Table 1

Patient advantages and disadvantages of shared patient accommodation and single-room accommodation

Shared patient accommodation in an open ward
Advantages	Patient interview data
1. Security—visibility and staff proximity
Shared patient accommodation meant nurses’ station visible from patient beds: (i) Enabled patients to see staff and evaluate staff competence, leading to a sense of safety (ii) Staff were close by at all times, and this proximity also increased patients’ perceptions of security (iii) Shared patient accommodation allowed patients to witness the care of others which helped patients feel they were in a safe environment	“You were so close to the station anyway so if something did go wrong you could call somebody. They didn't draw the curtains so they could see you all night…they did keep a good watch on you” Patient, MAU (female—age 55) “You could always see that there was a nurse there….You were never ever left alone…and to me that's important because if you press the buzzer, they look up, they're with you within seconds….” Patient, surgical ward (male—age 73)
2. Community—patient camaraderie
(i) Proximity of other patients created a ‘ready-made’ community which many patients appreciated (ii) Watching or observing other patients passed the time or distracted patients from their own discomfort (iii) Actively interacting with other patients to provide and obtain emotional support was noted by many as important.	“In the bed I was in, you had a nice little community of us, all within talking distance…It's good for morale…[it] created a wonderful atmosphere between…we got on well with one another. And we all knew what each other had got wrong with them.” Patient, surgical ward (male—age 73)

Disadvantages	Patient interview data

3. Community—confused /disruptive patients
'Community’ dynamic could change quickly; positive aspects negated: (i) When another patient became confused, or when a disruptive patient was admitted to the ward (ii) Patients described feeling vulnerable and concerned, for the patient's welfare and sometimes their own (iii) Staff were ‘tied up’ caring for or dealing with an individual patient—leading to a reduced sense of security/emotional comfort	“The man who was opposite…he'd got dementia and he was in the shouting stage…shouting out ‘Help’ all the time…they tried everything to help him; they were terribly, terribly patient… most of us, well I think all of us, understood, but it was a nuisance, because in the end it took over, you couldn't do anything else but listen, and see how they were getting on with him.” Patient, surgical ward (male—age 71)
4. Lack of privacy—confidentiality and embarrassment
(i) Some patients accepted a lack of privacy as an unavoidable aspect of the environment (ii) Others were left feeling vulnerable, particularly on the maternity ward	“It's difficult to keep everybody private…..they'd pull the curtains but you obviously can hear what they're saying… if you're relatively well I think it might be a factor but once you're so ill you really don't care about anything.” Patient, MAU (female—age 55) “I had patients with families peeking through the curtains that didn't fit properly. It was awful. I was so embarrassed…There's no privacy” Patient maternity ward (primiparous) “I was trying to keep him [baby] quiet to try not to disturb everybody else….I was getting really anxious because I was thinking, ‘Oh, don't wake everybody else up.’” Patient, maternity ward (primiparous)
5. Lack of physical comfort—noisy and no control
(i) Aspects of physical comfort of importance to patients included location and size of shared toilet facilities, lack of space around the bed, and inability to control lighting, temperature and noise	“I had two drains to carry with me and your drip thing to get to the bathroom, and it pulls all your nightie up at the side ….You're constantly looking somewhere else, trying not to make eye contact because I get very embarrassed.” Patient, surgical ward (female—age 57) “I got no sleep because it is just so noisy…..the other babies screaming…. So it was very difficult to sleep in a maternity ward like that.” Patient, maternity ward (primiparous)

100% single rooms
Advantages	Patient interview data
1. Comfort—en-suite convenience, rest and sleep-‘hotel’ Patients experienced high levels of comfort in the single rooms, in relation to: (i) En-suite toilet facilities, lighting, ventilation, having a view from a window and noise levels (ii) The single room was frequently compared favourably with a hotel or home environment (iii) The design of the room helped reduce patients’ anxiety, promote rest and sleep, and support physical comfort	"You had a shower, toilet, and washing facilities. Got your own TV […] I would rate it really as probably on a par with a three star hotel […] That's how good it was.” Patient, surgical ward (male—age 70). “I only just made it into my bathroom in time […] I would have been so embarrassed, if I'd had to go out of my [room] and across the corridor and feel sick, and wet myself, I would just die of embarrassment […] but there it was absolutely fine.” Patient, surgical ward (female—age 45) “The single room is, I think, the most perfect solution they came up with because […] sometimes babies are crying constantly, […] at least if baby was asleep, I could also go to sleep because there wasn't anyone next to me with a baby crying or anything.” (Postnatal patient, age 26)
2. Control—enhanced privacy and freedom- ‘at home’ (i) Control rarely featured in patients’ accounts of staying on shared patient accommodation (ii) Control was closely associated with privacy and freedom; not being observed by others; retaining independence and agency- patients valued not having to worry about what other patients might be thinking about them (iii) Patients compared the single room with being at home, in their own space, with similar control and privacy (iv) Privacy and flexibility of the single-room environment for receiving visitors	"Being in a room on my own where I didn't have to talk to people if I didn't want to, I could watch the telly […] And the fact that I'd got privacy, and things like being able to go to sleep when I wanted, and wake up when I wanted, was really beneficial […].” Patient, MAU (female—age 44) “It just gives you time to properly relax, and you haven't got other people shouting across the ward… It's just nice because you can relax in your own time. You're given that privacy, and that's what I like.” Patient, surgical ward (female—age 72) “You can ask them anything […] I had a C-section and I would ask them about the pains, the bleeding, the catheters… Because it's private, I felt comfortable and they could even show me and […] actually demonstrate it for me”. (Postnatal patient, age 26) “I do think visiting in here is very much easier, in single rooms. [There's] more space. And there's more confidentiality, you feel not everyone's hearing your business […] it is nice really [visitors] can come whenever they like and that's a very big bonus.” Patient, old people ward (female—age 80)

Disadvantages	Patient interview data

3. Connection—seeing staff and being seen (i) Anticipating the move to single rooms patients in shared patient accommodation expressed anxiety about staff not being in close proximity and able to monitor them sufficiently (ii) Proximity and monitoring not directly mentioned by patients in single-room accommodation who spoke more generally about feeling or not feeling alone (iii) The quality of interaction with staff experienced by patients in single rooms affected how connected they felt to staff (iv) Some patients thought that the single room enabled staff to give them undivided attention and supported one-to-one care, others that staff were ‘very distant’, ‘busy’ and ‘did not have time to chat’ (v) Not being able to see staff going about their work beyond the single room meant patients often had little idea of other patients needs or how busy or not busy staff were	Anticipating the move a patient in shared patient accommodation said: “The problem is if you have these low blood pressure episodes they happen so quickly that you might not have a chance to ring the bell. And that would have worried me. Say you'd got up to go to the bathroom and then had one of these episodes and fallen over…then you just do wonder how often they would come along and check on you….I would have thought that's not a good idea.” Patient, MAU (female—age 55) “They didn't really have time to chat […] They just came in and did what they had to do, the temperatures and blood pressures, and things […] You get more time [in a multi-bed bay], not to chat to the staff, but to ask them questions, because they're in a bay more than they are in a single room. They would only come to your room just to see if you're okay, every so often or if you called them.” Patient, surgical ward (male—age 71) “If you're in hospital, you're ill, you're not there for a holiday, and if you're ill you need a lot of treatment, you have your blood pressure taken three times a day, your temperature …So you are being constantly attended by nurses because of your condition….. so actually, a [single room] is a very busy place, you're not on your own, hardly ever.” Patient, surgical ward (male—age 84)
4. Isolation (i) Anticipating the move to single rooms patients in shared patient accommodation expressed anxiety about potential isolation in single rooms (ii) For some patients in single rooms, lack of interaction with other patients led to strong feelings of isolation (iii) Patients who felt little connection with staff were likely to report feeling isolated in single rooms (iv) Some patients wanted to have the opportunity to socialise with other patients to counter this isolation (v) Patients who missed ‘company’ felt confined in their rooms and unaware of dayroom opportunities or whether it was permissible to walk the corridors or ‘visit’ other patients	Anticipating the move a patient in shared patient accommodation said: “I think…single bed [rooms] are a bit isolating. You wouldn't see life going by. Yes, it would be quieter, but perhaps a bit too quiet? [other patients] they're not going to go into an individual room really to say ‘Hello’ and see how you're getting on, rather than if they're just passing by the bed, will they?” Patient, surgical ward (female—age 56) “It would have been nice to have been able to see other people, or maybe just to chat with other mothers […] If you're in an open ward, you just see people coming and going […] you can chat to people across the ward […] I just wanted to get home […] because there isn't anyone to chat to and I just felt a little bit isolated being in the room on my own.” (Postnatal patient, age 36) “It did get a little bit lonely […] you don't really get to talk to many people, other patients. […] I wanted to go for a walk just to get out of the room and maybe have a chat with someone. You do start to feel a little bit stir crazy stuck in a room […] I kind of felt like I had to stay in my room.” Patient, MAU (male—age 44)