Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care

Lindsey Fay, Allison Carll-White, Aric Schadler, Kathy B. Isaacs, Kevin Real

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Objective: The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. Background: An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. Method: A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses’ stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. Results: Overall, the data comparing the centralized and decentralized models yielded mixed results. This study’s centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. Conclusion: Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

Original languageEnglish
Pages (from-to)80-94
Number of pages15
JournalHealth Environments Research and Design Journal
Issue number5
StatePublished - Oct 1 2017

Bibliographical note

Publisher Copyright:
© 2017, © The Author(s) 2017.


  • nursing unit design
  • operational efficiency
  • postoccupancy evaluation (POE)
  • pre-/postdesign

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care'. Together they form a unique fingerprint.

Cite this