For years, healthcare design has been focused on the needs of patients, and with good cause. But current trends, accentuated in large part by the pandemic, are casting a similar spotlight on healthcare workers. The enduring health, wellness, and retention of the more than 22 million healthcare workers nationwide is essential to the success of our nation’s healthcare system, and it takes a carefully thought through plan and actively engaged healthcare administrators to successfully and effectively design to improve the patient and healthcare worker environments.
Impact of High Healthcare Turnover
While many professions deal with turnover problems, healthcare has recently taken it to a new level. According to indeed.com, the average U.S. hospital has turned over 91% of its workforce in the past five years with 60-65% of all turnover happening in the first year of employment. The cost to replace one registered nurse is estimated to be 1.3 times salary. Nurse dissatisfaction has been shown to be the most consistent predictor of turnover, adverse events, and patient dissatisfaction.
Causes for the high turnover rate include high levels of stress, exhaustion, and burnout, which has been exacerbated by the pandemic. 18% of healthcare workers have left the profession altogether since the pandemic began, and another 12% have been laid off. Healthcare staff have often cited empty pandemic promises regarding workplace well being from healthcare administrators as a reason for considering quitting their position. Other primary factors for leaving include family needs and violence in the healthcare setting. Data from 268 nursing units at 100 hospitals indicate higher levels of turnover are associated with increased medical errors and patient falls. Additionally, workforce challenges are also compounded with the nurse population rapidly aging.
Incorporating Design Elements that Promote Well Being
Design can improve working conditions of healthcare staff in many ways and at an affordable cost. By adhering to WELL Building Standards—air, water, nourishment, light, fitness, comfort, and mind—designers can positively impact the staff experience. Impacts can include reducing staff stress and anxiety which can lower risk for other conditions such as heart disease, high blood pressure, diabetes, obesity, and depression. Changes as simple as new ceilings, new wall paint, and floor finishes can make spaces much more inviting, comfortable, and help relieve stress. Similarly, removing walls and barriers to create more open space and to allow for direct lines of sight can have a positive impact on the mental health and wellbeing of occupants.
The Mayo Clinic in Rochester, Minnesota, includes a staff respite area for brief periods of relaxation without leaving the building.
Design can improve working conditions of healthcare staff in many ways and at an affordable cost. By adhering to WELL Building Standards—air, water, nourishment, light, fitness, comfort, and mind—designers can positively impact the staff experience."
David Huey
Other positive design strategies include:
- Technology/equipment upgrades
- Touch-down spaces
- Increasing artificial and natural light
- Ergonomic solutions
- Scenic views
- Tranquil colors
- Landscaping/green roofs
- Water features
- Acoustical privacy/respite areas
The Houston Methodist hospitals use imagery that create relaxing atmosphere to reduce anxiety and stress.
Designers should be the tip of the spear in recommending to clients the benefits of WELL design. Some best practices architects and consultants can offer to aid healthcare administrators include:
- Listen to staff. Promote ownership of solutions.
- Consider more break room and relaxation space on the same or different floor
- Change space use or cross-utilize spaces
- Consider separating patient-facing from non-patient-facing spaces to improve staff circulation and efficiency
- Consolidate non-patient-facing staff space in proportion to remote work opportunities
- Maximize use of unused departments, floors, units, or wings
- Design flexible new space for future similar needs
- Verify code compliance
This staff break area at the Northside Hospital Medical Office Building in Cumming, Georigia, includes tranquil colors, comfortable seating, natural light, and great views.
Staff Satisfaction = Patient Satisfaction. It All Begins with Leadership.
There are many design strategies that help improve healthcare staff retention, but it ultimately requires commitment from healthcare leadership to engage in these projects. Strong healthcare leaders find value in a meticulous strategic plan that considers the wellbeing of patients and staff in equal measure. According to research, staff satisfaction scores increase at nearly three times the increase in leadership scores, so there is a strong return on investment. Effective leaders invite deep staff participation, set priorities and goals for project outcomes, and follow through with implementation of agreed upon staff-focused solutions. Healthcare leaders don’t need to tackle all of this on their own, architecture and design consultants can help build an effective plan and can offer the best recommendations when it comes to implementing the benefits of WELL design.
The Cancer Treatment Centers of America, Atlanta, includes natural light in areas of the hospital that are typically buried far inside, far from the exterior.