In-clini respite space concepts for the TriHealth Center in Cincinnati, currently under conctruction and designed by GBBNn are conceived as connected to both clinical workspace ( shown on left ) and outdoor areas.
Awareness of staff and their space needs is coming to the forefront of healthcare design—and with good reason. Healthcare organizations face a staffing crisis that’s predicted to only get worse, with the United States expected to see a shortage of up to 120,000 primary and specialty care physicians by 2030, according to the study “The Complexities of Physician Supply and Demand: Projections from 2016-2030,” published in March 2017 by the Association of American Medical Colleges. Additionally, there’s the ongoing issue with job satisfaction, with 83 percent of clinicians, clinical leaders, and healthcare executives viewing physician burnout as a problem at their organizations, according to the report “Immunization Against Burnout,” released by New England Journal of Medicine Catalyst in spring 2018.
Those who are entering the field or already working in healthcare are finding crowded work spaces and growing competition for offices, conference rooms, or countertops at the nurses’ station. It’s all due to the ongoing shift to multidisciplinary care bringing larger staffs—including pharmacists, behavioral health specialists, phlebotomists, nurse practitioners, and nutritionists—to the care floor, whether in outpatient clinics or hospitals. “The ancillary staff are kind of squatting wherever they can because they don’t have a place to sit,” says Angela Mazzi, associate principal at GBBN Architects (Cincinnati).
Other staff spaces, including break and locker rooms, can feel like an afterthought, tucked into out-of-the-way places or in windowless rooms, as healthcare organizations usually focus their efforts more on patient areas and improving the experience there, says Sheila Cahnman, president of JumpGarden Consulting LLC (Wilmette, Ill.).
Looking for an antidote to this space crisis, healthcare organizations are turning to design to deliver appealing work areas that can help retain staff, support employee well-being, and improve operations, driving a new conversation between healthcare clients and their design and architecture partners. “The owners are coming to us and saying, ‘We want to create spaces that our employees enjoy, for both recruitment and retention. What ideas do you have?’” says Tina Larsen, managing principal, healthcare sector at Corgan (Dallas).
Mirroring the corporate world
While designers say they’re seeing work space become a priority on a variety of projects, including new builds and renovations, many of the staff-centric design ideas being put to use in healthcare are being adapted from the corporate environment—an early adopter of using workplace design to address staff burnout and retention. “Corporations have seen how spaces that promote health and wellness, including spaces for respite, affect their bottom line in terms of productivity, recruitment, and retention.” Mazzi says. “Healthcare has been slow to focus on the staff work and respite environment, because usually space is at a premium. But they are starting to see, because of the emerging staff burnout epidemic, that they can’t ignore it any longer.”
For example, Mazzi says employees in general want to feel engaged and connected, which aligns with the open-concept office design that’s beginning to make its way into healthcare. “The very hierarchical, siloed days of healthcare don’t match culturally with where we are today,” she says. “Certainly we see that connectedness in workplace design, and we’re starting to see that more [in healthcare] as team-based care has become the norm.”
Another trend that’s carrying over is the dissolution of private offices in favor of hoteling, where a clinician, nurse, or specialist might occupy a work space for a shift, and the use of huddle areas for more collaborative work. “Instead of having everybody in their own space with cubicles around you, it’s opening up a little bit,” Larsen says. “So you may not have as much individual peripheral space, but there are additional collaboration spaces that are within that same work zone where you can pull up a chair next to someone and work together.”
However, designers recognize there’s a lot of hierarchy that still exists in healthcare, with some physicians demanding private offices—a request that some organizations are more willing to accommodate to help recruitment efforts. “We’re trying to challenge that,” Mazzi says. “If you work for a health system and spend one day a week in one location and two days in another, what purpose is an office serving?”
As designers search for the right mix of open and task-based spaces, they’re foregoing the traditional role-based work spaces of the past, including an office for every physician or even a workstation on wheels for each nurse. Instead, they’re looking at who needs to be productive in a space and what type of work must be done—from quiet, focused to more collaborative—and delivering the necessary space/equipment to accomplish that. Mazzi says she also talks to clients about what kind of work space characteristics they’re seeking, including how team-based it needs to be, if it’s interdisciplinary, and how centralized they want the area to be located. By combining these characteristics with the types of tasks being done, she can develop a more tailored plan. “It makes such a difference when you think about the culture of the space and what people are trying to do,” she says. “We’re trying to give them space that supports what they’re doing so they don’t have to come up with workarounds.”
In clinical operations, both in inpatient and outpatient settings, Larsen says she’s seeing nurses’ hubs that incorporate space for collaboration, head-down task areas for individuals, and quiet space to return a phone call or take a quick break. “These hubs offer much more opportunity for people to do the work they need to do within those various environments,” she says. In outpatient settings, designers are seeing a call for more centralized collaboration spaces where providers, nurses, and specialists can work together, whether that’s in an off-stage environment or a more centralized bullpen area with tables or cubicles as well as alcoves for small group meetings.
Give them a break
In addition to having workplaces that are more conducive to the tasks at hand, designers are also emphasizing the importance of staff respite and fitness rooms to support wellness and combat employee burnout. Cahnman says that previously these “soft spaces” had gotten smaller or were value-engineered out of projects, “especially when everyone was Leaning everything because they wanted to reduce ‘non-essential’ spaces in a hospital.” Offices and locker rooms were pushed into other buildings or different floors—where, she says, they were inconvenient for staff and sometimes not used.
A better approach—and one that’s gaining favor in light of the renewed focus on staff well-being—is to locate respite spaces near staff hubs or in the back of clinics so they’re steps away from where employees are already working. “We’ve also tried to give them spaces where there’s natural light and views, so it feels a little bit nicer,” Mazzi says.
For a recent infusion area project for Moncrief Cancer Institute in Fort Worth, Texas, Corgan’s Larsen says designers located a respite room within the nurses’ work core, across the hallway from the break room, because so many of the nurses felt that they couldn’t leave the unit during patients’ treatments, which can last two to four hours. “It’s small, but it has a floor-to-ceiling window and comfortable lounge chairs, so a person could go in there and relax for a few minutes,” she says.
Still, designers say it’s not uncommon for staff to be reluctant to use break rooms. “It’s a little bit of healthcare culture that makes it difficult to admit you need a five-minute break,” Larsen says. “But we also recognize that a caregiver who’s not stressed out and is engaged and feeling relaxed provides much higher-quality care to the patient. So it’s important to put these as a priority within work spaces.”
Furnishings to fit
Further supporting these efforts to improve healthcare work spaces is a variety of new furnishings and adjustable components and systems that can be reconfigured into different layouts. For example, Mazzi says 54-inch-tall wall or furniture partitions to delineate work spaces within an open environment provide privacy without totally blocking views out to the clinical area. And while she hasn’t seen adjustable workstations catch on in healthcare as much as they have in corporate design, she is seeing more standing-height options with stools rather than sitting-height designs. “If you think about it, if you’re on your feet a lot but you don’t need to stand for a certain task, it actually expends less energy to sit on a stool because you don’t have to lower or raise yourself,” she says. “So it’s easier. Especially if you watch nurses or medical assistants in a clinic, they’re up and down all the time.”
In respite and break areas, Larsen says she tries to use products, such as LVT flooring in a wood look, brightly colored fabrics, and soothing paint colors, to bring in a more residential vibe that can add a sense of calm. It’s also important, she says, to address acoustics , especially in the more open settings where sound transmission and privacy can become an issue. Design solutions can range from sound-absorbing materials in the ceilings or wall panels to acoustical ceiling clouds and light fixtures that can also add visual interest. “There are a lot more opportunities today,” she says.
Getting it right
Designers say the next step in improving work space planning and design is using new technologies to analyze how space is actually being used, so there’s data backing up the importance of staff areas. For example, Mazzi says a lot of times she’ll hear employees say they need a large conference room that fits their entire staff for meetings. “However, a conference room sized for that maximum 30 people, that is underutilized and empty 50 percent of the day … it’s easy for that space to get taken away as the clinic grows and they need more space,” she says. “If you rightsize the space, you won’t lose that critical function within the department.”
Anne DiNardo is executive editor of Healthcare Design. She can be reached at email@example.com.