“Every practitioner, nurse, social worker, physician—they are worried for their own health. They’re worried they’re going to bring this home to family members. They’re worried they can’t see their family members. They are feeling exhausted from it. They’re petrified. They’re dealing with human emotions because this has gone now beyond just stress; this is full-fledged trauma.”Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP, DBH(s)
Patient experience has long been discussed at the forefront of healthcare projects, and for valid reason. Facilities providing a perceived positive experience for their patients receive higher HCAHPS scores, one measure in an organization’s Medicare/Medicaid funding levels.
However, as experts in the influence and impact of design on humans, the architecture and design industry cannot neglect or underestimate the value of providing an equally positive experience for staff. COVID-19 has made that exponentially clearer. The physical and emotional toll that frontline healthcare workers face on a day-to-day basis has been exasperated by the pandemic, heightening already concerning levels of burnout and stress, and leading to an increased number of individuals wrestling with grief and even PTSD. “That ‘bank’ of engagement and goodwill is now significantly drawn down, with the emotional exhaustion caused by multiple major public crises making workforce burnout far more prevalent and serious,” says Steven Berkow, vice president of the Advisory Board.
These were all real factors pre-pandemic. In the midst of the pandemic when staff trauma and stress is real-time and at levels many have never experienced, now is the time for a greater focus on fostering a resilient health care workforce, both to retain those already providing the care and recruit those who will be needed to continue the care. Supporting that resiliency takes an environment that promotes resiliency.
Small Changes, Big Impacts
While there are undoubtedly operational improvements that can be made to contribute to a positive work environment for health care workers, there are opportunities through space and design to create positive change as well. Previous strategies to support staff often took the form of a well-designed breakroom, and while those strategies have evolved through the past decade or two with cafeterias and commons areas that are more welcoming, comforting, and have better options, it still relied on a capital expenditure and real estate allocation. As our knowledge of employee health and wellness and their connection to work effectiveness and satisfaction has grown, we understand how small changes to existing staff-dedicated spaces significantly impacts staff’s physical and mental wellbeing.
The WELL Building Standard launched in 2014 helped expand the knowledge on what components of a built space truly influence the lives of those living and working in it. With that said, going beyond physical space or location. the standard spotlights elements that encourage and support communication, camaraderie, and rejuvenation. It’s about caring for those who care for us. Making a few of the changes to any physical space already dedicated to staff offers an opportunity for major positive impact on resilience of those individuals. These spaces should provide respite, a place to go to mentally and physically disconnect from everything else going on.
Nature is one strategy to induce positive change in staff environments. Studies continually show that incorporating nature, real or implied, has a proven healing effect on individuals, hence why it is, and will continue to be, a common theme and concept used in the design of patient and public spaces. “Areas may be interior or exterior and encountered physically or by sensory perception. Any contact with nature, from looking at a picture to lying in the grass, has a wide range of positive psychological effects and subsequent benefits,” says Jerry Smith, ASLA, LEED AP.
As noted, adding even a few nature-based pieces of art on the walls can both create positive distractions and provide the healing benefit of experiencing a form of the outdoors. To simplify things, staff could bring in some of their own photography to post throughout, also helping to create a sense of personalized space. Incorporating a variety of real or fake plants, or even a using an existing monitor to cycle through still images of nature. Scenes such as a flowing creek or clouds passing through the sky will grant a sense of calm and can help transform a static break room into a relaxing respite space for staff to disconnect and recharge.
The Benefit of Control
Allowing staff control over their environments via sound and lighting options offer further opportunities to create a space for relief and positive distraction and can be incorporated relatively easily into existing space. Establishing a sense of control is especially important when people are in a seemingly uncontrollable situation, whether that is work-related like patient surges or mandatory overtime to something that is more environmental such as seasonal affective disorder.
Beginning with sound, a noise machine or a blue tooth speaker provides an option of background noise or music as a way to disconnect. It also offers the opportunity for individuals to create a tranquil environment for focused meditation, prayer, or to just be in their thoughts.
Providing a variety of lighting levels also allows the space to flex more actively or create a deeper sense of calm. Table or floor lamps throughout the space not only allows staff control over their environment but provides a more welcoming, home living room-type of setting. Taking that idea one step further, creating a small sensory space with tunable lighting would provide staff a place to focus their attention on healing. These examples of personal control over the environment have long been incorporated into patient space design; the same strategy can also provide similar benefits to staff with places for mental and physical healing,
Not limited to sound and lighting, technology can be leveraged to give staff a physical or mental escape from the daily stresses that tax their health. A monitor in a break room or dedicated staff space, if there isn’t one currently, can provide a number of beneficial resources, from on-demand programming such as quick yoga sessions to guided relaxation/meditation or one-on-one counseling for emotional support. Monitors also provide an opportunity to boost morale by displaying messages of appreciation and gratitude both from the community and leadership, helping staff to feel supported, valued, and appreciated for the work that they perform every day.
Encouraging staff to get help for themselves by providing easily accessible, convenient access is key. “It’s not a bad thing. This is why there are so many wonderful resources out there being built on virtual platforms strictly for professionals. If we can’t attend to our own human condition, we are useless to care for the human condition of other,” says Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP, DBH(s) to HealthLeaders. Health care staff can tend to think of themselves as the ones that provide help, but this should not deter them from asking for it when they are the ones in need. (Helpful resources are listed at the end of this post.)
Supporting staff mental health needs goes further, enabling staff to access the family and friend’s support structure so vital to their health. Since not everyone goes home after a shift for a variety of factors, whether due to proximity to work, fear of spreading the virus, etc., dedicating space to staff for those important, meaningful connections and conversations is critical. Spatial dividers, a few high-backed seating options, or even positioning the furniture within the room differently can turn an otherwise open, shared, active space into a more intimate one conducive for personal calls or video chats. When those types of arrangements are not needed it, the space can easily flex back into a typical shared breakroom space, promoting collaboration and camaraderie among workers.
COVID-19 has spotlighted the value that appreciation and gratitude has on the psyche of frontline care providers. The pandemic has also revealed how the unrelenting stress and demands can overwhelm both the body and mind of staff who are so focused on the care of others that they may overlook their own needs. Communication has always been a key strategy to building morale within an organization, but as we’ve learned over the past decade, the physical and technological structures organizations put in place to support the physical and mental health needs of its staff can communicate something greater – that their staff’s experience is as important to the care of patients as the patients’ experience, itself.
For more on strategies for supporting staff mental and physical needs as well as restorative environments:
- National Alliance on Mental Illness
- Sprout Health Group: List of Mental Health, Mindfulness, and Mental Exercise Resources (including free resources)
- American Medical Association: 5 Wellness Task Force Tactics Designed to Prioritize Physician Health
- Advisory Board: Starter List: How You Can Support Frontline Staff during the COVID-19 Crisis
- Journal of Environmental Psychology: Exposure to Restorative Environments Helps Restore Attentional Capacity (PDF)
Devan Swiontkowski, Assoc. AIA, EDAC, is a project planner at BWBR who graduated from University of Kansas with both a master’s degree in architecture and a certificate in architecture of health and wellness. Dani Ostertag is a senior interior designer who holds a bachelor’s degree in fine arts-interior design from University of Wisconsin-Stout.