INPATIENT ACCOMMODATION “I will change my own behaviour if…”


Component actions • Leadership embodying the change


• Getting opinion-shapers on board


• Peer interactions Role-modeling


“I see superiors, peers and subordinates behaving in the new way”


Fostering understanding and conviction “I know what is expected of me – I agree with it and it is meaningful”


• Talent management – Hiring – Replacing – Retaining


• Learning


– On-the-job development – Training – Action learning


Mindset & behaviour shifts


Developing talent and skills “I have the skills and competencies to behave in the new way”


Reinforcing with formal mechanisms “The structures, processes and systems reinforce the change in behaviour I am being asked to make”


Source: John Drew et al, Journey to Lean: Making Operational Change Stick, p201, fig 10.3


Figure 2: The ‘influence model’ can help Trusts embed the new ways of working required by single patient rooms, say the authors.


hospitals and Trusts in how they use their bed base. Single patient rooms eradicate the issue of gender-based bed blocking, where patients cannot be allocated to an empty bed in a shared ward, as people of a different sex are occupying other beds on the ward.20


This, combined with


the fact that single patient rooms allow for incremental changes in capacity (e.g. partitions or re-designation of rooms to reallocate resources as needed), increases how adaptable a hospital can be, allowing it to be resilient and flexible in responding to pressures.


Challenges Nevertheless, moving to a model of single patient rooms also comes with a number of challenges.


Patient outcomes and experience It is harder to monitor patients in single rooms, compared with in a ward with a central nursing station. Single patient rooms have been linked to delays in getting help, for example when a fall occurs.11, 21, 22


There are, however, studies


with contradictory results, in which increases in falls were not statistically significant,23


or reversed in the subsequent


months, as staff got used to the new ways of working.11


Similarly, both patients and


staff raise concerns that single patient rooms will reduce the opportunities for patients to interact with each other and healthcare staff, reducing social support, and making patients feel isolated.11


This


has been found to primarily affect patients with few passers-by.23


Despite discussions and concerns about isolation, the evidence ‘‘


is clear that most patients prefer single patient rooms.11,24


Provider and system performance Another disadvantage of the single patient room model is that such rooms require greater square footage to implement. In space-constrained settings, this necessitates a trade-off between the number of beds and other clinical spaces. If trade-offs aren’t required, then the larger square footage will increase capital and certain operating costs, and pose staffing challenges. In fact, moving from 50% single patient


rooms to 100% such rooms has been estimated to require an additional 5-10% in capital costs.11,25


In addition to the one-off


capital costs, single patient rooms will also increase certain running costs. One study11


estimated that moving from 50%


to 100% single patient rooms increased ongoing cleaning costs, but did not impact the costs of maintenance. While the authors of that study were unable to quantify the potential financial benefits, other studies25,26


Component actions • Story development (includes all the key elements – e.g. values, strategy, case for change)


• Story delivery (across relevant levels – e.g. organisational, employee, functional)


• Organisation structure • Targets and metrics • Management processes • Business processes • Rewards, recognition and consequences


• Information systems


pressures and vacancy rates across the NHS raise serious questions about what this means for patients in single patient room settings. While studies have shown that an increased share of single patient rooms increases the time staff spend walking,11


difficult to isolate.


Making single patient rooms a reality To maximise the potential benefits of single patient rooms and mitigate the potential risks, such rooms require an approach and a model of care distinct from those in place for wards. Clinically- led planning, redesigned processes, and digital innovation, should be integrated into Trusts’ business cases, designs, and estates strategies, from the outset.


Implementation approach – clinically led planning Where a hospital is being designed with single patient rooms, we recommend a clinically-led approach to the design that ensures that any operational challenges are addressed upfront. Clinicians and designers can work together to come up with solutions to maximise the benefits and address the potential problems with single patient rooms. For example, handrails, adjustable height beds, and roll-in showers can reduce the risk of falls, while improving ventilation, appropriately placing basins, and selecting easily disinfected equipment, can improve infection control. Many of these elements were incorporated into the new Tunbridge Wells Hospital in Pembury in Kent – such as placing the clinical basin at the rooms’ entrance, including natural ventilation, and placing the bedhead on same side as the en-suite bathroom doors to reduce the risk of falls.27


Good design can also promote have suggested that any


increase in operating cost is outweighed by the cost-benefits from reduced patient transfers, reduced stay length, and improved infection control, and may be sufficient to recoup the higher capital costs within 3-5 years.25 The additional square footage also poses challenges for hospital staff. Surveys of such personnel have found that both perceptions of staff’s ability to deliver high-quality care, and teamwork and training, worsened following the move to single patient rooms.11


The current staffing


Addressing the concerns of staff, and particularly nurses – who tend to be ward-based – will be crucial to ensure that hospitals adopt single patient rooms safely and efficiently. Doing so will include updating staffing models to reflect staff concerns, and encouraging a behavioural shift among staff


32 Health Estate Journal March 2023


increased socialisation. In designing its majority single patient room decant ward, James Paget University Hospital in Great Yarmouth included a dementia- friendly outdoor courtyard to encourage patient socialisation.28


These spaces can


host social activities. For example, the Tunbridge Wells Hospital started a lunch club in a shared social space to combat isolation and improve food intake at lunchtimes.11


Implementation approach: redesigning ways of working Addressing the concerns of staff, and particularly nurses – who tend to be ward-based – will be crucial to ensure that hospitals adopt single patient rooms safely and efficiently. Doing so will include updating staffing models to reflect staff concerns, and encouraging a behavioural shift among staff. Staff concerns around delivering high-quality care, teamwork, and informal learning, can be mitigated through improved processes and smart


the impact on staff cost has been


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