Kerstin Sailer’s research while affiliated with University College London and other places

Lengthy waiting times for ophthalmology appointments in the UK National Health Service (NHS) increased further in the immediate aftermath of the Covid-19 pandemic, necessitating a different approach to triaging patients safely and at speed. Moorfields Eye Hospital NHS Trust therefore opened an additional diagnostic hub designed with a linear spatial layout and patient flow system, which is analyzed in this paper in comparison to an existing clinic. We integrate direct observations of patient flows, and an architectural layout analysis based on space syntax methods with queuing simulations from operations research and show that the two clinics operate differently and that both clinics have their advantages and disadvantages. The newly opened clinic with a lane system supports flows and coordination by line of sight between stations, which contrasts with a lack of sightlines in the existing clinic. The latter layout with clusters of stations compensates by enabling a more organic flow especially in conjunction with experienced technicians, which is beneficial when the clinic gets busy. When high patient load is simulated in the queuing models, the lane system results in slightly bigger bottlenecks and longer clinic durations. An ideal allocation of the number of stations to diagnostic activities based on clusters is suggested. This work stands in the tradition of combining architectural and operations research. By reflecting on the variability of diagnostic processes found in our observations, we contribute to the understanding of routines as performative. We also add insight to the growing field of evidence-based design, particularly by highlighting the importance of line-of-sight relationships in ophthalmology.

Purpose: To describe the research principles and cohort characteristics of the multi-disciplinary Project HERCULES, which evaluated implementation of an innovative model of high-volume outpatient eyecare service to monitor patients with stable chronic eye diseases. The rationale was to improve capacity and efficiency of eyecare in the National Health Service (NHS) in England through the creation of technician-delivered monitoring in a large retail-unit in a London shopping-centre, with remote asynchronous review of results by clinicians (named Eye-Testing and Review through Asynchronous Clinics (Eye-TRACs)). UCLs Bartlett School of Sustainable Construction produced the RIBA (Royal Institute of British Architects) Stage 1 briefing requirements for optimal design specifications and operational parameters for this new model of care from first principles research, by analysing and developing ergonomic data from multiple iterations. Participants: Patients aged 18 years or above being monitored in secondary care in Moorfields Eye Hospital NHS Trust for stable glaucoma or retinal conditions were given appointments at Eye-TRAC at Brent Cross, London. Willing participants were recruited when attending Eye-TRAC from September 2021- November 2023 and formed the intervention cohort. The comparator cohort consisted of patients that continued to be monitored in secondary care during the same period. Other than residence of the participants, there were no other demographic or disease severity differences in this cohort. Additionally, anonymised data from across the Trust informed an analysis of the impact of opening the Eye-TRACs on Trust-wide waiting times. A nationwide stakeholder preference survey of health-care professionals, members of the public and ophthalmology patients was carried out. Findings to date and conclusion: 41,567 patients attended the Brent Cross Eye-TRAC between September 2021 and November 2023. 5,539 patients were recruited to Project HERCULES. Four spatial iterations, with different configurations of equipment were investigated in succession. Spatial configurations promoting independently parallel patient journeys with limited queuing, and direct line of sight between diagnostic stations, supported efficient patient flow. The latter iteration incorporated cataract clinics. Although it added more system complexity, it enabled the evaluation of a further indication for use of Eye-TRAC. Future plans: Qualitative analysis of patient and staff feedback alongside rapid ethnographic work to streamline services is under way. We seek to develop a framework to help inform NHS guidance for ophthalmology and other outpatient diagnostic services. Our data will be analysed to identify enhancements to further streamline operational efficiency. We will identify and enumerate limitations in information technology that create bottle-necks in the review process.

In this paper, we explore the mutual effect of prior background expectations and visibility afforded by the 3D configuration of the physical environment on wayfinding efficiency and strategy in multilevel buildings. We perform new analyses on data from 149 participants who performed six unaided and directed wayfinding tasks in virtual buildings with varying degrees of visibility. Our findings reveal that the interaction between visibility and prior background expectations significantly affects wayfinding efficiency and strategy during between-floor wayfinding tasks. We termed this interaction effect strategic visibility, which emphasizes the importance of the strategic allocation of visibility towards actionable building elements in promoting efficient wayfinding and shaping wayfinding strategy. Our study highlights the significance of strategic visibility in promoting inclusive and accessible built environments for neurodiversity. Finally, we provide an open-source dataset that can be used to develop and test new wayfinding theories and models to advance research in the emerging field of human-building interaction.

An unwanted experiment of prolonged periods of working away from the office was forced on many societies by the COVID-19 pandemic. In the three years since the COVID outbreak, many organisations have shifted to hybrid work practices by mixing working from home with office-based work. Unsurprisingly, a plethora of both academic and grey literature has been published on hybrid work since 2020. This paper scans that literature in order to understand some of the most important questions emerging and compares these with the experience of a small sample of UK-based participants living and managing in this rapidly changing environment. Considering different disciplinary domains (human resources, management, architecture, real estate, technology), the literature in conjunction with the lived experience highlights real tensions surfacing between individual choices, worker wellbeing and organisational needs. Stuck in the middle of these perpetual conflicts are middle managers trying to make things work day-to-day. It is argued that the implications of hybrid work are potentially as profound as those of Taylorism in the early 20th century. Based on the foundations of architectural sociology, a holistic socio-spatial approach is proposed that responds to the rapidly changing world of work. Practice relevance Leaders of organisations need to pay attention to how profound are the changes imposed by hybrid work and to monitor their potential impacts. The dangers of not doing so are manifest as organisations run the risk of inadvertent discrimination and marginalisation, of creating siloes, of damaging their innovative capacity, and of burning out their employees. Middle managers are living with the tensions and conflicts caused by this revolution on a day-to-day basis. The changes in physical space and technology, although evident, are rarely quick or radical enough to strengthen the working practices already in place. Supporting the workforce by investing in these areas will help the transition to more effective hybrid work practices for everyone.

Organisations wishing to combine working from home with some office-based activities in a so-called hybrid model seem to struggle knowing where to start and how to decide what is right for them. In this paper we address this apparent lack of strategies on how to make decisions around a hybrid office and develop a systematic framework covering five distinct aspects of the post-pandemic office: 1) Where will staff work? 2) How will the office be organised spatially? 3) How do management and practices need to adapt? 4) What to do with existing real estate? 5) What technology will support this? The COVID-19 pandemic has provided a natural experiment for many organisations to trial working from home at speed and at scale. Employees have adopted these more flexible practices, and many are now demanding a different approach to physical office space allowing them to work from home for 2-3 days a week. In setting their return to the office policies, organisations find themselves faced with tricky decisions to make to be able to balance competing objectives with newly introduced variables. A review of the latest published research, surveys and articles covering the topic of hybrid working. By defining a series of parameters and spelling out decisions, options and parameter interplay as well as potential outcomes such as collaborative cultures, learning, onboarding, knowledge exchange, coordination or well-being, this framework allows organisations to ask themselves a series of relevant questions, helping to reflect on the hybrid office, its possible shapes and variations, and how those might support desired organisational outcomes and strategies. This newly developed framework will help organisations who wish to adopt hybrid working to decide where to start from and understand hidden implications of certain decisions and their interdependencies.

Gebäude sind soziale Gebilde. Sie kanalisieren und verteilen Bewegungsströme und strukturieren, wem wir wo und wann begegnen. Architekt*innen haben es in der Hand, wie offen für soziale Interaktionen ein Gebäude durch seine räumliche Anlage und sein Vermögen, Menschen zusammenzubringen oder voneinander zu trennen, werden kann. Folgt man diesem Gedanken von Bill Hillier und Julienne Hanson, den diese in den 1980er-Jahren als Theorie der Raumsyntax (space syntax) entwickelten, könnte man meinen, die räumliche Anlage selbst orchestriere das Zustandekommen, die Frequenz und die Verteilung von Aktivitäten im Raum. Trifft diese Annahme auch in Bezug auf das Thema der Lernräume zu?

Apart from providing essential care for elderly inhabitants, a well addressed purpose of community-based elderly care facilities is to promote social integration through encouraging visitors from the neighbourhood to continuously participate in activities and use services offered by the facility. The location of care facilities and their local environment have been widely argued to constitute a critical factor for older people’s continuous participation, which induces the formation and maintenance of personal networks between the different user groups, as well as a sense of attachment. However, existing literature on care facility location and older people’s participation predominantly uses qualitative methods, and often applied to a single case. This causes ambiguity and controversy when comparing findings from different cases and also makes the generalisation of study findings problematic. This paper introduces a spatial network model which based on Space Syntax theory to explicitly describe spatial relations between care facilities and urban fabric. With a large dataset of social participation records from 91 community-based elderly care facilities in the Chinese city of Nanjing, the study will investigate how differentiated locational properties exert influence on patterns of older people’s social participation. Findings indicate that local-scale spatial properties could influence occurrence patterns of social participation in care facilities, and the mechanism local-scale spatial properties exert influence varies in differentiated global-scale spatial contexts.

The importance of school buildings is rooted in the vitality of education for societal development. Literature perceives learning as a social process, enriched by student interactions and self-directed activities, and the school design should afford those learning practices. The term afford refers to spatial affordances which are defined, in this paper, as the set of possibilities for activities offered by the spatial design to students. Therefore, research on school buildings requires a broad investigation of the spatial design, to uncover the design potentiality and explore the actuality of school operation, in terms of the occurring student interactions and self-directed activities (as representations of social learning). This investigation outlines the research scope, while more attention is drawn towards informal learning spaces outside classrooms, including corridors, open-plan studios and social spaces. This paper focuses on the affordances of the spatial design of secondary school buildings. It presents the outcome of quantitative spatial analysis (using Space Syntax tools) on eleven UK schools, designed by three architecture firms, supported by qualitative interviews with the architects of those schools. This data set explores the school design potentiality for possible learning practices. The paper, thereafter, presents quantitative recording of student interactions and self-directed activities in two of the eleven schools, supported by qualitative interviews with the school managements and teachers; and student questionnaires. This data set explains the actuality of student interactions and self-directed activities, relative to operational managerial schemes and student preferences. Findings discuss the influence of functionalities allocation and configurational accessibility on student interactions, activity types and distribution. This is portrayed through the example of school corridors which afford interactive learning if being highly accessible and connected to open learning spaces. Nevertheless, operational managerial schemes and student preferences still influence the occurring activities. The research outcome explains the school actual operations, and how they correspond to (or divert from) the original design potentiality. This outcome contributes to the existing knowledge on the student social life in schools, and how the spatial design and school rules impact activity types across informal spaces. This possibly links to futur e work on interactive design processes that include architects, teachers and school managements to reduce the gap between school design intentions and operation.

Social network analysis offers powerful ways to investigate personal relationships, however, to date little work has explored the more routinized, impersonal work processes present in bureaucratic organizations. Asking whether network analysis has insights to offer into routine work, this paper investigates a data set of direct observations of diagnostic care processes in ten outpatient clinics of two different hospitals. Instead of networks of agents, this study constructs so called action networks, tying together sequences of tasks into networks structures. Following the strong social networks tradition of considering contexts, this paper examines the architectural layout of a setting as key variable. Drawing in particular on ecological approaches to the study of networks by focusing on variability, it is hypothesized that the spatial configuration of clinics is associated with performativity, i.e., a more varied set of sequences to emerge within more open-plan layouts. Results indicate that this is the case, showing how different sets of routines emerge in different types of layout depending on their spatial openness. Variability in routinization is also found between doctors, nurses and clerks, highlighting ecological niches. Network density as well as edge-weighted centralization turned out to be useful metrics for performativity. The work presented contributes to the study of bureaucratic organizations, making a case that social network methods can be fruitfully applied to impersonal, routinized and rule-driven relations.