the same five departments of nursing units in one hospital to assess spatial design and work efficiency, thus evaluating the impact of specialized design on departmental performance. Additionally, agent-based modeling (ABM) was utilized to simulate nursing efficiency in each department, comparing spatial arrangements before and after optimization by simulating nurses' behaviors. Results indicated obvious differences in spatial needs among departments, suggesting that standardized nursing unit designs fail to meet specific departmental needs, resulting in low satisfaction of nurses. Adjusting the spatial environments of nursing units based on departmental differences can improve efficiency. This study proposes optimization strategies for the spatial environments of nursing units in different departments, aiming to enhance nursing efficiency, job satisfaction, and reduce occupational stress.

Keywords

Agent-based modeling / Nursing units / Specialty diversification / Efficiency optimization

References

[1] Annells, M. , 2007. Where does practice nursing fit in primary health care? Contemp. Nurse 26, 15- 26.

[2] Baraki, Z. , Girmay, F. , Kidanu, K. , Gerensea, H. , Gezehgne, D. , Teklay, H. , 2017. A cross sectional study on nursing process implementation and associated factors among nurses working in selected hospitals of central and northwest zones, Tigray region, Ethiopia. BMC Nurs. 16, 54.

[3] Blibli, M. , Bouchair, A. , 2023. Contribution of numerical simulation to the study of pedestrian mobility in the context of COVID-19: case of a university campus in Algeria. Archit. Sci. Rev. 66, 271- 292.

[4] Boyle, D.K. , Miller, P.A. , Gajewski, B.J. , Hart, S.E. , Dunton, N. , 2006. Unit type differences in RN workgroup job satisfaction. West. J. Nurs. Res. 28, 622- 640.

[5] Carta, S. , Loe, S.S. , Turchi, T. , Simon, J. , 2020. Self-organising floor plans in care homes. Sustainability 12 (11), 4393.

[6] Cima, R.R. , Brown, M.J. , Hebl, J.R. , Moore, R. , Rogers, J.C. , Kollengode, A. , Amstutz, G.J. , Weisbrod, C.A. , Narr, B.J. , Deschamps, C. , 2011. Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiarycare academic medical center. J. Am. Coll. Surg. 213, 83- 92.

[7] Combrink, A. , Johnson, D. , Moldan, P. , Fabian, M. , 2024. Discreteevent based patient flow simulation of an emergency surgery department. 2024 10th International Conference on Control, Decision and Information Technologies (CoDIT), pp. 1243-1248.

[8] Craswell, A. , Bennett, K. , Dalgliesh, B. , Morris-Smith, B. , Hanson, J. , Flynn, T. , Wallis, M. , 2020. The impact of automated medicine dispensing units on nursing workflow: a crosssectional study. Int. J. Nurs. Stud. 111, 103773.

[9] Cuevas-Santos, C. , 2019. Nursing specialities and professional practice: current situation and future perspectives. Enfermería Clínica (English Edition) 29, 357- 363.

[10] Deng, Q. , Jiao, C. , Wang, G. , Song, X. , Zang, J. , 2023. A study on the layout of hospital ward buildings in cold regions of China based on the efficiency of nurse rounds. Buildings 13 (6), 1399.

[11] Diana, L. , D'Auria, S. , Acampa, G. , Marino, G. , 2022. Assessment of disused public buildings: strategies and tools for reuse of healthcare structures. Sustainability 14, 2361.

[12] Disch, J. , 2006. Clinical microsystems: the building blocks of patient safety. Creat. Nurs. 12, 13- 14.

[13] 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 15, 270- 282.

[14] Fu, M. , Kurnat-Thoma, E.L. , Starkweather, A. , Henderson, W. , Cashion, A. , Williams, J.K. , Katapodi, M. , Reuter-Rice, K. , Hickey, K. , Mendoza, V.B. , de, Calzone, K. , Conley, Y. , Anderson, C. , Lyon, D. , Weaver, M. , Shiao, P. , Constantino, R. , Wung, S. , Hammer, M. , Voss, J. , Coleman, B. , 2019. Precision health: a nursing perspective. Int. J. Nurs. Sci. 7, 5- 12.

[15] Gaba, D. , 2004. The future vision of simulation in health care. Qual. Health Care 13, 10- 12.

[16] González Chordá V.M. , 2024. Precision nursing and personalized care. Enfermería Clínica (English Edition) 34, 1- 3.

[17] Gutiérrez-Rodríguez, L. , García Mayor, S. , Cuesta Lozano, D. , Burgos-Fuentes, E. , Rodríguez-Gómez, S. , Sastre-Fullana, P. , De Pedro-Gómez, J.E. , Higuero-Macías, J.C. , Pérez-Ardanaz, B. , Morales-Asencio, J.M. , 2019. Competences of specialist nurses and advanced practice nurses. Enfermería Clínica (English Edition) 29, 328- 335.

[18] Hassmiller, S.B. , Wakefield, M.K. , 2022. The future of nursing 2020-2030: charting a path to achieve health equity. Nurs. Outlook 70, S1eS9.

[19] Hooper, V. , 2023. Nurse-patient ratios: the big debate continues. J. PeriAnesthesia Nurs. 38, 679- 680.

[20] Jones, C.B. , Kim, S. , McCollum, M. , Tran, A.K. , 2024. New insights on a recurring theme: a secondary analysis of nurse turnover using the national sample survey of registered nurses. Nurs.Outlook 72, 102107.

[21] Kang, F. , Liu, D. , Mao, Y. , Li, L. , Li, Y. , 2018. Research on performance assessment of nursing workload in hospital. Chin. Nurs.Res. 753-759.

[22] Katsaliaki, K. , Mustafee, N. , 2011. Applications of simulation within the healthcare context. J. Oper. Res. Soc. 62, 1431- 1451.

[23] Khudyakov, A. , Jean, C. , Jankovic, M. , Cardinal, J. , Bocquet, J. , 2013. Simulation Methods in the Healthcare Systems, pp. 141-149.

[24] Kimbrough, C.W. , McMasters, K.M. , Canary, J. , Jackson, L. , Farah, I. , Boswell, M.V. , Kim, D. , Scoggins, C.R. , 2015. Improved operating room efficiency via constraint management: experience of a tertiary-care academic medical center. J. Am. Coll.Surg. 221, 154- 162.

[25] Kutney-Lee, A. , McHugh, M.D. , Sloane, D.M. , Cimiotti, J.P. , Flynn, L. , Neff, D.F. , Aiken, L.H. , 2009. Nursing: a key to patient satisfaction: patients' reports of satisfaction are higher in hospitals where nurses practice in better work environments or with more favorable patient-to-nurse ratios. Health Aff. 28, w669-w677.

[26] Lee, J. , Lee, H. , Shepley, M.M. , 2020. Exploring the spatial arrangement of patient rooms for minimum nurse travel in hospital nursing units in Korea. Frontiers of Architectural Research 9, 711- 725.

[27] Liu, Y. , Zhou, Y. , Yang, L. , Xin, Y. , 2024. Simulating staff activities in healthcare environments: an empirical multi-agent modeling approach. J. Build. Eng. 84, 108580.

[28] Lucero, R.J. , Lake, E.T. , Aiken, L.H. , 2009. Variations in nursing care quality across hospitals. J. Adv. Nurs. 65, 2299- 2310.

[29] Mayer, M.L. , Cockrell Skinner, A. , Slifkin, R.T. , 2004. Unmet need for routine and specialty care: data from the national survey of children with special health care needs. Pediatrics 113, e109-e115.

[30] Meng, L. , Batt, R. , Terwiesch, C. , 2018. The impact of facility layout on service worker behavior: an empirical study of nurses in the emergency department. Manuf. Serv. Oper. Manag. 23, 819- 834.

[31] Mohajan, D. , Mohajan, H. , 2022. Exploration of coding in qualitative data analysis: grounded theory perspective. Research and Advances in Education.

[32] Nelson, E. , Batalden, P. , Huber, T.P. , Mohr, J.J. , Godfrey, M. , Headrick, L. , Wasson, J. , 2002. Microsystems in health care: part 1. Learning from high-performing front-line clinical units. Joint Comm. J. Qual. Improv. 28 (9), 472- 493.

[33] Ness, E. , 2020. The oncology clinical research nurse study coordinator: past, present, and future. Asia-Pacific Journal of Oncology Nursing 7, 237- 242.

[34] Nguyen, L.K.N. , Howick, S. , Megiddo, I. , 2020. A hybrid simulation modelling framework for combining system dynamics and agent-based models. Proceedings of SW21 the OR Society Simulation Workshop.

[35] Pachilova, R. , Sailer, K. , 2020. Providing care quality by design: a new measure to assess hospital ward layouts. J. Architect. 25, 186- 202.

[36] Pouyan, A.E. , Ghanbaran, A. , Shakibamanesh, A. , 2021. Impact of circulation complexity on hospital wayfinding behavior (case study: milad 1000-bed hospital, Tehran, Iran). J. Build. Eng. 44, 102931.

[37] Quality Control Indicators for Nursing Professionals (2020 edition) , 2020. A comprehensive study on ensuring excellence in healthcare delivery.

[38] Richard L, K. , Ronald L, S. , Michael B. , 2005. Medical Building. China Building Industry Press, China, 1st ed., translated by Wei, F., Mo, L.).

[39] Roberts, S.D. , 2011. Tutorial on the simulation of healthcare systems. Proceedings of the 2011 Winter Simulation Conference(WSC), pp. 1403-1414.

[40] See, K.F. , Md Hamzah, N. , Yu, M.-M. , 2024. Multi-period state healthcare efficiency for heterogeneous parallel hospital units. Soc. Econ. Plann. Sci. 92, 101790.

[41] Thoun, D. , 2011. Specialty and advanced practice nursing. Nurs. Sci. Q. 24, 216- 222.

[42] Tongur, V. , Hacibeyoglu, M. , Ülker, E. , 2020. Solving a big-scaled hospital facility layout problem with meta-heuristics algorithms. Engineering Science and Technology, an International Journal 23, 951- 959.

[43] Vorderstrasse, A.A. , Hammer, M.J. , Dungan, J.R. , 2014. Nursing implications of personalized and precision medicine. Semin. Oncol. Nurs. 30, 130- 136.

[44] Wang, Z. , Zhang, Q. , Zhang, L. , Cheng, Q. , 2008. Research progress on quantitative management of nursing work intensity. Chin. J. Nurs. 261-264.

[45] Wang, Y. , Ye, W. , Zhao, J. , Zhu, J. , Zhang, L. , 2005. To Establish and Implement the Comprehensive Evaluation System of Nursing Work Performance. Chinese Journal of Nursing, pp. 50-51.

[46] Wootton, M. , Davidson, L. , 2023. Responding to global emergencies: what has the role of nurses been and what can it be in the future? Clinics in Integrated Care 20, 100166.

[47] Wang, X. , Gong, X. , Geng, N. , Jiang, Z. , Zhou, L. , 2020. Metamodel-based simulation optimisation for bed allocation. Int. J. Prod. Res. 58, 6315- 6335.

[48] Xuan, X. , Duan, X. , Feng, Z. , 2022. The demand for specialization and its influence on the design of inpatient nursing units: can standardized design be done once and for all? HERD 15, 154-170.

[49] Xuan, X. , Duan, X. , Feng, Z. , Zheng, Y. , 2023. Differences in nurses' satisfaction and demand for spatial design among different departments of nursing units: a case study in China. HERD 17 (2), 129- 145.

[50] Xuan, X. , Li, Z. , Chen, X. , 2019. An empirical examination of nursing units in China based on nurse experience. HERD 12, 108- 123.

[51] Xuan, X. , Li, Z. , Chen, X. , Cao, Y. , Feng, Z. , 2021. Study of the physical environment of waiting areas and its effects on patient satisfaction, experience, perceived waiting time, and behavior in China. HERD 14, 108- 123.

[52] Yang, H. , Lu, Y. , Zhou, J. , Zhang, H. , 2015. Establishment and implementation of nursing workload assessment system based on hospital information system. Chin. Nurs. Res. 3481-3484.

[53] Yang, Y. , Wu, Q. , Xie, Y. , Zhang, M. , Xu, G. , Song, Y. , Bai, Y. , 2020. Calculation method of nursing workload based on working hours and difficulty. Nurse J China PLA, 25- 31.

[54] Yoo, Young , Ryu, I. , Kim, S.R. , 2013. Determinants of hospital nurses' satisfaction on hospital information system (HIS): focused on perceived HIS quality, individual and organizational characteristics. The Journal of the Korea Contents Association 13 (6), 438- 449.

[55] Zhang, H. , Xu, J. , Jia, L. , Shi, Y. , 2022. Modelling the walking behavior of pedestrians in the junction with chamfer zone of subway station. Phys. Stat. Mech. Appl. 602, 127656.

[56] Zhou, A. , Guan, L. , Lu, Y. , Wang, Z. , 2015. Discussion on RBRVS Based Nursing Workload Performance Assessment. Chinese Hospitals, pp. 13-14.

[57] Zhou, T. , Wang, D. , Zong, D. , He, X. , 2012. The study of the responsibility space regionalization of emergency shelters in the urban center and the evaluation of evacuation road based on microscope computer simulation—A case of chongqing three gorges square area. Disaster Adv 5, 230- 236.

RIGHTS & PERMISSIONS

The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.