Using Systems Theory to Examine Patient and Nurse Structures, Processes, and Outcomes in Centralized and Decentralized Units

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

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives: This study utilizes systems theory to understand how changes to physical design structures impact communication processes and patient and staff design-related outcomes. Background: Many scholars and researchers have noted the importance of communication and teamwork for patient care quality. Few studies have examined changes to nursing station design within a systems theory framework. Method: This study employed a multimethod, before-and-after, quasi-experimental research design. Nurses completed surveys in centralized units and later in decentralized units (N = 26pre, N = 51post). Patients completed surveys (N = 62pre) in centralized units and later in decentralized units (N = 49post). Surveys included quantitative measures and qualitative open-ended responses. Results: Patients preferred the decentralized units because of larger single-occupancy rooms, greater privacy/confidentiality, and overall satisfaction with design. Nurses had a more complex response. Nurses approved the patient rooms, unit environment, and noise levels in decentralized units. However, they reported reduced access to support spaces, lower levels of team/mentoring communication, and less satisfaction with design than in centralized units. Qualitative findings supported these results. Nurses were more positive about centralized units and patients were more positive toward decentralized units. Conclusion: The results of this study suggest a need to understand how system components operate in concert. A major contribution of this study is the inclusion of patient satisfaction with design, an important yet overlooked fact in patient satisfaction. Healthcare design researchers and practitioners may consider how changing system interdependencies can lead to unexpected changes to communication processes and system outcomes in complex systems.

Original languageEnglish
Pages (from-to)22-37
Number of pages16
JournalHealth Environments Research and Design Journal
Issue number3
StatePublished - Jul 1 2018

Bibliographical note

Publisher Copyright:
© The Author(s) 2018.


  • built environment
  • centralized nurse station
  • communication
  • decentralized nurse station
  • healthcare design
  • hospital
  • outcome
  • process
  • structure
  • systems theory

ASJC Scopus subject areas

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


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