On the old surgical ward, a nurse on night duty could sit at the desk and see all eight to ten of her patients. If you needed a hand, as a nurse on the same ward put it, you could “just pop your head out the curtain.”
In 2011 Tunbridge Wells Hospital opened, replacing buildings at Pembury and the Kent and Sussex hospitals, some of them 100 years old. It was the first NHS hospital in England with nothing but single rooms for inpatients. Staff and patients moved in two phases, in January and September, mostly out of large bays and open Nightingale wards. The National Patient Safety Agency had championed the design to cut infections, falls and noise. Every room had its own bathroom, and the layout was planned to give patients views of the wooded valley around the hospital.
A team from King’s College London, led by Jill Maben, interviewed nurses before and after the move. Before, they described a ward they could read at a glance. “You can see if somebody is flagging,” one said of her colleagues. After the move, nurses described something else. “As soon as I’m in a room I’m away from everybody,” said one on the surgical ward. On the assessment unit, a nurse said you “can’t eyeball nurses enough to know that they’re drowning and they need help.” The bathrooms sat by each room’s door, and on most corridors they blocked the sight lines, so a nurse could see into only one room at a time. Pedometers showed staff walking more: on average, from 716 steps an hour before the move to 839 after. “It’s almost like three separate wards,” a staff nurse said.
The nurses had to change the way they worked, and they felt ill prepared for it. Working out how to divide their time among patients behind closed doors was largely left to individuals, and staff teams tried new routines by trial and error. On the assessment unit, falls and medication errors rose right after the move and fell back to previous levels about nine months later. The researchers judged that the rooms themselves were probably not the cause; one explanation they offered was the disruption of the move.
The two wards studied most closely adapted at different speeds. The surgical ward had a strong leader and the fewest other changes at the same time. It kept a central handover of all staff every morning, which its manager saw as a way to hold on to the ward’s identity, and its team reported adapting fairly quickly. Staff on the assessment unit, which also faced sicker patients, an unusual layout and staffing trouble, reported taking more than six months to settle in.
Two-thirds of the patients interviewed preferred single rooms. After the move, 18% of staff surveyed said they preferred wards of all single rooms. And after the study ended, the hospital converted a board room and offices into a new 38-bed ward, with nine four-bed bays and two side rooms.