The Overlooked Workplace: NBBJ and UW Research Spotlights Need to Focus on Healthcare Workforce
Healthcare environments are among the most critical workplaces in our society, but are often not treated as such due to the need to prioritize patients. Given the demands placed on caregivers and the impact of burnout, it’s critical to provide staff with the resources and spaces they need to perform their best. Here we discuss NBBJ's research in partnership with the University of Washington into caregiver wellbeing, and design ideas that can take advantage of existing spaces to improve caregivers’ workplace experience.
The clinical floor is a workplace. It is here that the complex job of diagnosis, treatment, collaboration, and care requires a 24-hour workforce. Yet surprisingly, these front-line work environments are rarely designed along the same lines as an office—that is, with a focus on talent attraction and workplace experience. That’s because prioritizing the health of nurses, doctors, and other staff often lags behind patient needs and facility costs. However, given the stressful and highly critical nature of the work done in hospitals, have we overlooked the caregiver? And what can realistically be done to improve their workplace?
The health of caregivers, patients and healthcare organizations is closely connected—burnout leads to worse patient outcomes, higher turnover and labor shortages. One recent study found that critical care nurses in poor physical and mental health reported significantly more medical errors, while “nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health.” In a study of the mental health of healthcare workers post-pandemic, 55% reported worse mental health than before the pandemic, and 37% intended to leave healthcare in less than five years.
This focus on provider burnout was recently the subject of an episode of NBBJ’s podcast Uplift. In it, Karen Grimley, Chief Nursing Executive at UCLA Health observed:
The Research: What We’ve Learned About Caregiver Wellbeing
To more deeply understand how to improve caregiver well-being through design, NBBJ partnered with the University of Washington (UW) to survey more than 180 nurses and nurse practitioners. The focus of the research—conducted by an academic researcher, workplace strategist and designer—was on amenities that help overcome stress. Here’s what we learned:
1) Caregivers Aren’t Taking Enough Breaks
In fact, while the majority of nurses are allocated breaks, the majority take either only one, or even no breaks at all.
As an aside, according to research by NBBJ Fellow Dr. John Medina, intense work efforts should not extend beyond 90-minute intervals as the body needs pauses to reset focus, alertness, and efficiency.
2) Caregivers Aren’t Happy With Their Break Spaces
Our study also shows that of the breaks taken, 80% happen in either a break room or at a workstation. Yet more than 75% of respondents were not satisfied with these spaces. Not surprisingly, almost 90% agreed that these spaces have an influence on their mental health, and most respondents noted a respite space would influence their decision on working elsewhere.
3) Caregivers Want Similar Amenities as Office Workers.
Our research team asked what specific amenities participants would want in future break spaces. The top answers were…access to natural light, the outdoors, windows, views, variety of spaces, privacy, areas to nap, and ease of access.…which mirrors the requests we hear from workers in non-healthcare settings.
Not everything was driven by layout, though. The study also found that at the most basic level, nurses also have an appreciation for art, good coffee and snacks and a clean space, attributes we’ve taken for granted in non-clinical workplaces for decades. Hover over each "+" symbol below to see other ideas:
The Design Response: How Overlooked Spaces Can Improve the Overlooked Workplace
Squaring the need to address caregiver stress and burnout with the financial realities of healthcare systems is an ongoing challenge. Margins are smaller in healthcare systems than in their corporate counterparts. Beds are a priority; they outweigh considerations for extra floor space, daylight and views that would be welcome in respite and break rooms. Given what we know and have learned about what caregivers want, are there design strategies that can bring results without requiring more space?
We think there are, and the answer lies in enabling required building elements—those overlooked and underappreciated spaces within a hospital—to play a bigger role. Here are a few ideas:
Respite Lounges
Staff lounges are commonplace in healthcare environments, but they typically function more as break rooms than therapeutic spaces. Respite lounges, by contrast, can be created within existing staff areas, and are designed to reduce stress by incorporating nature or daylight, enabling privacy and the agency to change elements within the environment, and creating comfortable, homelike settings for people to connect. Respite lounges could even be created within underused areas like rooftops—incorporating nature and views.
On the St. Michael Medical Center acute care expansion, for example, care was given to provide spacious staff lounges with key amenities—including expansive views, natural light and comfortable seating options that provide an overall atmosphere of calm and warmth.
The staff lounge location takes full advantage of the site’s sweeping views, while providing privacy and quiet at the end of the wing.
Captivating Stairs, Pathways and Bridges
Circulation areas have great potential to act as additional amenity spaces for staff, though they’re not often used to their full potential. For example, at the Lunder Building at Massachusetts General Hospital in Boston, NBBJ designed egress stairs with floor-to-ceiling windows, which quickly became an informal break space where providers could easily catch a breath and view the horizon.
Years later, we are now working on another project on the MGH campus called the Ragon Building, which utilizes a series of bridges to connect two patient towers. These bridges provide spectacular views of the campus, and were intentionally design with seating and water refill stations to support the flexibility of the space as both a connector and as a respite area.
Sensory Sanctuaries
Not every solution needs to be architectural in nature. There are opportunities to use existing spaces closer to clinical care environments, such as the on-call rooms that typically serve as rest areas for physicians, as restorative multisensory environments.
Stimuli such as color, scent, lighting and sound can be carefully calibrated to help reduce stress and provide a break. Experience design and the use of interactive and dynamic digital environments can also create diverting, restful and engaging digital installations in these types of spaces. Some hospitals attempted something similar on a temporary basis during the pandemic, turning underutilized places – like parking garages – into makeshift respite tents with comfortable chairs, nature scenes and music.
In any human-centered workplace design, great experiences are created through scale, variety, adjacency, and interaction. These baseline considerations should not be neglected, especially in high-stress environments. While healthcare environments face unique issues given the need to prioritize patients and families, there are still creative ways to use existing spaces to improve the workplace experience of caregivers. Such approaches can help improve well-being and directly impact the ongoing challenge of physician burnout.
