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 where nurses (servers) have discretion over how they interact with their patients (customers) in a facility that introduces significant heterogeneity in necessary walking distance. 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 make adaptations to their work behavior to enhance their productivity in light of facility layout constraints. Methodology: We utilize a unique dataset consisting of infrared nurse location tracking data, patient electronic medical record data, bedside patient call data, and the architectural floor plan, to study this empirically. Results: Nurses working in a busy ED reduce their walking distance by appearing to batch their tasks to distant patient rooms. While 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. Nurse call button use is linked with poor patient satisfaction with care, and interrupts nurse work flow. Managerial Implications: These findings show that even in services, facility layout can lead to servers with discretion over task timing using that discretion in ways that help the server but that lead to reduced perceived customer quality. The negative effects of distance-based task batching can likely be addressed through proactive regular rounding by the service provider, or improved operational transparency for the patient.