Balancing bricks, bytes and behavior: lessons learned from inpatient wards with 100% single occupancy rooms

The design of a new hospital is typically used as a catalyst for change, redesign and implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (Bricks), processes and supporting IT (Bytes) and work processes (Behavior). Even when stakeholders are engaged in the design that is not to say that their needs will be safeguarded during trade-offs in various phases of decision-making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes for the perceived mismatches as expressed by ward managers some 12 months after relocation. This was altogether some 6 years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing has been combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking into use, with stakeholder engagement as a key element. Additionally we found Health Care Worker Behavior not well enough considered in a predominantly rational design and implementation process focusing on patient centeredness.