Balancing the Human Touch with the Need for Integrating Technology in Ambulatory Surgical Environments: Barriers and Facilitators to Nursing Work and Care Team Interactions

Abstract

Ambulatory surgical environments are dynamic and complex, involving coordination across multiple groups of care providers and requiring numerous sources and handoffs of information. As in other areas of healthcare, these settings have grown increasingly complex over the years with the integration of new equipment and technology such as electronic medical records. However, little thought has been given to the design of workspaces in these settings to support evolving work processes and emerging technologies. The purpose of this research study was to understand nurses’ work patterns in preoperative and postoperative workspaces of ambulatory surgery centers, and to identify environmental design strategies that support or act as barriers to critical interactions between care teams due to the integration of new technologies. In–depth case studies were conducted at two ambulatory surgery centers using a multimethod approach consisting of behavior mapping, shadowing, spatial analysis, and semi–structured interviews with nursing staff. The study data were collected over two consecutive days at each site. The majority of patient care activities such as bedside care and charting were carried out directly with the patient in the patient bays. Nurses were observed standing or walking for approximately 70% of the observations, and face–to–face interactions were dominant in both case studies regardless of the technology implemented. Key environmental facilitators and barriers to nurses’ work in surgery centers include: accessibility, flexibility, visibility, size, and privacy. Architects and interior designers can play an important role in designing human–centered work environments for nurses in surgical settings that effectively support the critical tasks and interactions that must take place. Designing work systems requires a human–factors approach to design that examines the range of activities, interactions, people, technology, and design of the workspace and its elements.