The role of place on healthcare quality improvement: A qualitative case study of a teaching hospital. (April 2018)

• Record Type: Journal Article
• Authors: Melo, Sara
• Is Part Of: Social science & medicine. Volume 202(2018)
• Page Start: 136
• Page End: 142
• Publication Date: 2018-04
• Subjects: Place -- Healthcare quality management -- Patient safety -- Hospital -- Case study; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2018.03.003
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: This article examines how the built environment impacts, and is impacted by, healthcare staff day to day practice, care outcomes and the design of new quality and patient safety (Q&PS) projects. It also explores how perceptions of the built environment affect inter-professional dynamics. In doing so, it contributes to the overlooked interplay between the physical, social, and symbolic dimensions associated with a hospital's place. The study draws on 46 in-depth semi-structured interviews conducted at a large teaching hospital in Portugal formed by two buildings. Interview transcripts were analysed inductively using thematic analysis. The major contribution of this study is to advance the understanding of the interactions among the different dimensions of place on Q&PS improvement. For example, findings indicate that some of the characteristics of the physical infrastructure of the hospital have a negative impact on the quality of care provided and/or significantly limit the initiatives that can be implemented to improve it, including refurbishment works. However, decisions on refurbishment works were also influenced by the characteristics of the patient population, hospital budget, etc. Likewise, clinicians' emotional reactions to the limitations of the buildings depended on their expectations of the buildings and the symbolic projections they attributed to them. Nevertheless, differences between clinicians' expectations regarding the physical infrastructure and its actual features influenced clinicians' views on Q&PS initiatives designed by non-clinicians. Highlights: Interactions between physical, social, and symbolic dimensions of place are explored. Connects evidence-based design literature with medical sociology research. The interactions among the different dimensions of place impact on Q&PS improvement. Perceptions of the built environment affect inter-professional dynamics. The built environment impacts on staff's perceptions of an organisation's identity.