Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of "Neighborhoods" in a Pediatric Intensive Care Unit

Publication Date


UMMS Affiliation

Graduate School of Nursing

Document Type



Architecture | Critical Care | Health Communication | Health Services Research | Nursing | Pediatrics | Place and Environment


OBJECTIVES: The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition.

BACKGROUND: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, "macrocognition in the healthcare built environment" (mHCBE) addresses this relationship.

METHOD: A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data.

RESULTS: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs).

CONCLUSIONS: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how macrocognition in the HCBE can improve physical space by designing new spaces, refining existing spaces, or adapting interprofessional team practices to maximize formal and informal SMI opportunities to improve safety and quality for interprofessional teams, patient, and family care.


architecture, macrocognition, neighborhoods, nursing, pediatric intensive care unit, space syntax

DOI of Published Version



HERD. 2017 Jan 1:1937586717728484. doi: 10.1177/1937586717728484. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title



Susan O'Hara undertook this study as a doctoral student (view her dissertation) in the Graduate School of Nursing at UMass Medical School.

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