Hospital design experts Ryan Hullinger and Sarah Markovitz explain the design changes to help healthcare facilities reduce stress for workers during the Covid-19 pandemic and beyond.
Frontline healthcare workers face enormous stressors during normal times, but especially today during the pandemic: fear of contracting the virus, concern for protecting their families, grief over watching patients die, and anxiety over resource rationing decisions. Tragically, these issues are increasing healthcare provider stress and harming their mental health, as some begin to display symptoms similar to post-traumatic stress disorder.
Even before the pandemic, levels of stress and burnout in healthcare workers were high. Fifteen percent of nurses reported feelings of burnout in a 2019 survey. Burnout is among the leading patient safety and quality concerns among healthcare organizations, as it can decrease work performance and increase risk of errors.
Although we can’t completely remove stress in the healthcare setting, changes in the environment may help boost employee resilience. Mindfulness micro practices—such as micro-breaks and a variety of respite spaces in which to take them—can mitigate stress. Meanwhile, developing resilience practices in the immediate setting where they are needed most could reinforce the impact of these practices. As the coronavirus continues, and we anticipate new pandemics ahead of us, how can we improve the experience now and for future events? We propose the following design solutions for hospitals and other healthcare facilities.
Rethink The Break Room
Taking breaks can help improve productivity and prevent burnout, yet healthcare workers may be reluctant to take them, especially in times of crisis. We need to ensure that when a break does happen, the environment is optimized for caregiver decompression, support and restoration.
One way is to transform the break room into an oasis of respite, where employees can relax and meditate. The first is to employ the power of nature to boost resilience and cognition. Research illuminates that surrounding ourselves with real or simulated green plants can lower our physiological stress response, such as blood pressure and heart rate. Break rooms with windows that face gardens, trees and other green spaces can take advantage of these critical nature benefits. Artwork or wall graphics of a forest, rolling countryside or green lawn, can help too, as can the introduction of birdsongs and other natural sounds.
Leverage Underutilized Corridor Spaces
Micro-break spaces along typical pathways, such as corridors and alcoves may decrease stress and boost wellness. For example, underutilized areas along a nurse’s route or a physician’s daily rounds can transform into a variety of calming alcoves for a moment’s rest. These spaces could include soft-cushioned chairs with ottomans and seating booths for solo rest or a quiet place to call family. In addition, corridor ends with a comfortable couch and views to the outdoors can offer a peaceful retreat, and with the addition of a whiteboard, can also allow staff to informally connect and share knowledge.
Provide Areas For Physical Exercise
Movement and physical fitness — especially high-intensity aerobic exercise — offers a host of short-term and long-term benefits, such as improved memory, a boost in mood, enhanced cognitive function and better quality of life. Walks in nature and views of green plants can help reset the harmful effects of sustained stress. Outdoor gardens can provide exercise and the restorative effects of nature.
Offer Immersive Respite Pods
It is crucial to bring respite to those who need it most, from ICU nurses to emergency department physicians to support staff. One approach under development is called the mobile respite pod. This indoor modular system can provide a customizable and sensory experience to promote rest, relaxation and meditation. Inviting seating, adjustable lighting, calming sounds and green forest or ocean imagery may help healthcare workers recharge in their preferred way. Meanwhile UV lights engaged before and after each use could provide a convenient cleaning process. Designed to be easy to assemble and break down on site, these pods, offered in various sizes, could be installed in currently underutilized areas like waiting rooms or lobbies, or even outside in plazas or near gardens.
Decrease Stress At The Bedside
The opportunities for reducing healthcare worker stress are not limited to staff areas. In fact, many of the best opportunities are right next to the patients. We have long understood that high noise levels and incessant equipment alarms in patient areas are anxiety-producing for patients, families and healthcare workers’ communication, wellbeing and performance. Alarm fatigue is proven to decrease focus and memory, raise cortisol levels, lower concentration and even provoke a negative immune system response. Studies indicate background noise above 45 decibels can create adverse effects, and many healthcare settings are much louder than that. Simple environmental strategies like providing white noise, employing sound-absorbing materials and using smoother cart wheels are all beneficial.
Consider The Return On Investment
As we addressed in an earlier Forbes column, hospital systems currently face extraordinarily difficult financial challenges, so every solution needs to be carefully vetted in terms of costs and benefits. While some of the proposals above would have very little cost impact, others (like the respite pods) would require a larger investment. It is important to note, however, that the cost of not responding to provider stress is perhaps the highest of all.
Last year—even before the COVID outbreak—healthcare organizations on average faced 17.8% staff turnover. This came at a huge cost, averaging more than $60,000 for replacing a registered nurse and $500,000 for replacing a physician. Decreasing staff turnover by just 2% could save the average hospital over half a million dollars per year, and could quickly offset the construction cost for many supportive environmental solutions.
Our society has rightly reframed healthcare workers as heroes, who are sacrificing so much of their own security every day in order to save others. It is our hope that this new-found societal recognition will not be squandered, but will instead generate unprecedented advocacy and investment in the emotional safety and well-being of our nation’s devoted front line staff.