Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: A mixed methods study protocol.

Introduction
Traditionally, wards in acute care hospitals consist predominately of multi-occupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the United Kingdom (UK) National Health Service (NHS) advocating for single room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multi-occupancy bays on patient care and organisational outcomes.

Methods and analyses
This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP) – WP1 is a quantitative data extraction of routinely collected patient and staff data, while WP2 is a mixed methods process evaluation consisting of one-to-one, in-depth, semi-structured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff.

Ethics and dissemination
Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high impact journals, and presented at relevant conferences.

Strengths and Limitations of this Study
• A multi-method study using innovative and interdisciplinary approaches to explore the impact of a new ward environment on patient and staff experiences and outcomes.
• Using a mixed methods approach provides an opportunity to gain rich and meaningful data from patients and staff over three different clinical areas.
• Study findings will inform future hospital design at the research setting and potentially, other NHS Trusts.
• Being a single site study and the sampling technique in qualitative interviews may limit transferrability and applicability of study findings.