(i) Enhanced surveillance and monitoring of patients

(ii) Staff ability to monitor and communicate with patients enhanced by the proximity of patients to each other

(iii) Staff benefitted from patients acting as an extra pair of eyes on the ward 

(i)  Staff valued being easily able to request or provide assistance where needed

(ii)  In staff survey, surgical and medical (older people) ward staff had the highest mean scores for the items ‘Obtaining advice from colleagues’, ‘Finding a staff member’ and ‘Knowing when other staff might need a helping hand’ (mean scores >4)

(iii) Staff learning from each other and supporting each other highlighted as important. During observation sessions ward managers were frequently observed on the ward ‘floor’, assisting and encouraging or advising their team 

(i) Staff were positive about patients being able to see, hear and interact with each other in shared open plan areas

(ii) Social contact between patients was seen as an aid to staff on busy wards, who might not have time to interact for longer periods with patients

(iii) Social contact was perceived to support recovery and relieve boredom on the wards 

(i) Lack of space for staff to provide nursing care to patients emerged as a key constraint

(ii) Lack of space in toilets and showers made it difficult for staff to assist patients and created obstacles for patients attempting to mobilise independently

(iii) Problems created by lack of space included risk of musculoskeletal injuries, trip hazards and a perceived increase in time required to undertake tasks 

(i) Space at staff bases generally considered inadequate—limited space and poor access to the limited number of PCs and telephones

(ii)  Staff break rooms had limited facilities and no kitchen. Often dark, cold and shabby, and multipurpose, serving as meeting rooms as well as staff break rooms

(iii) Lack of staff toilets was problematic (particularly maternity and surgical wards), meaning staff often had to go away and return later to use facilities 

(i) Staff were looking forward to improved privacy, sleep and rest for patients

(ii) Patients in the old accommodation were disturbed, for example, by general ward activity, or by other patients, which could create anxiety 

(i) Patients having their ‘own space’, including an en-suite bathroom and toilet, where personal care took place away from other patients

(ii) Allowing patients to sleep, rest and recuperate without disturbance

(iii) They could also better accommodate visitors.

(iv) Privacy was particularly valued for patients who were seriously or terminally ill and for their families

(v) Staff also reported less likelihood of interruption and distraction 

(i)  Improved working environment for delivering patient care and rooms described as modern, clean, spacious and safe

(ii) The en-suite facilities one of the most positive aspects, allowing nursing staff to more easily assist patients with personal care 

(i)  Centralised ward support facilities (eg, clean and dirty utility, drug preparation room, kitchen) liked by staff

(ii) Secure ward entry system to allow patients and visitors to enter and exit (see also disadvantages)

(iii) Dedicated staff break rooms (on surgical ward and the older people ward) 

(i) Staff anticipated that single rooms would reduce infection risk

(ii) New wards were perceived by staff to support good hygiene practices, with no-touch clinical hand washbasins in every patient room

(iii) Personal protective equipment and alcohol hand gel and antibacterial wipes were available from wall-mounted dispensers outside every room. This provided a visual reminder for staff entering a patient room to comply with infection control procedures 

(i) Staff described visibility of patients from the ward corridor as limited to the patient room they were directly outside, and then only if the door or vision panel in it was open

(ii) The line of sight into the patient room was interrupted by the wall of the adjacent room's en-suite bathroom (‘in-board’ single-room design) also obscuring the view of patient room doors for staff looking down the corridor

(iii) All staff interviewed perceived that lack of visibility of patients in the single-room wards had contributed to an increase in falls in the new hospital

(iv) Experienced nursing staff thought that it had been easier to prevent falls in multi-bed accommodation because they could ‘keep an eye’ on patients and were more aware of warning signals, for example, patients attempting to get up from their chair or bed

(v) Staff adapted work patterns to monitor and safeguard patients, but use of cordless telephones to locate each other was variable 

(i) Staff felt social isolation was a disadvantage of single-room wards compounded by ward design with limited day rooms

(ii) Social isolation influenced, patients’ satisfaction with their hospital stay and their emotional well-being and recovery

(iii) Staff felt that provision of social or communal space for patients should have been given much higher priority

(iv) Staff felt older patients likely to be more lonely (though our patient data does not support this from our sample) although staff also recognised that patients of all ages could be disadvantaged by not mixing with others and hearing their experiences, which was thought to help individuals assess their own progress and could be reassuring, motivating and encouraging

(v) Socially isolated patients were seen as likely to make more demands on staff, for example pressing call bells frequently or talking a lot to ‘keep’ nurses in the room with them which created tensions for staff 

(i) After the move, staff felt that the quality of teamwork had been difficult to recreate

(ii) Nurses described seeing less of their colleagues, being unaware of what was happening in other parts of the ward, and sometimes feeling isolated

(iii) One of the main difficulties described by staff was finding colleagues to obtain assistance and information. This was a cause of much frustration, especially for HCAs, use of technology to support this was variable (cordless telephones)

(iv) Nursing staff worked in small, decentralised teams, caring for patients in a cluster of eight to ten rooms, rather than one large team. Some staff liked this, but others felt that the mutual support they had experienced on multi-bed wards could not always be relied on in the new hospital

(v) Single-room wards impacted on the ability to support, train and develop staff as more difficult to supervise junior staff

(vi) There were also fewer opportunities for informal learning than on multi-bed wards