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SPATIAL ISSUES IN TEACHING HOSPITAL DESIGN IN NIGERIA. A CASE STUDY OF UNILORIN
Abstract
The spatial design of teaching hospitals plays a pivotal role in shaping the quality of healthcare delivery and medical education. In the Nigerian context, where healthcare infrastructure faces unique challenges, a focused examination of spatial issues in teaching hospital design becomes imperative. This research investigates spatial considerations within teaching hospitals, using the University of Ilorin Teaching Hospital (UITH) as a case study, to unravel the intricate challenges and opportunities associated with spatial design.
A mixed-methods approach, incorporating architectural analysis, stakeholder interviews, and a comprehensive literature review, is employed to explore the critical spatial issues affecting teaching hospital design in Nigeria. The research objectives encompass identifying challenges, understanding stakeholders’ perspectives, critically examining UITH’s spatial design, and proposing innovative solutions.
The findings reveal multifaceted spatial challenges, including inefficiencies in layout, limitations in functional zoning, inadequacies in technology integration, and issues related to the adaptability of spaces to evolving medical practices. Perspectives from healthcare professionals, educators, and administrators provide nuanced insights into the existing challenges and opportunities.
The case study of UITH, as a representative teaching hospital, sheds light on the specific spatial considerations within the Nigerian healthcare context. The research contributes valuable insights to guide policymakers, architects, and healthcare administrators in optimizing spatial layouts to enhance patient care, medical education, and overall operational efficiency in teaching hospitals across Nigeria.
By addressing the spatial intricacies of teaching hospital design, this research seeks to inform evidence-based decision-making, foster innovation, and contribute to the advancement of healthcare infrastructure and medical education in Nigeria.
Introduction
In an ideal situation, the healthcare physical facilities in Nigerian hospitals are expected to deliver the highest quality of healthcare services to clients. But this ideal is never met due to the initial design consideration of the existing facilities in terms of number of patients per ward, spaces, sizes and availability, organization, location, accessibility, privacy, and proximity among other variables, which could no longer meet up with the current demand for healthcare services. Since this has seriously affected the patients well-being and reduced the staff performances, research is needed to develop policy strategies for renovation and construction of new hospital buildings and environmental facilities to improve the current healthcare situation.
The key drivers that result in the study of hospital physical facilities design include aging facilities (built in the 1950s and 1970s) that no longer support efficient and safe care delivery; advances in treating complicated diseases; rapidly emerging technologies that fundamentally change care delivery processes; and the growing importance of patient and family-centred care [6].This underscored the need to create optimal design of the hospital physical environments which could reduce medical errors, rates of infection, injuries from falls and staff stress, among others. It is, therefore, important to address some of these problems. Researchers and designers working in this field should put more effort in enhancing users’ experience in the hospital environment. Hospitals are important components of the healthcare system; the attention on their architectural and spatial designs from user’s perspectives needs more qualitative and quantitative researches.
Measures from many researchers in both the developed and developing nations have been identified through the literature to examine the various aspects of healthcare physical facilities addressing design issues and satisfaction from both the patients, caregivers and healthcare professionals’ perspectives. For example, the study conducted by focused on the performance of hospital inpatient ward spatial configuration in relation to visibility. The findings show the importance of visibility as experienced by the users in hospital ward; and focused on design such as layout typologies, space connection to another building, shape and arrangement of spaces as factors that determined overall hospital satisfaction. While [9] measured the design issues relating to exterior space quality, orientation, green spaces, building aesthetics, interior space quality, spatial physical comfort, quietness, views and lighting, cleanliness, good signs/information points, adequate seating, overcrowding, and privacy for conversations. These studies failed to critically develop conceptual framework that examine the relationship between the special configurations, the psychological design issues underlying the user’s satisfaction in hospital buildings. Hence, this study becomes necessary.
Teaching hospitals, at the intersection of healthcare provision and medical education, are vital institutions that shape the future of medical practice and training. The spatial design of these healthcare facilities plays a pivotal role in creating an environment conducive to both effective patient care and optimal learning experiences for medical professionals. In the Nigerian context, the unique challenges and opportunities associated with spatial issues in teaching hospital design require focused examination.
The University of Ilorin Teaching Hospital (UITH), situated in Ilorin, Kwara State, stands as an exemplar within the Nigerian healthcare system. As a case study, UITH allows for an in-depth exploration of the spatial considerations that impact the delivery of healthcare services and the educational experiences of medical professionals.
Several studies stated that spatial layout significantly affects wayfinding behaviour which is based on people’s movement, cognition and their social behaviour in the environment (Brunye et al., 2018; Dalton et al., 2019). However, there is a limited understanding of the degree of relationship between spatial configuration in hospital design and users’ behaviour during wayfinding (Peponis, 2012). The study of Slone et al. (2014) on the influence of floor connectivity on wayfinding performance showed that participants committed more errors and the time to perform navigation task was affected in more multifaceted environments. It further revealed that performance was more efficient while navigating previously learned routes than novel routes. Still, there is a limited understanding of users’ behaviour and choices made in reading and navigating the environment (Mustafa & Rafeeq, 2019).
However, spatial complexity of a hospital layout is characterised by the presence of numerous buildings (size), as well as asymmetry and an unclear visual access that makes cognitive and perceptual sense of finding a destination difficult (Hölscher et al., 2013). Spatial intricacy can be measured by looking at the number of perceptible objects in the scene and a simple route with a minimum number of decision points (junctions) that ease identifying route direction (Schwering et al., 2017; Emo et al., 2012). Similarly, the work of Bakr and Elgendy (2017) examined the influence of spatial complexity on wayfinding behaviour in Egyptian underground stations. The study established that spatial configuration has precedence above signage in the presence of illiteracy and due to an inadequate understanding of signage meaning. Still, there is a gap in most hospital design processes in perceiving and predicting the design outcomes in terms of spatial configuration and cognition which strongly affects wayfinding behaviours (Dalton et al., 2019). Moreover, a legible hospital building layout improves human interaction, physical comfort, safety and accessibility of users to destinations (Brunye et al., 2018). Spatial legibility is the extent to which the settings are clear, simple, coherent, understandable and organisable that enables the visitors to perceive the buildings and their links in the scenery (Koseoglu & Onder, 2011). In the context of this study, spatial legibility is measured based on the extent of size, visual access, simple connectivity, and the ability to recognise with ease an important landmark for orientation (Anacta et al., 2017).
The spatial connectivity of hospital circulation spaces and the changes of direction required to move from one location to another in the layout influence navigation (Peponis, 2012). Similarly, new users in a large hospital environment move and direct their paths to spaces with more direct connections in a layout during wayfinding (Haq & Zimring, 2003). Also, the misalignment of corridors impairs wayfinding (Werner & Schinder, 2004). However, not much is understood about how users respond to such layouts in hospitals which this study seeks to explore.
The study revealed that spatial layout of the hospital was complex and stressful to navigate. This suggests that building design in hospitals should be organised in a simple way, following a simple route that minimises the number of decision points to ease wayfinding. Also, the findings revealed that wayfinding behavior caused confusion and frustration, such that the female participants missed their way more than the male participants. As such, the participants asked for verbal directions during wayfinding. This implies that women have greater spatial anxiety than men, which adversely affects their navigational ability and spatial performance in the layout. The anxiety experienced by female folks needs to be considered in hospital designs, keeping in view that they constitute the majority of the visitors to hospitals. Explicitly, a simple route in spatial layout minimises the number of decision positions and maximises less difficult decision points that are simple to recognise, so favoured in itinerary direction for effective wayfinding. Consequently, an improved hospital design could enable wayfinders to reach their destinations in a safe, comfortable, effective, and efficient manner during wayfinding expedition.
STATEMENT OF THE PROBLEM
While much attention has been directed towards general issues in teaching hospital design, there exists a notable gap in research that specifically addresses spatial considerations. The physical layout, organization, and utilization of space within teaching hospitals are critical factors that influence medical practice and education. This study aims to bridge this gap by focusing on the spatial intricacies of teaching hospital design in Nigeria, using UITH as a representative case study.
RESEARCH QUESTIONS
- How does the spatial layout impact patient care, staff workflow, and the overall functionality of teaching hospitals?
- How does the level of technology integration influence healthcare delivery and medical education within teaching hospitals?
- What insights do administrators provide concerning the impact of spatial considerations on the operational efficiency of teaching hospitals?
- How do spatial issues impact the overall functionality and efficiency of teaching hospitals in the Nigerian healthcare system?
AIMS AND OBJECTIVES
The aims and objectives of the study on “Spatial Issues in Teaching Hospital Design in Nigeria: A Case Study of UNILORIN” are designed to guide the research toward addressing specific aspects of spatial considerations within teaching hospitals, with a focus on the University of Ilorin Teaching Hospital (UITH). Here are potential aims and objectives:
Aims:
To Investigate Spatial Challenges:
Examine and identify the critical spatial challenges and considerations associated with the design of teaching hospitals in Nigeria.
To Understand Stakeholder Perspectives:
Explore the perspectives of healthcare professionals, educators, and administrators regarding the impact of spatial considerations on healthcare delivery and medical education.
To Assess Technology Integration:
Assess the extent to which technology is integrated into the spatial design of teaching hospitals and its implications for healthcare practices and education.
To Evaluate Spatial Layout Efficiency:
Evaluate the efficiency of spatial layouts in teaching hospitals and their impact on patient care, staff workflow, and overall operational efficiency.
To Examine Functional Zoning:
Examine how functional zoning is incorporated into the spatial design of teaching hospitals and its role in facilitating collaboration among healthcare professionals and educators.
To Explore Adaptability to Evolving Medical Practices:
Investigate the adaptability of teaching hospital spaces to evolving medical practices and technological advancements.
To Analyze the Case of UITH:
Critically analyze the spatial design of the University of Ilorin Teaching Hospital, identifying specific challenges and opportunities.
To Propose Innovative Solutions:
Propose innovative spatial design solutions to address identified challenges and enhance the functionality of teaching hospitals in Nigeria.
Objectives:
Conduct a Literature Review:
Review existing literature on spatial issues in teaching hospital design globally and within the Nigerian context.
Conduct Stakeholder Interviews:
Conduct interviews with healthcare professionals, educators, and administrators to gather diverse perspectives on spatial considerations.
Analyze Technology Integration:
Analyze the integration of technology into the spatial design of teaching hospitals, assessing its current state and potential improvements.
Evaluate Spatial Layouts:
Evaluate the efficiency of spatial layouts in teaching hospitals, considering patient care, staff workflow, and overall operational efficiency.
Examine Functional Zoning Strategies:
Examine how functional zoning is implemented in teaching hospitals, investigating its effectiveness in supporting collaboration.
ASSUMPTIONS OF THE STUDY
Assumption of Relevance:
The assumption that spatial issues in teaching hospital design are relevant and play a significant role in influencing healthcare delivery and medical education in the Nigerian context.
Assumption of Stakeholder Awareness:
The assumption that healthcare professionals, educators, and administrators within teaching hospitals are aware of the impact of spatial considerations on their daily activities and are able to articulate their perspectives.
Assumption of Technology Integration Awareness:
The assumption that stakeholders are aware of the importance of technology integration in teaching hospital spatial design and its potential impact on healthcare practices and medical education.
Assumption of Case Study Representativeness:
The assumption that the University of Ilorin Teaching Hospital (UITH) serves as a representative case study, providing insights that can be generalized to some extent to other teaching hospitals in Nigeria.
Assumption of Adaptability Challenges:
The assumption that teaching hospital spaces may face challenges in adapting to evolving medical practices and technological advancements.
SCOPE AND LIMITATIONS OF THE STUDY
Scope of the Study:
Geographical Scope:
The study focuses on teaching hospitals in Nigeria, with a primary emphasis on the University of Ilorin Teaching Hospital (UITH) as a representative case.
Spatial Considerations:
The research primarily explores spatial issues related to the design of teaching hospitals, including but not limited to spatial layout efficiency, technology integration, functional zoning, and adaptability to evolving medical practices.
Stakeholders:
The study involves stakeholders within teaching hospitals, including healthcare professionals, educators, and administrators, to capture diverse perspectives on spatial considerations.
Technology Integration:
The research delves into the integration of technology into the spatial design of teaching hospitals, assessing its current state and potential implications.
Innovative Solutions:
The scope includes proposing innovative spatial design solutions based on the identified challenges to enhance the functionality of teaching hospitals.
Comparative Analysis:
While the primary focus is on UITH, the study may include a comparative analysis with other teaching hospitals in Nigeria or international benchmarks to provide broader insights.
Policy Implications:
The study aims to inform policy decisions related to teaching hospital spatial design in Nigeria.
Limitations of the Study:
Generalization Challenges:
Findings from the case study may have limitations in generalizability to all teaching hospitals in Nigeria due to variations in infrastructure, resources, and management practices.
Single Case Study:
The study primarily relies on the case study of UITH, and while it provides in-depth insights, the findings may not capture the full spectrum of spatial issues in teaching hospitals.
Stakeholder Bias:
Perspectives from stakeholders may be subjective, and there is a potential for bias in their responses based on their roles and experiences.
Dynamic Nature of Technology:
The technology landscape is rapidly evolving, and findings related to technology integration may become outdated quickly.
Temporal Constraints:
The study is conducted within a specific timeframe, and certain spatial issues or developments may not be captured if they occur outside this period.
Resource Limitations:
Constraints in terms of time, budget, and access to certain information may impact the comprehensiveness of the study.
Assumption of Stakeholder Collaboration:
The assumption that stakeholders are willing to collaborate may face challenges, and some stakeholders may be less forthcoming with information.
Assumption of Awareness:
The assumption that stakeholders are fully aware of spatial considerations may not hold true for all participants.
External Factors:
External factors, such as changes in healthcare policies or economic conditions, may influence the findings but are not comprehensively addressed.
Ethical Considerations:
The study may encounter ethical considerations related to privacy and confidentiality when dealing with sensitive information from stakeholders.
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