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                      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 (
                                                                               in hospitals; it proposes a conceptual framework

62        WWW.HERDJOURNAL.COM iSSN: 1937-5867
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                                                            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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