A Quiet Building is a Healthy Building

Because noise disrupts productivity and elevates stress, strategies to reduce it can lead to healthier outcomes.

October 11, 2021

Principal, NBBJ

A version of this post initially appeared on Forbes. This post was co-authored by Sarah Markovitz and Ryan Mullenix.

Despite the fact that the pandemic has pushed many of us to embrace the outdoors in new ways—whether to safely meet with friends, family and colleagues, to exercise, or to embrace a new hobby—we still spend the vast majority of our lives (over 90 percent!) indoors. This reality points to the importance of healthy buildings, the impact of which reaches beyond physical or environmental factors, affecting not just individuals, but also organizations.

Elements such as noise, access to light and views, thermal comfort, the incorporation of nature, and healthy materials are shown to increase cognitive function, resulting in improved productivity among workers, higher test scores for students and quicker recoveries for patients. A healthy building can also impact a business’s bottom line—from energy reduction to more efficient and engaged employees. According to a recent World Green Building Council report, 69 percent of owners report improved worker satisfaction due to their healthier building investments, and 46 percent of commercial building owners say that they are able to lease space in buildings with healthy features more quickly.

Acoustics are one of the major contributing factors to a building’s overall health. While all building types are affected by acoustics, their effect is felt most strongly in workplace and healthcare environments. In the workplace, noise pollution leads to decreased productivity, absenteeism and dissatisfaction among employees, resulting in a massive financial burden for companies; whereas in hospitals, noise negatively impacts both patient recovery as well as staff performance and satisfaction, taking an enormous toll on patients, families and staff. This post explores the implications of noise in the design of workplace and healthcare environments.

Noise Reduction in the Workplace: Counteracting the Sound of the Human Voice
At the most basic level, we cannot ignore the sound of the human voice—it’s a survival mechanism. However, research tells us that voices over 55 decibels (roughly the sound of a loud phone call) can cause measurable stress. In the office, it is almost impossible to tune out the various conversations, phone calls and Zoom meetings. Because we often hear only one side of a conversation, our brain works tirelessly to fill in the other half—a concept called a “half-alogue” that can be even more distracting than other disruptive office noise. By contrast, a modest level of unintelligible background noise actually helps concentration in the workplace. So rather than aiming to reduce all noise, focus on materials and systems that specifically dissipate speech sounds. Here are four ideas to do so:

  • Build it in: Think about sound reduction strategies that can be built directly into a space. For example, we worked with the University of Washington to develop an acoustic panel system that can be embedded into concrete and mass timber structural systems. Shaped like empty bottles, these sound dissipating systems muffle noises and are highly effective at trapping low-frequency, intelligible sound due to their narrow necks and wide empty cavities. Tests of prototypes measured noise reductions of around 13 decibels, the equivalent of wearing noise-canceling headphones. Alternatively, consider prefab: conference rooms and other spaces that are regimented in size can be prefabricated to include acoustic solutions rather than relying on materials applied post-construction. Because each module is prepared as a separate unit with its own walls, floor, and ceiling, panels can be fabricated or milled in advance to directly address the preferred room acoustics and reduce both time and waste.
  • Isolate the noise: Create insulated quiet zones within work areas, each with a target decibel level based on the type of work being done there. Nooks made of soft materials such as felt, or phone booths with soundproof glass can serve as quiet areas within a larger, more open office, and adding transitional cues through materials, light and volume reinforces the intent for each zone.
  • Incorporate biophilia: Not only does being around nature improve our mood and make us more productive, but plants are also incredible natural sound absorbers. While a green wall is excellent for capturing sound, even greenery dispersed throughout the office can help mitigate noise.
  • Not all noise is bad noise: While spaces that are too loud can be stressful and distracting, those that are too quiet can feel awkward and uncomfortable — or even drive you crazy. Aim for the din of a coffee shop, where noise is ambient but not distinguishable.

Noise Reduction in Healthcare Environments: Promoting an Atmosphere of Rest and Focus
As in the workplace, heightened noise levels in healthcare settings have a strong negative effect. Researchers at Johns Hopkins University found that excessive noise not only hindered patients’ ability to rest, but also increased the likelihood of medical errors and contributed to stress-related burnout among workers. One example of noise reduction that has stood the test of time is Massachusetts General Hospital’s Lunder Building, which was completed in the 2000’s. The building combines design innovation with changes in clinical practice to reduce average noise levels by 35 percent as compared to the worldwide average. To design quieter healthcare environments, consider these five solutions:

  • Move activity away from patient rooms: Many challenges related to noise in healthcare environments have to do with issues of proximity and speed. Caregivers need to be close to patients, teams and families to provide the highest quality of care, so while it is beneficial to design units that place patients near caregiver teams, it is equally important to remove other sources of noise—such as mechanical equipment, closing doors, ice machines and cart traffic—from outside patient rooms.
  • Tailor clinical team work spaces for appropriate visibility and noise levels: In hospitals, clinical teams on patient floors are getting larger, there are more interactions happening amongst various care team members—both in-person and remotely—and information is constantly being updated. Caregivers must be able to focus, pivot and think on their feet to stay on top of their tasks and patients. By providing enclosed team work areas and space for heads-down concentration, while ensuring that staff can still see their patients and converse, caregivers are able to perform at a high level without noisy distractions.
  • Remove rounding teams from corridors: In academic medical centers, rounding teams often conduct impromptu conversations or teaching moments in corridors outside patient rooms. And while these types of walking meetings are beneficial for many reasons, the noise that comes with them is not. Designing alcoves that take teams out of earshot helps to maintain an impromptu, informal atmosphere while increasing privacy and significantly reducing noise.
  • Take cues from lighting: Ambient lighting is an unexpected way to suggest how quiet or noisy a particular area should be. The way that corridors and nurse stations are lit during certain times of day—for example, brighter in the morning and dimmer at night—can indicate the appropriate voice level to staff, in addition to supporting staff members’ circadian rhythms and creating a more calming atmosphere, both of which are important in managing stress.
  • Explore materiality: Absorptive materials are often overlooked in healthcare settings because they may appear difficult to clean. However, rubber flooring, antimicrobial fabric panels or even quieter cart wheels can all help to dissipate sound.

Designing a healthy and acoustically sound environment is a delicate balance of transparency and privacy, concentration and energy. By creating thoughtful spaces that consider how noise affects rest, stress and productivity, we can achieve buildings that are healthier for those that occupy them.

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What if Returning to the Office Felt Like Coming Home?

Ways to Bring the Comforts of Home and Hospitality Into the Workplace

August 31, 2021

Principal, Workplace Strategist, NBBJ

Last year, we abandoned our workplaces practically overnight. Now, as companies plan a phased return to the places we left behind, they may no longer be suited to how we do our best work. Despite the comfort and flexibility in working remotely, research shows that employees miss connecting with their colleagues, and crave a change in scenery that an office provides. In-person interaction is also crucial for innovation, productivity and profitability, not to mention building culture and connection. The pandemic provides us the unique opportunity to rethink our old offices and rituals to improve productivity and employee satisfaction.

So, how can we take the best of working from home and imbue it into the office?

Embrace Flexibility

Work is no longer about absolutes—office or home, heads down or heads up, independent or team-based. Instead, each mode has a role to play in creating healthier, more effective work. An organization should invest in environments that support a range of work modes throughout the day. Hyper-flexible workplaces with movable, adjustable infrastructure like walls, furniture and technology, can accommodate a range of needs. Flexible arrangements also offer more personal choice and agency (which is crucial to employee satisfaction) as well as adapting quickly as safety and work policies evolve.

After months of working at home, the constant flurry of activity in an office may feel overwhelming. Build in library, booth or café spaces for quiet, heads-down work where people can be alone but not isolated. In the same way, encourage side-by-side problem solving and passive collaboration with drop-in teaming spaces and tools such as digital whiteboards, monitors and multipurpose wall space that help teams see their work clearly, even if some members are in the office and others are online. Finally, accessorize. Equip communal spaces with phone props or provide sanitized headsets for impromptu video calls.

Encourage Community
The past year and a half taught us that it is difficult to maintain community and build culture online. However, embracing a hybrid work model seems to be the norm for the immediate future. In addition to investing in and expanding technology offerings to better connect with remote team members, changing the appearance of the workplace so that remote workers are not met with a “sea of workstations” when on video calls—an image that implies people must be at a desk and are missing out if they are not in the office—evens the playing field between in-person, hybrid and remote employees.

In the office, encourage people to think about who they need to see or work with, rather than defaulting to the same desk every day. Building on the routines we established while working from home—uninterrupted concentration in a home office, collaborative problem-solving at the kitchen table, virtual brainstorming on the couch—every space in the office is now a place to work. Create areas for communal interaction that are not explicitly geared toward work as well. Expanding places to share a meal or grab coffee helps people create new rituals and come together after a long absence. Offering “whole life” amenities and shared or learning experiences such as yoga or gardening also contributes to a feeling of community and organizational health. Take it one step further and introduce amenities that are also neighborhood touchpoints, such as a public garden where your company can host health and cooking seminars, or a maker space to mentor local high school students.

Take Cues from Hospitality
Consider the hotel lobby. Often the only common area in a hotel aside from the elevators and restaurants, the lobby must offer a variety of spaces for different types of activity. Groupings of furniture such as low tables with surrounding seating encourage conversation, whereas high-backed chairs tucked into corners or nooks along a wall provide more privacy. This idea can also be applied to the office. Invest in multipurpose furniture that is shaped and configured to work in multiple ways, and that adapts as needs reveal themselves, makes it easier to collaborate. The more home- or hospitality-like an office feels, the less stressful the environment. Introduce softer lighting, more texture and organic shapes.

Likewise, think about the check-in process. You’re greeted graciously, often offered a refreshing drink or warm towel, and given clear directions for how to get to your room and use the amenities. What if this type of experience was present at the office? Many hygiene and safety elements that will need to be incorporated into the workplace, such as wayfinding and cleaning, can also create pleasant rituals and experiences. For example, attractive cleaning stations with welcoming designs or ambient effects could be located as intentional arrival points to common areas.

Design with a Healthier Workplace in Mind
Supporting employees’ mental and physical well-being is no longer optional. After months of working from home, employees have figured out what works best for them in terms of concentration, productivity and stress management—a walk to regroup, movement around the house to support different types of focus, a catnap to refresh. These same options can extend to the workplace, from incorporating walking paths (or scheduling walking meetings) to more spatial and experiential variety inspired by residential and hospitality design.

Long-term, focus on access to fresh air by improving ventilation and filtration in mechanical systems. Employees will feel safer and breathe better. Increase views and daylight in the office, which reinforces people’s circadian rhythms and helps with productivity during the workday. Build in moments of respite in the work environment. Horticulture, sound or aromatherapy can quickly transport people to a calmer and more soothing place. While sleeping at work may not be an option, areas to rest—and the cultural permission to take a break—can help people feel more focused and supported.

The pandemic has allowed us to re-examine how we want to work and live. Design can be a transformative tool for reshaping work into a healthier, more purposeful experience. By bringing the comforts of home and hospitality into the workplace, organizations can provide the best of both worlds.

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NBBJ Developed the First Open Core Hospital Design. Twenty Years Later, Here’s What We’ve Learned

August 18, 2021

Partner, NBBJ

This post was co-authored by Ryan Hullinger and Eric Koffler.

 

With provider burnout looming as a key challenge post-pandemic, the impetus is increasingly on hospitals to explore measures to improve the working environment. Open core, an innovative hospital layout which distributes care team work areas along corridors within patient wings, is one approach that can benefit caregiver wellbeing and performance as well as the patient experience. While the layout is still comparatively new, it has been refined through numerous projects around the country since the first open core hospital was designed by NBBJ for the Great River Medical Center in Iowa in the early 2000s. Our experience provides valuable insights and lessons which underscore the advantages and trade-offs of the layout to providers, patients and hospitals.

But First…What is Open Core?
Hospitals have traditionally used a “racetrack” layout, which accommodates patient rooms around the exterior and situates work areas and offstage functions in a central block. Open core layouts, by contrast, move the major support functions such as break rooms, staff lockers, conference rooms, elevators and offices into a centralized hub that connects to patient wings. Patient wings feature double-wide 16-foot corridors with 8-foot-wide clinical zones along one side that house decentralized team workstations and alcoves for commonly used supplies and equipment. Each workstation has two seated stations and two walk-up positions, with visual sight lines to four patient rooms. Patient wings in open core are double-loaded—with patient rooms on both sides of the corridor.

Why Adopt an Open Core Layout?
Open core is not for every hospital, but it does offer the following key advantages over traditional racetrack layouts:

Enhanced Staff Wellbeing
Access to daylight and views is the number one amenity associated with employee wellbeing and satisfaction. Open core maximizes daylighting in team work areas by distributing workstations along patient wings with rooms and windows on both sides, which significantly increases overall daylight levels throughout the day. Similarly, off-stage support zones including staff respite areas, which are usually windowless in racetrack designs, benefit from views by being on the building perimeter in open core layouts.

Open core also reduces the distances caregivers need to travel by situating key supplies in proximity of work areas. By minimizing repetitive physical activities like obtaining supplies, open core can reduce mental and physical stress and enable nurses to spend more time directly caring for patients.

High Performance Workplace with Improved Visibility
A key feature of open core layouts is that providers can always see the entire wing. With any activity readily visible, teams can respond more quickly during emergencies and communicate more easily during normal operations. Open core work areas draw on design lessons from the workplaces of leading tech companies, creating a more open, collaborative workspace with enhanced sightlines that ensure teams have easier access to one another.

Improved Patient Experience
Open core also enhances the patient experience by putting care teams closer to patients. In our experience, patients in open core hospitals have reported high satisfaction with their care, especially the accessibility and proximity of care teams. Additionally, the double-wide, daylit corridors of open core foster a calmer, more welcoming environment than traditional 8-foot corridors. Finally, noise levels, which can impact stress, are reduced by spacing team work areas along the corridor rather in one place.

When Open Core May Not be the Right Solution
The open core layout can have significant advantages over racetrack layouts, but it may have certain disadvantages depending on a project’s parameters including:

Elongated Footprint
While open core layouts aren’t typically larger than racetrack layouts, they are usually more elongated. Consequently, tighter sites with constrained elevator locations may be more suited to racetrack than open core layouts. Open core layouts also typically have about 15% more exterior surface area than comparable racetrack layouts. More exterior surface enables better daylighting, but it can also require larger investments in exterior cladding.

Non-Conventional Structural Grid
To enhance sightlines, open core layouts may have a non-orthogonal structural grid which can be challenging to accommodate within renovation projects. This grid may also require transfer beams on lower floors to align the upper and lower grid systems depending on the type of functions housed below the inpatient tower.

Lessons Learned from Two Decades of Open Core

Drawing on our experience designing open core hospitals over the past twenty years, there are two key lessons that have contributed to the success of these projects:

Leverage Mock-Ups to Prepare Staff for the Changes in Workflow
Full-scale mock-ups enable detailed input from all departments on design options for patient rooms and work areas, fostering buy-in and ownership of the design. Mock-ups can be particularly useful on open core projects as a way of building consensus, as open core introduces design concepts that may be new to staff. As one example, staff are often skeptical that open core layouts can enable ICU-level visualization of patients, but mock-ups can demonstrate the sight line performance.

Manage the Cultural Shift
Open core layouts can introduce significant operational changes, and success depends on effectively aligning every workstream—which can be challenging given that leadership changes often occur during multi-year hospital construction projects. Ensuring a continuity of vision—the translation of design intent to behavioral and cultural shifts and ultimately operational performance—is critical.

Transition planning, which encompasses strategizing, managing and training to facilitate a move into a new facility, can be critical in this regard. Adapting to a new facility can be disruptive and people are naturally resistant to change. Transition planning can help leadership achieve the type of cultural shift required for open core by working through key issues with staff to ensure operational readiness

The past twenty years of projects have demonstrated the benefits open core can bring in areas like staff wellbeing, patient care and performance. Open core may not be the right solution for every hospital, but it can be a highly successful approach depending on a hospital’s goals and location. And, given the challenges hospitals face, from provider burnout to improving the patient experience, we anticipate that open core will be a solution more hospitals explore in the near future.

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