Previously,
designing clinical spaces for well-being was focused primarily on the
patient. Now, taking care of patients is table stakes; caring for the
people who serve them is crucial to creating and maintaining a
high-performing hospital system.
Designing
buildings for the well-being of health care staff is not just necessary
to curb the mental health crisis among the profession. It’s also
critical to buttress the financial fallout that ensues with high
turnover, preventing additional strain on a system already taxed from
financial losses due to differed treatment during the pandemic.
These
numbers have prompted hospitals to rethink their approach to the
physical environment and incorporate research-based design strategies
that improve well-being for both patients and the staff guiding their
recovery. Below, we outline three lessons for designing hospitals and
clinics based on current projects NBBJ is working on with Massachusetts
General Hospital, Atrium Health, Loma Linda University Medical Center,
and Montage Health.
Lesson 1: Employee mental health can be part of a building’s identity.
Massachusetts
General Hospital (MGH) in Boston is currently building a 482-bed
expansion called Cambridge Street that focuses on staff and patient
satisfaction, operational efficiency, and environmental stewardship.
Several years ago, NBBJ also oversaw the creation of MGH’s 150-bed Lunder Building.
Both facilities offer key insights into how seemingly simple design
interventions can have a significant impact on the mental well-being of
staff members.
It’s
important to note that what we recommend are not amenities, even if
some may call them that. Rather than focusing on the “nice to have”
perks found in tech company headquarters, many of the spaces in MGH’s
facility are “must haves” given the fact lives are on the line:
stairwells flooded with light, deliberately quiet patient floors, and
safer working conditions, for example.
The
Lunder building offers plentiful access to daylight through a
glass-encased stairwell used only by staff, who have adopted the
corridor as a de facto meeting space (nicknamed the “stair conference
room”). Staff also use this stairwell as a place to “be alone together”
and report that they find comfort watching employees traverse the
stairwell while they use the space to think and decompress.
The building further expands staff’s exposure to daylight — which impacts work-related stress and job satisfaction and is found to affect clinician burnout — through corridors that allow staff to access rooms from an exterior wall. Since less noise can reduce stress among caregivers
and also help patients recover from illness, the Lunder building uses a
variety of sound-absorbing materials and techniques to make the patient
floors 35% quieter than typical health care buildings. Other features
designed to minimize noise include sliding doors, distributing work
zones for clinical staff across the floor rather than in a single
location, and elevators and visitor waiting areas located away from
patient rooms.
Finally,
staff safety is perhaps the most critical “amenity” of all. For
example, overexertion — in the form of repetitive routine physical tasks
such as bending, stretching, and standing — account for 45.6% of all
injuries occurring to nurses, according to a 2018 article
published by the U.S. Bureau of Labor Statistics. These injuries can
result in musculoskeletal disorders such as sprains and strains that
accounted for 8,730 days away from work among nurses in the private
industry in 2016. Features such as motorized overhead patient ceiling
lifts or full-height glass doors that provide greater situational
awareness can help reduce injuries.
Designing
buildings in this fashion makes a difference. For example,
post-occupancy data from new inpatient units and staff work areas NBBJ
designed for Atrium Health indicates that vast majority of employees
feel safer and more at ease in the workplace. In the same post-occupancy
evaluation, employees mentioned “the collaborative nature of the
research floor,” “increased interaction with colleagues,” and “improved
team collaboration” as positive aspects of the new building, further
illustrating that opportunities for collaboration and interaction
improve employee satisfaction.
Lesson 2: Design features can reduce stress in core working spaces.
Many
hospitals are embracing support spaces that enable people to choose how
they spend their precious break times. These spaces, both “offstage”
(where staff can gather or be alone) and “onstage” (where caregivers see
patients), allow staff to spend less time navigating a building and
more time recharging.
Loma Linda University Medical Center’s expansion
in Southern California boasts an open-core design. It features wide
corridors, access to daylight, and the distribution of patient and
supply rooms along the wings, which allows staff to connect better with
each other and patients. In open-core hospitals, major support functions
such as staff lockers, break rooms, and conference rooms are in a
centralized hub that connects to patient wings along the exterior. This
layout reduces the need for staff to travel between patient and supply
rooms, the type of inefficient and repetitive physical tasks that can
lead to burnout.
In
addition to open-core designs, collaborative clinician rooms — such as
the new examination rooms at MGH’s Cambridge Street project, which are
sized to allow for multidisciplinary consults — reflect the evolving
nature of medicine. Collaborative clinician spaces decrease the load on
caregivers and their teams while also providing patients with a new,
more effective way to navigate their medical journey.
In
the future, these recharging spaces could take different forms, which
would acknowledge that everyone refuels in a different way. For
instance, because the availability of private spaces has
been shown to reduce caregiver stress some hospitals are exploring
restorative zones with nap areas for their staff that would be located
close to the patient unit for ease of use.
Lesson 3: Good design is ultimately good for business.
Health
systems such as Montage Health on the Monterey Peninsula are taking
advantage of their less-densely-populated location by incorporating
nature into the design of their buildings. For example, Montage’s Ohana Center’s
garden-like environment and private patios for staff are designed to
lower levels of arousal fatigue — the psychological exhaustion that
results from sustained stimulation without breaks. Arousal fatigue is
one of the key factors contributing to burnout among behavioral health
caregivers, who have an annual turnover rate of 40%.
Other
organizations are exploring solutions such as satellite food lockers,
mobile ordering apps, and meal programs that offer discounts for
nutritious food options. These types of design interventions are
investments in staff longevity; they help to reduce stress and encourage
positive lifestyle choices, ultimately supporting the mental and
physical well-being of the people charged with helping others
recuperate.
Behavioral
health challenges existed before the pandemic and will persist after
it’s over. Consequently, as health care systems navigate the lingering
impacts of the pandemic, it’s more important than ever that they shift
towards a more caregiver-centric mindset. Only by creating spaces and
implementing solutions that promote staff well-being and patient healing
at the same time can they effectively retain and recruit staff and
reduce the financial impact of burnout and turnover. Designing buildings
to enhance employees’ well-being will help keep them satisfied and
productive.
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