Making 'invisible architecture' visible: A comparative study of nursing unit typologies in the United States and China

Rapidly increasing needs for better healthcare in China are resulting in massive investments in healthcare facilities. This once-in-a-lifetime construction boom provides a valuable opportunity to rethink Chinese hospital design, and especially to consider how to design modern hospitals that are effective and efficient in delivering care, and are responsive to the cultural needs of the Chinese people as well.;The particular socio-cultural factors under consideration in this study focused on communicational needs that had been identified as being very important for the optimum organizational performance of nursing units. The study identified these needs through a thorough review of both the national schema and the organizational culture of Chinese nursing units. The specific communicational needs of Chinese care teams were then translated into spatial metrics based on an extensive review of previous space syntax studies on spatial configurations and communication.;In order to find out whether Chinese nursing unit designs have been adapted to fit specific models of communications which were strongly influenced by culture, an indepth comparative study was developed that included six U.S. and six Chinese nursing units, with each representing an example of one nursing unit typology. The comparisons were conducted under a holistic framework encompassing four main factors as drivers of nursing unit designs: space economy, staff efficiency, access to optimal (southern) natural light, and cultural preferences in terms of face-to-face communication. Key metrics were proposed for a quantitative evaluation of each factor. For space economy, measurements included corridor length per bed, corridor length per patient room, area per bed, and the composition of various zones. Staff efficiency measures included furthest distance from nursing station(s) to patient rooms, average distance from nursing station(s) to patient rooms, and average distance from nursing station(s) to patient beds. For natural light, the percentage of patient beds that have access to southern sunlight was calculated. To evaluate how space supported cultural preferences of communication, spatial metrics were proposed; including mean connectivity, mean integration, intelligibility of the layout, and the rank order of integration values of various functional zones for the analysis on visibility and accessibility. The number of axial lines per space and the structure of colored axial maps were also taken into consideration.;The results revealed significant national differences in the application of unit typologies between the U.S and China. It shows that Chinese nursing unit designs have been modified from the Western precedents to adapt them to local economic conditions, different requirements for efficiency, the Chinese preference for southern natural light, the task-based care model, and the unique socio-cultural needs as defined by the Chinese national schema.;This study is the first of its kind exploring the cultural dimensions of nursing unit designs. It provides a comprehensive description of the design evolution of Chinese healthcare architecture, with a special focus on nursing units. Moreover, it provides an indepth examination of the relationship between nursing unit typologies, communication, and the complexity of national and organizational culture in healthcare settings. The theoretical framework, the research methodology, and the findings can be applied beyond the Chinese nursing units and extend to other cultural and organizational contexts.