The Impact of Facility Layout on Service Worker Behavior: An Empirical Study of Nurses in the Emergency Department

Problem definition: We study the impact of service facility layout on how service workers organize their tasks. We focus on the hospital emergency department (ED) as a service setting in which nurses (servers) have discretion over how they interact with patients (customers) in a facility that introduces significant heterogeneity in necessary walking distance. Academic/practical relevance: Prior studies on facility layout in operations have largely focused on the direct effect of transit times on reduced productivity. We extend this work to show how skilled service workers such as nurses adapt their work behavior to enhance their productivity in response to facility layout constraints. Methodology: To study this empirically, we utilize a unique data set consisting of infrared nurse location tracking data, patient electronic medical record data, bedside patient call data, and the architectural floor plan of a large academic ED. Results: Nurses working in a busy ED appear to reduce their walking distance by batching their tasks to distant patient rooms. Although the patients in these rooms receive the same amount of care time, this behavior results in longer wait times between nurse visits and more nurse call button activations, but it does not compromise the overall quality of care delivered. Nurse call button use is linked with poor patient satisfaction and interrupts nurse workflow. Managerial implications: These findings show that even in services, facility layout can lead to servers using task timing discretion in ways that help the server but lead to a additional waiting time for the customer. We propose countering the negative effects of distance-based task batching through proactive nurse rounding and operational transparency.