Workplace Utilization in hospitals – a study of space efficiency potentials

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Workplace Utilization in hospitals – a study of space efficiency potentials Stefanie Lange ^1*, Eunji Häne ², and Prof. Dr. Lukas Windlinger ³

¹ ZHAW Institute of Facility Management; Stefanie.Lange@zhaw.ch; ORCID ID: 0000-0002-8928-7663

² ZHAW Institute of Facility Management; Eunji.Haene@zhaw.ch; ORCID ID: 0000-0001-8367-1587

³ ZHAW Institute of Facility Management; Lukas.Windlinger@zhaw.ch; ORCID ID: 0000-0001-9762-8504

* corresponding author.

Keywords: space utilization study, administrative workplaces in healthcare, space efficiency, workplace management

1. Introduction

The number of hospitals in Switzerland has been reduced by 21% over the last 20 years (Hplus, 2021). At the same time, population growth and a steady improvement in medicine took place, resulting in more cases per hospital (BfS, 2021). For hospital employees, this means more patients, more work, and more staff in existing building structures. The limited availability of space also led to a densification of administrative workplaces in offices and often called for ad hoc solutions to accommodate growth.

In recent years, a national hospital renovation wave has started in Switzerland (medinsight, 2020) and those in charge are challenged to make strategic decisions for the next years or decades. Regarding administrative workplaces, modern, open office types and desk-sharing concepts, as known from offices outside the healthcare sector, are increasingly being adopted for the hospitals of the future. Cell offices in the form of individual and group offices are considered to be too inefficient in terms of space.

Reasons for these workplace strategies are obvious: administrative workplaces of medical staff that are far away from patients are often only partially utilised, as doctors use other places in their daily hospital routine. Space efficiency potentials are thus obvious in the context of multi-local working. However, until now it is unclear how much and for which activities the doctors’ office workplaces are used. Case-related utilisation figures and benchmarks are missing as a basis for decision-making and planning.

In order to measure the occupancy of the administrative workplaces and to document the activities of the medical staff at the workstations, space utilisation studies were conducted. Occupancy data were collected in four projects in three hospitals by means of a space utilisation study. Observations were conducted on three consecutive workdays in each project. The use of the workstations was systematically documented twice per hour. The data on utilisation and modes of use were then analysed descriptively and compared with a data set of 14 office buildings.

2. Theories and Methods

Alignment of workspace to users is a crucial process in corporate real estate management (Vischer, 1996). Work organisations generally want to provide workplaces that maximally support employees’ work activities and processes while keeping cost and environmental footprint as low as possible. In order to find the right balance between number and activities of employees on the one hand and type and amount of different work settings (such as workstations, meeting rooms, private offices, and support spaces) on the other hand, space utilization analyses provide important information. Strategic workspace decisions are therefore often based on accommodation and occupancy intelligence (Vischer, 1996) and combined with organisational data and calculation mechanisms (De Bruyne & Beijer, 2015).

Space Utilization Studies (SUS) can be used as an analysis instrument in projects. SUS consist in observations of when and how work settings are used. The observations are either performed as structured and standardized visual inspections or by applying electronic methods (see Tagliaro et al., 2021). The main advantage of visual inspections over electronic methods is that not only occupancy is recorded, but also the activities carried out at specific places. This provides information on which activities are performed where and how often. This information allows to conclude about the kind of support spaces that are needed by the workers and organizational units observed. SUS therefore contribute to evidence-based planning and design of administrative workplaces in healthcare (cf. Fröst, 2016). Furthermore, basing design of work environments on data follows a human-centred approach that focuses on employees’ needs, capabilities and behaviours and aims to design environments that accommodate them. Such an approach emphasizes usability of the environment for the users over the technical quality (cf. Windlinger & Tuzcuoglu, 2021).

While evidence-based (e.g. Becker & Parsons, 2007) and human-centred (see Fornara & Andrade, 2012) approaches in the design of healthcare facilities have long be called for, no studies on utilisation of administrative (and other) work settings in hospitals have been published up to now.

Aim and Objectives

The aim is to compare the occupancy rate of medical administrative workstations in hospitals with the occupancy rates of offices in other industries. In addition, the activities performed at the workstations are analysed and compared. The findings on the utilization of hospital workplaces will lead to an improved understanding of workplace management in the context of medical work environments.

The objectives of the study are to:

1. measure and document the occupancy rate of administrative, back-office workplaces in general hospitals in Switzerland

2. systematically document the activities performed by users (physicians, nursing staff & therapists, and management & administrative staff) at their workstations

3. compare the use of workplaces in traditional offices to workplaces in hospitals

4. evaluate the use of administrative, back-office workplaces in general hospitals in Switzerland and identification of potentials regarding space efficiency.

Study Design

The study consists in a secondary analysis of existing data from previous projects. Data from two groups of projects is included: data from hospitals and data from traditional offices. Data is used for a comparison of hospital and office workplaces.

Setting and Sample

Administrative medical workplaces in a total of four hospitals were observed between 2017 and 2021. Information about each hospital project such as project year, office concept, number of observed workstations can be found in table 1. Three hospitals used a traditional office concept and one hospital had implemented an activity-based working office concept as a pilot. The traditional concepts included single and group offices, which were used with a fixed allocation as a single (one person, one desk) or shared workplace (several people, one desk). Often several employees shared a workstation. Higher management levels usually had their own workstation or office room.

All workplaces observed were used only for administrative work and internal communication. No patient contact or treatment occurred in these rooms.

Table 1: Overview of hospitals projects

The data set of office buildings includes data from 14 observation projects (Table 2). In these cases, administrative units of private sector companies with different office concepts, such as Activity Based Working (ABW, see e.g. De Bruyne & Beijer, 2015), multispace or traditional group offices, were observed.

Table 2: Overview of office projects

Data Collection and Analysis

The Space Utilization Survey focuses on the use of space or workplaces. Here, the investigations were conducted as observational studies since occupancy measurement via electronic methods prevents the recording of activities.

Only data from standard workstations were included in the study. Data from other place like meeting facilities, think tanks and recreation areas were only available in one case of activity-based working and excluded because the dataset was too small.

Users of the offices surveyed were physicians, non-medical professionals, nurses, researchers, and employees with strategic or administrative functions.

The occupancy of the workstations was documented in two projects with three categories: "occupied", "empty" or "cold occupation" (workstation is occupied but currently not used) and in two projects with only two categories: "occupied" or "empty". For the data analysis, the records with information on "empty" and "cold occupation" were summed and recoded into the “empty” category. After this adjustment of the datasets, they were comparable. The background for the adjustment is a changed observation logic for hospital workplaces as compared to office workplaces from other industries. This is because the category "cold occupation" is difficult to identify in hospitals with traditional office concepts lacking clean desk routines.

Adopting the procedure of a systematic space utilisation study, workstations were observed following a regular observation grid on a fixed route within the defined observation area. The observation grid specified data collection every 30 minutes between 7:00 am and 6:00 pm in hospitals and 8:00am and 5:00pm in offices for 3-5 days in each project. In total, 4067 (533 hospital and 3534 office) workstations were observed, and 216’862 observations generated for the analyses.

Observation data were collected by students. Students received 2 hours of training on how to conduct an observation and how to navigate to the observation points. Paper and pencil were provided, and data were transferred directly into Microsoft Excel spreadsheets. After combining all data, mistakes from the transfer and errors were eliminated.

Data were analysed using descriptive statistics and comparisons using chi-square tests were carried out.

3. Results

3.1. Descriptive analysis

A frequency analysis of physicians’ administrative workplaces in hospitals was conducted. Physicians were divided into two groups (chief physician & chief of service; attending physician & resident physician). The number of observed workstations of the two groups were not significantly different (chief physician & chief of service: 106, attending physician & resident physician: 127). The observed workstations of chief physician & chief of service showed a higher occupancy rate: 37% of the observed workstations of chief physician & chief of service were occupied, whereas 23% of the observed workstations of attending physician & resident physician were occupied.

In the next step, the occupancy of administrative office workplaces in hospitals was analysed regarding occupant type. Occupants were divided into three types (physicians; nursing staff & therapists; management/administrative staff). The number of observed workstations of physicians was nearly twice that of others (physicians: 262, nursing staff & therapists: 132, management /administrative staff: 139). Among the three groups, observed workstations of management /administrative staff had the highest occupancy rate with an average of 37%. The occupancy rates of physicians and nursing staff & therapists were both under 30% (physicians: 29%, nursing staff & therapist: 27%). Table 3 summarises the occupancy rates of the three employee types.

Lastly, occupancy rates of workplaces in offices and in hospitals were analysed and compared by using frequency analysis. The observed workstations of office projects had a higher occupancy rate than those in hospitals: 38% of the observed workstations of office projects were occupied, whereas 31% of the observed workstations of hospital projects were occupied. Table 2 shows the occupancy of workstations from office projects with project information. Information on occupancy rates in hospitals are summarized in table 3.

Table 3: Occupancy regarding physician types, other hospital occupants types

3.2. Comparison of workplace utilisation in hospitals and office buildings

For the comparison of the use of workplaces in offices and workplaces in hospitals a chi-square test was used. A chi-square test of independence was performed to examine the relation of occupancy rates between organization types (office vs hospital). The relation between organization type and occupancy was significant, X² (1, N = 216’862) = 1098, p <.001. The effect size for this finding, however, was small (Cramer’s V = .07). This result indicates that office workplace was more likely to be occupied than hospital workplace.

4. Discussion and conclusions

The utilisation of administrative workplaces in hospitals is low. Medical staff spend a large part of the working day away from their backstage desks. The occupancy rate in hospitals is – on a generally low occupancy level - lower than in administrative offices, where the workstation is the main place of work.

These results suggest significant space efficiency potentials. Workspace could be shared, i.e. instead of assigning employees to specific places, workstations and support spaces could be used by a defined group of employees. Considering the low occupancy rates, desk-sharing could lead to a reduction of workspace with a higher utilisation rate of the remaining places.

Before implementing desk-sharing in hospitals, some issues have to be considered: (1) desk-sharing works better for larger groups than for smaller ones, i.e. the efficiency gains are higher and easier to realise with larger user groups. (2) desk-sharing may affect group identity (Elsbach, 2003) and may conflict with organisational culture. Particularly, the role of workplace as status markers fundamentally changes with the introduction of desk-sharing (cf. Vischer, 2005). (3) work processes of the different user groups must be understood. Despite low utilisation, administrative workplace may be important places of work for medical staff and daily medical routines result in requirements for the workplace environment that must be considered for future solutions. For example, not only the duration of using a workstation is important, but also the frequency since frequent short periods of utilisation may imply that it would be impractical to put away one's utensils every time and clear the workstation so that colleagues could use it.

There is clearly a need to further analyse the current and future role of administrative workplaces in hospitals in terms of their functional, symbolical, and spatial properties.

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