How can design respond to burnout in healthcare professionals?
May 09, 2024
The next-generation spaces and approaches could boost satisfaction, retention, and well-being in those who provide care
A version of this article first appeared in Design Quarterly Issue 20 as “How can design respond to the caregiver burnout epidemic?”
Healthcare is experiencing a crisis in staffing. Burnout is an epidemic, especially in nursing. The COVID-19 pandemic worsened simmering issues.
In the US, 34 percent of nurses surveyed said they would leave their jobs by the end of 2022, with 44 percent saying that stress and burnout contributed to their decision. Canada has experienced similar issues. Healthcare providers know that patient satisfaction scores correlate to staff well-being. And yet, in the US, the budgets for spaces that promote satisfaction among the care team are often thin. While funding for these spaces is more standardized in Canada, they may need more attention. The result is that try as we might as designers, there are sometimes too few spaces dedicated to reducing stress for the care team.
High turnover rates can result in staffing shortages, impact the quality of care, and hit healthcare providers in their bottom line. Recruiting and training new staff is expensive. At the same time, the older segment of the population is growing; demand for healthcare services swelling. While funding models vary, health organizations are increasingly recognizing that these staff workspaces and amenities need attention and thoughtful design to succeed.
The Cambridge Memorial Hospital Redevelopment in Cambridge, Ontario, offers views to the outdoors. Gathering spaces with natural light are key to well-being for healthcare professionals.
So, what kind of spaces might be useful in counteracting burnout?
The healthcare institution is a workplace. Working in healthcare can be extremely rewarding, but, at times, it is also draining and stressful. Care team members tend to be always “on.” How do we create places that provide a little time away from what is often a high-stress environment?
On any typical day, in addition to direct patient care, healthcare professionals will need to confer and collaborate, focus on solo tasks, build personal connections, and recharge. They need spaces that allow for all these activities. Let’s start by looking at the types of spaces we see today and what we think we need in the future.
Places for breaks: Nurses are in demand and pulled in many directions throughout their shifts. Today’s care desks (also known as nurse or staff stations and communication centers) are designed to make staff visible and accessible to families and patients. So, when it comes to spaces for staff to take designated breaks or a moment of respite, location, privacy, and comfort are key. We often see staff lounges shared between two units. Depending on overall planning, this can make the lounges feel out of the way and inconvenient, which likely decreases their use. In the US, we see lounges often double as conference rooms. We need to think of ways to integrate these staff lounges and make them more convenient and permissible for all staff, particularly nurses, to use.
On a recent hospital project in the US, the staff encouraged us to reduce the visibility into their new interior team room to give them more privacy. Increasing the visual privacy level allows the care team to work through their emotions and feelings, away from the clinical floor. Giving caregivers a more private and supportive place where they can switch off or share with coworkers was a game changer. Making these team break spaces comfortable is important.
On the South Niagara Hospital project in Niagara Falls, Ontario, we prioritized team room placement along the perimeter of the building. The provides nearly every team room access to daylight. These spaces also will include biophilic graphics to elevate the atmosphere and provide a positive distraction for staff. Ensuring a variety of furnishings, and access to Wi-Fi and filtered water, also helps to create a destination with useful amenities that promote choice and a supportive environment.
The Kaiser Downtown Commons Medical Offices building in Sacramento, California, transformed a six-story office building into a clinic location with multiple areas of focus. For staff, it offers sanctuary spaces like the residency lounge.
What’s in a name? What we name these rooms is more important than you’d think; a different name may change how the spaces are viewed and used. A team lounge is not for “lounging” but for connection-building, recharging, and respite. “Team room” has become a more common term, but in a large mental healthcare facility, we’ve also heard the term “oasis” used.
Places to collaborate: The current trend in the healthcare industry is toward decentralized nursing stations and substations. These can sometimes leave nurses socially disconnected. A well-located and well-designed team room can help address feelings of isolation. We know that collaboration spaces are a must in research settings and the workplace—and these spaces are critical for nurses, too. Collaboration spaces can foster the informal exchange of ideas.
Today, care is interdisciplinary with specialists on the floor and fewer individually assigned spaces. Therefore, team hubs, huddle rooms, and collaboration zones for multidisciplinary care teams are essential.
Often, the open care center is connected to an enclosed team huddle room with transparent walls. This allows the team to discuss patients or personal matters with a measure of privacy while remaining accessible. It’s a space between being fully “on the floor” and a private team room. At Phase 1C of the Centre for Addiction and Mental Health in Toronto, Ontario, we designed glazed partitions with large-scale biophilic graphics to separate the team collaboration spaces from the common patient spaces. This helped provide a degree of privacy and visual interest.
It’s not unusual for a stairwell to be the largest volume space in an otherwise massive healthcare complex. With natural light, we can make an exit stairwell more inviting for the care team to use for quick chats, taking calls, or a quiet moment “off stage.”
The healthcare institution is a workplace. … How do we create places that provide a little time away from what is often a high-stress environment?
Places to decompress: In addition to the more typical team rooms, many healthcare organizations are asking for designated spaces for contemplation, meditation, and recharging in smaller rooms. Sometimes, we’re designing yoga and gym spaces for staff in larger spaces. These types of decompression spaces work best when they’re easily accessible and the work culture encourages attention to health and well-being. However, given space is always at a premium in healthcare, if underused, they could be at risk of repurposing.
We are beginning to see accessibility consultants propose sensory rooms. These are places where a person can dim the lights and shut out external stimuli (and screens) for a time. In Ontario, these spaces (which can be for staff, as well as visitors and family) are not typically included in functional program planning as single-purpose spaces. Rather, they are a secondary use of other existing spaces. In the meantime, we are looking at spaces (small offices, telephone rooms, and quiet rooms) that can double as sensory rooms with the appropriate signage, acoustics, and lighting controls.
Places for wellness: In Canada, where the programming for hospitals can be quite consistent from one project to the next, space for staff exercise has become more common. These spaces encourage staff to reduce stress through exercise—such as yoga—in a familiar and convenient setting. We’d expect to see these spaces become more common for US hospitals embracing a holistic approach to wellness. We shouldn’t, however, discount the benefits of unprogrammed space. Research tells us that access to nature, natural light, and fresh air (with operable windows) benefits humans in the workplace. We can apply these lessons in healthcare while navigating the demands of code and cost. Gardens, plazas, and terraces can encourage healing and tend to be dedicated to patients and families for that reason. But if we can find opportunities to create some open-air spaces for staff only, the spaces will be well taken care of, cherished, and used.
What design considerations can make a difference?
Acoustic comfort: The constant thrum of day-to-day life in the hospital and its beeping sensors can be stressful. We can employ design strategies for the flow of caregivers and other staff that mitigate disruptive sound. At Intermountain Medical Center in Murray, Utah, we designed the corridors with clear views to daylight on either end. However, it was the design’s noise reduction that made the greatest impression on caregivers. Controlling noise can also improve communication and reduce errors.
An outdoor gathering space at the VA Puget Sound Mental Health & Research Building in Seattle, Washington. Access to the outdoors is important for both patients and staff members.
Privacy: As we mentioned above, varying degrees of visibility, accessibility, and transparency are important. They help the healthcare team do its work or attend to personal matters, from the collaboration zones to the privacy of the team room.
Community: Camaraderie and social support can increase engagement and reduce burnout in healthcare workers. Care team members need to be able to connect with their coworkers, with appropriate levels of privacy in both designated team spaces and more public places, such as dining and outdoor facilities on site.
Our holistic vision of healthcare should extend to the healthcare workplace. Our designs should be tilting the healthcare institution toward a role as an everyday wellness destination embedded in the community. These holistic healthcare destinations include multiuse athletic spaces where one can work out, meditate, or grab a healthy bite. Seen from this angle, we can make hospitals part of the wellness continuum where staff have more options and can be encouraged to habitually access services that reduce their stress.
Design that respects and supports
Ultimately, design strategies can support the battle against burnout. Designs that respect the important role of nurses, recognize their daily challenges, make them feel safe and protected, and provide a more supportive built environment will enhance morale. That will increase job satisfaction and retention.