Transitioning from traditional hospital design to activity-based care: A longitudinal case study of differential occupational health and safety consequences across clinical settings and professional roles

The activity-based care (ABC) model, adapted from activity-based offices, has emerged as a new approach to healthcare facility design. Evidence on its consequences for occupational health and safety-relevant outcomes remains limited. The study examines how transitioning from a traditional hospital design to the ABC model is associated with changes in employee experiences of task–environment alignment and psychosocial work environment, self-reported health, sick leave and turnover over time, and differences in changes across professional roles and clinic types. A repeated-measures survey was conducted in an outpatient hospital unit across 10 specialised clinics. Data were collected 3 months before relocation and at 6 and 18 months post-relocation. Generalised least-squares models examined change over time and tested interactions with professional role and clinic type. Sick leave and turnover were analysed over approximately 1 year before and after relocation using segmented interrupted time-series regression. Ratings of task–environment alignment varied across clinic types and professional roles. Consultation-based clinics and physicians and administrative employees showed persistent declines over time, while surgical/radiology clinics and nursing roles remained stable or improved. Stress and recovery indicators worsened similarly across all groups. Psychosocial conditions were stable, though job satisfaction, perceived quality of work and referral intentions declined. Turnover remained unchanged, while sick leave varied across contexts and roles. The consequences of ABC implementation are not uniform but depend on the alignment of the redesigned workspace and the task demands of different clinical settings and professional groups, a contingency that cannot be easily detected with single time-point post-occupancy evaluation.