Contents lists available at ScienceDirect Health & Place journal homepage: www.elsevier.com/locate/healthplace Making space work: Staff socio-spatial practices in a paediatric outpatient department Tineke Water a, ⁎ , Jill Wrapson b , Stephen Reay b , Katrina Ford c a Department of Nursing, Auckland University of Technology, Auckland, New Zealand b Auckland University of Technology, Auckland, New Zealand c University of Auckland, Auckland, New Zealand ARTICLE INFO Keywords: Therapeutic landscapes Paediatric Space/place Healthcare practitioners Work Qualitative analysis ABSTRACT Studies of the characteristics of therapeutic landscapes have become common in medical geography. However, there is limited analysis of how therapeutic landscapes are produced. Based upon the qualitative theoretical thematic analysis of focus group data, this study examined the spatial work carried out by healthcare practitioners in a paediatric outpatients’ department, turning unsatisfactory space into a therapeutic place. The study highlights the spatial strategies employed by staff to mitigate socio-spatial deficiencies in the healthcare environment. Staff perceived the task of making space work as an integral part of their duty of care to patients and an important facet of their professional identity. This study concludes that many of the spatial aspects of health care practice are often taken for granted. However this may hide the crucial role that health professionals have in producing places that heal. 1. Introduction The notion of ‘place’ and its significance to health care environ- ments has been analysed over a variety of settings reflecting a ‘spatial turn’ that has taken place in the social sciences research (Bondi, 2005; Kearns and Moon, 2002; Martin et al., 2015; May and Thrift, 2001). The ‘spatial turn’ can be traced from conventional assumptions of place as stable with fixed boundaries, content and time, through to a relational view of place as fluid, dynamic, temporal and therapeutic (Andrews, 2016). References to ‘therapeutic landscapes’ in the litera- ture of medical geography have become so numerous as to be almost ubiquitous (Smyth, 2005; Williams, 2007). However, less attention has been given to how these therapeutic spaces are produced in health care settings. The socio-spatial nature of the work done by health profes- sionals to construct therapeutic environments is an area of research and practice that warrants further attention. This paper examines the productive aspect of the relationship between people, health and space, by focusing upon the spatial practices of staff in a busy outpatients’ department of a children's hospital. It is argued that the creation of therapeutic spaces is a constant process of production and reproduc- tion by staff, as they attempt to mitigate the undesirable effects of poor spatial design upon patient experiences. This is achieved through a range of apparently mundane but significant spatial practices which contribute to making space work. 1.1. Spatial practices of health professionals The critical analysis of these health professionals’ spatial practices rests on the proposition that place is constituted by, and is constitutive of, social relations. As Kearns and Moon (2002) note, traditional medical geography tended to regard place as an unproblematized container where activity occurred. By contrast, the well-established approaches of health geography emphasise the constructed meanings and the experiential aspects of place (Kearns and Joseph, 1993). Bondi (2005) describes place as ‘social relations stretched over space’. Kearns and Joseph (1993) suggest that it is space that will shape the character of places as ‘experienced’ or ‘socio-spatial’. Space has an active role in the production of meaning and identity; not as “a ‘frame’ or ‘container’ for lived experience but…a ‘tool of thought and action’ through which individuals ‘give expression to themselves’” (Halford and Leonard, 2003, p. 202). At the same time as being part of the production of meaning, space itself is regarded as produced through action and interaction (Gilmour, 2006). Because space is not a neutral backdrop, it therefore follows that constructions of space can uphold dominant cultural discourses, social divisions and inequalities in medicine. Within this understanding, the spaces in which health care occurs no longer disappear into the background, but are foregrounded as an essential part of the construction of health care. As Martin et al. (2015) note, “hospital buildings are more than mere backdrops to medico- https://doi.org/10.1016/j.healthplace.2018.01.007 Received 1 August 2017; Received in revised form 9 January 2018; Accepted 26 January 2018 ⁎ Correspondence to: Department of Nursing, Auckland University of Technology, North Campus, Private Bag 92006, Auckland 1142, New Zealand. E-mail address: tineke.water@aut.ac.nz (T. Water). Health & Place 50 (2018) 146–153 Available online 22 February 2018 1353-8292/ © 2018 Elsevier Ltd. All rights reserved. MARK