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RESEARCH HERD VolumE 2, NumbER 4, pp 62-84 CopyRigHt ©2009 VENDomE gRoup, llC Hospital Design and Face-to-Face Interaction Among Clinicians: A Theoretical Model Mahbub Rashid, PhD injuries in the United States that are attributable Abstract to medical error, and it recommends the pro- motion of effective communication for a safer A growing body of literature suggests that face-to-face healthcare system (Kohn, Corrigan, & Donald- interaction among clinicians in hospitals affects patient out- comes. How can face-to-face interaction among clinicians be son, 1999). The Joint Commission on Accredita- influenced positively to improve patient outcomes in hospitals? tion of Healthcare Organizations study of sen- So far, most strategies for improving face-to-face interaction in tinel events (defined as unexpected occurrences hospitals have focused on changing organizational culture. In contrast, this paper proposes a theoretical model that shows involving death, serious physical or psychologi- how spatial program and structure can help face-to-face cal injury, or the risk thereof) points to commu- interaction fulfill its purposes in hospitals by controlling the nication breakdown as the primary root cause interfaces among different communities of clinicians. Key Words: Face-to-face interaction, hospital communities, of more than 60% of the 22,966 sentinel events communities of practice, communities of interest, hospital analyzed (cited in Monroe & Graham, 2005) design, space, spatial structure and program over the period 1995–2004. Other sources sug- gest that the majority of errors in healthcare are Introduction caused by factors imbedded in different levels of Communication and the way healthcare provid- complicated systems of care delivery; they point ers work together are major variables in health- to poorly functioning teams and failed commu- care safety. A 1999 Institute of Medicine (IOM) nication among individuals as major contribu- report estimates that there are 44,000–98,000 tors to error (e.g., Andrews et al., 1997; Buer- patient deaths each year and 1,000,000 excess haus, 2001). It is in this context that this paper considers the clinical, social, and spatial dimen- sions of face-to-face interaction—one of many Author Affiliation: Dr. Rashid is Associate Professor of Architecture at the University of Kansas in Lawrence, KS. systems of communication—among clinicians Corresponding Author: Mahbub Rashid, PhD, 1465 Jayhawk Boulevard, Lawrence, KS 66045 (firstname.lastname@example.org). in hospitals; it proposes a conceptual framework 62 WWW.HERDJOURNAL.COM iSSN: 1937-5867 RESEARCH pA p E R S HoSpitAl DESigN AND fACE-to-fACE iNtERACtioN AmoNg CliNiCiANS that engages all these dimensions for promoting A growing body of literature on collaboration in effective face-to-face interaction. healthcare settings lends direct and indirect sup-
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