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Estimating Design Impact on Waste Reduction: Examining Decentralized Nursing

Pati, Debajyoti PhD, FIIA, LEED®AP; Harvey, Thomas E. Jr MPH, FAIA; Thurston, Terry MBA, RN

JONA: The Journal of Nursing Administration: November 2012 - Volume 42 - Issue 11 - p 513–518
doi: 10.1097/NNA.0b013e31827144c9

The objective of this study was to understand the impact that decentralization of nursing support spaces may have on the total distances nurses walk and hence the magnitude of time that can be diverted to productive use. Reducing nurse walking has attracted attention from multiple perspectives—human factor, system performance, lean process, care quality, and safety. A simulation-based experimental study was designed that incorporated task frequency data from a nationwide sample of 700 RNs. The simulation runs were conducted on a 30-bed medical-surgical unit, over 12-hour day shifts, in which physical locations of 8 nursing support spaces were systematically manipulated. Findings suggest that total walking time can be reduced by as much as 67.9%, depending on the level of decentralization. Care quality and efficiency issues can be significantly addressed through appropriate levels of decentralization.

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Author Affiliations: Rockwell Endowment Professor (Dr Pati), Department of Design, Texas Tech University, Lubbock; President (Mr Harvey), Center for Advanced Design Research & Evaluation, Dallas, Texas; Director (Ms Thurston), Healthcare Operations Planning, BSA LifeStructures, Indianapolis, Indiana.

This study was funded by a monetary grant from Herman Miller Inc. HKS, Inc, provided in-kind contributions to this study. Hill-Rom ensured proper working of the ComLinx system installed at the 3 subject hospitals.

The authors declare no conflict of interest.

Correspondence: Dr Pati, College of Human Sciences, Department of Design, Texas Tech University, Box 41220, 1301 Akron Ave, Lubbock, TX 79409 (

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© 2012 Lippincott Williams & Wilkins, Inc.