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An investigation of spatial relationships and operational requirements in hospital emergency departments in Jordan

Abukeshek, Mohammad 2021. An investigation of spatial relationships and operational requirements in hospital emergency departments in Jordan. PhD Thesis, Cardiff University.
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This research investigates spatial relationships and operational requirements in hospital emergency departments (EDs) in Jordan. The preliminary literature review identified overcrowding and long waiting times as major challenges. A more detailed review examined current ED design research and guidance on ED design, functions, and operational activities and how the spatial relationships of ED functions influence ED's operational activities. The review revealed limited research in these areas and a lack of detailed design guidance about ED functional and spatial relationships. This research, therefore, investigates for the first time ED spaces and their functional relationships to explore their influence on operational activities. The research carried out fieldwork in two case study hospitals – one public and one private – in Jordan. A mixed-methods approach was adopted using three data collection methods: interviews, spatial analysis, and direct observations of operation of EDs. Interviews with hospital designers confirmed that ED design guides do not provide the necessary detailed explanations of ED functions and their spatial relationships. The findings highlighted limitations in stakeholders' engagement during design and a lack in the use of computer-based analytical tools during design. Accordingly, as a first step, this study explored the use of Space Syntax tools as potential design aids to analyse the two case study hospitals. This part of the research found that later changes to the original designs invalidated previous analysis and concluded that spatial analysis alone does not improve the design outcome and may create a false sense of certainty. Direct observations showed that in practice, the arrangement of the functions and their spatial relationships in the selected EDs hinder departmental workflow. The observations were supplemented by interviews with various ED staff members to understand why the spaces are used the way they are. The findings revealed that current spatial configurations do not support the medical procedures for the ED patients with different medical conditions. Therefore, the current spatial allocation of functions hinders EDs' efficient workflow operation and causes overcrowding and longer waiting times. The research identified three factors affecting operational activities. First, ED activities depend on the spatial organisation of functions, which in turn depends on medical procedures. Second, behavioural and management aspects both influence operational flow. Finally, the period between when the hospitals were designed and occupied saw an evolution in medical operational requirements supported by technological advances, which undermines the functional allocation of spaces. This research recommends that ED functions and their operational spatial relationships need to support EDs' complex operational demands to cater to the needs of different users (patients and staff) and their different requirements. Therefore, the spatial organisation of healthcare facilities in Jordan has to evolve by adopting new design strategies, including co-designing with key hospital stakeholders.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Architecture
Uncontrolled Keywords: spatial relationships; operational hospital emergency departments; Jordan; healthcare facilities
Date of First Compliant Deposit: 11 June 2021
Last Modified: 07 Jan 2022 02:10

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