No Entry: Prohibitions and Violations in Organizational Spaces Across the Patient-Staff Interface in Hospital

Introduction

The objective of the chapter is to analyse the spatial elements of hospital setting that hinder or foster patient engagement. Through the analysis of two empirical cases set in different hospital contexts, examples are provided of how both hospital’s configuration and hospital’s norms on use of spaces may influence the dynamic of encounters between staff, patients and relatives. The research takes into account the patient’s perspective, in particular considering one of the components of the development of patient engagement, that is to say the importance of building a trusted relationship between patient and health staff (Graffigna, Barello, Riva, & Bosio, 2014). In the paper we take into account the relational aspects in using organizational space in the first phase of the process of care, that is to say when the patient and his/her relatives enter the hospital. We highlight two cases in which practices of non-compliance with hospital norms on use of spaces are observed. The paper presents a reflection upon the interaction between the individual and the relational dimensions of patient engagement, in particular the relation patient-health providers and patient-caregivers. The study takes into account the role of spatial elements in the patient’s perception of access and continuity of care process, looking at the patient as a subject involved into a relational context. We take into account not only the perspective of the patient but also the point of view of the caregiver, considering the dyad patient-care giver as representing the consumer in the service offered by the hospital organization. The perspective of health staff (in particular of front office nurses) is analysed as well.