Creating a sense of place when implementing a new emergency department in Denmark: a qualitative study

Physical locations play an essential yet often overlooked role in healthcare implementation processes. Implementation Science frameworks such as the Theoretical Domains Framework, the Consolidated Framework for Implementation Research, and the Implementation in Context framework acknowledge the importance of the physical environment, but they often treat it as a passive backdrop for change. However, from a cultural geographic perspective, spaces and places are dynamic, influencing behavior, social structures, and the acceptance of new practices. This study aims to explore how managers and emloyees develop a sense of place in a new emergency department (ED) and how these spatial dynamics influence the implementation process.

This study used a multi-sited ethnographic design, tracking the implementation process across multiple hospital locations from 2019 to 2023. Fieldwork was conducted in settings such as management meetings, micro-simulation training, and tours of the new ED construction site. A total of 53 participants, including managers, nurses, and physicians from 12 specialized departments, were purposively selected. Data were collected through ethnographic field notes (750 single-spaced pages) and semi-structured interviews averaging 39 min. Analysis was guided by situational analysis and cultural geography, integrating human and nonhuman elements. An overall inductive approach was used to develop theory from observations through analysis, applying a coding system to identify key themes related to spaces, places, traces, and sense of place.

Five themes emerged regarding the development of a sense of place: (1) comfort, influenced by physical elements such as daylight and indoor climate; (2) spatial organization, affecting collaboration, workflow, and professional identity; (3) familiarity, highlighting cultural practices and equipment in fostering belonging; (4) time, where construction delays enabled deeper emotional engagement; and (5) involvement, showing that initial criticism transformed into stronger ownership through increased engagement.

This study highlights the importance of a sense of place during pre-implementation of new physical locations in healthcare. Factors such as comfort, spatial organization, familiarity, time, and involvement are key to participants' development of a strong sense of place in the new ED. These insights are crucial for designing implementation processes that address both physical and emotional needs, influencing outcomes such as acceptability, adoption, and sustainability.