Lessons Learned From Decentralization of an Elective Surgery Medical-Surgical Unit

The objective of this study was to examine changes in healthcare practitioners' perception of supportiveness of their physical work environment, and trend in patient fall, when moving from a centralized to a decentralized unit configuration.

Previous studies on decentralization have not uniformly provided findings consistent with desired outcome.

A pretest-posttest study was conducted in an elective surgery medical-surgical unit in the mid-Atlantic region of the United States. The independent variable was the physical design supporting centralized versus decentralized nursing models. Data were collected from healthcare staff with a self-report survey "before" (September 2017; n = 42) and "after" (June 2019; n = 22), and interviews. Before-after data were analyzed using both parametric and nonparametric tests to identify significant differences. Qualitative responses were analyzed to identify triangulating evidences. Monthly patient fall data were collected for a 3-year period and analyzed using log-linear Poisson Regression model.

Results show favorable assessments in the areas of overall supportiveness of design, equipment and soiled utility location, peer support, process flow visualization, and overall satisfaction. A reduction in patient falls was observed. Unfavorable outcomes were found in the contexts of walking distance, multidisciplinary collaboration, alarm audibility, nurse station size, and PPE location.

This study underscores that the success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture, and the physical design.