title: One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs.
abstract: OBJECTIVE
  There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs.
  
  
  METHODS
  Mixed methods pre/post 'move' comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms.
  
  
  RESULTS
  Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time.
  
  
  CONCLUSIONS
  Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0003-2439-2857
authors.initials: P
authors.lastname: Griffiths
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Penfold
authors.affiliation: Institute of Nursing Science, University of Basel, Basel, Switzerland Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Anderson
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Glenn
authors.initials: G
authors.lastname: Robert
authors.affiliation: Faculty of Population Health Sciences, Institute of Epidemiology & Health, UCL, London, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Pizzo
authors.affiliation: Independent researcher, Winchester, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Murrells
authors.affiliation: Business School, Imperial College, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Barlow
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006272:Health Facility Environment; D017721:Hospital Costs; D006749:Hospital Design and Construction; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D061214:Patient Safety; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010362:Patients' Rooms; D011369:Professional-Patient Relations; D006113:United Kingdom
keywords: Human factors; Infection control; Nurses; Patient safety; Patient satisfaction