Editor’s Note: Earlier this year, NBBJ hosted a virtual roundtable with leaders from healthcare systems in the UK and the US. This post identifies four key points from the conversation—investment in technology, the need to take a break, balancing beds with support spaces and encouraging healthy choices—that are important contributors to the well-being of healthcare workers. By considering these four factors, healthcare organizations can provide a more supportive environment and mitigate stress and burnout for staff. The ideas in this post have been condensed and reprinted with the permission of the participants.
Look Both Ways Virtual Roundtable Participants:
- Tonia Burnette, Senior Director, Architecture and Planning – Johns Hopkins Health System
- Carin Charlton, Director of Capital, Estates & Facilities Management – Cambridge University Hospitals NHS Foundation Trust
- Amanda Mewborn, Vice President, Planning, Design and Construction – Atrium Health
- Deirdra Orteu, Head of Design, Engagement and Operational Commissioning – Imperial College Healthcare NHS Trust
- Doug Spies, Senior Director of Architecture and Engineering, Corporate Construction and Real Estate – UPMC
Invest in Technology: The Promise to Do More with Less
A shortage of labor in the healthcare industry means an increased reliance on technology. While this issue is not industry-specific, healthcare technology is expensive and changes rapidly, and generational factors are also at play. Therefore, healthcare organizations must consider how to balance the cost of technology with the cost of labor.
As more and more healthcare workers, like doctors and nurses, retire, healthcare organizations are forced to weigh the operating costs of hiring people to replace them, or investing in technologies such as central bed control centers and centralized patient monitoring. While technology promises to do more with fewer people, it often costs more than labor, and evolves more quickly. For example, organizations struggling with hiring and retaining staff in back-of-house areas may consider leveraging Automated Guided Vehicles (AGVs) to deliver patient meals and transport supplies. But, while robots don’t take sick days, they are often more expensive than human labor, and may require upgrades or become outdated or obsolete over time.
“We’re framing the use for technology incorrectly. We need to think about how it can enhance people’s lives and experiences, rather than using it to ‘plug the gap,’” says Deirdra Orteu of the Imperial College Healthcare NHS Trust in London.
Take a Break: The Need to Pause to Prevent Burnout
The Covid-19 pandemic has increased stress, fatigue and burnout in healthcare workers. However, workplace culture and a sense of duty prevents many caregivers from taking a break to recharge during a shift. Because burnout can decrease performance and cause errors, not to mention take a toll on the mental and physical well-being of frontline workers, healthcare organizations must encourage staff to pause during the workday for increased resilience.
“If you take care of your staff, they’ll take care of your patients,” says Doug Spies at the University of Pittsburgh Medical Center. But considering what constitutes “wellness” and what it is that people want is the first step. Small changes such as better respite spaces, improvements to shared spaces like bathrooms or common areas, or the installation of rest pods are easier to implement compared to more traditional solutions due to their small footprint and relative convenience. A large, central break area like a wellness center or café is more difficult to execute—and it may not be what people want. Instead, providing each department with a 250-square-foot space to use as they see fit to meet respite needs on their unit, or the creative use of small alcoves or leftover spaces—such as the informal opportunity areas off stairwells or corridors—brings spaces to rest or take a break into the units when staff can’t step away.
Gathering and presenting data and employee feedback and stories on the impact of burnout and lack of respite space (for example, people napping in their cars or using the bathroom as a break room), can influence decision-makers to provide improved respite spaces. “We also need to come out of the Covid wake and see what the long-term effects are, and what the long-term strategies might be,” says Tonia Burnette of Johns Hopkins Health System. However, workplace culture is perhaps the greatest contributor—or deterrent—to staff taking time to pause during shifts. While organizations may be supportive, “Frontline caregiving is not a culture of taking breaks,” says Amanda Mewborn of Atrium Health who is also a registered nurse. “I don’t want someone else to have to cover for me.”
Balance Beds with Support Spaces: How to Spend the Square Footage
Reconciling budget with square footage has become increasingly challenging as costs rise and building footprints shrink—especially in urban areas. In addition, years of focus on patient environments has led to sub-optimal solutions for caregiver support spaces. Enabling staff to be comfortable and happy means they will deliver better service, but achieving return on investment for these spaces requires healthcare organizations to be strategic in their planning. “We need to ask ourselves, ‘How are our existing buildings going to serve us for the foreseeable future? How do we scale ourselves up to relate to, provide and plan for these needs?’” says Carin Charlton of the Cambridge University Hospitals NHS Foundation Trust.
Measuring ROI starts with the building’s initial programming. Decreased square footage often means a less-than-ideal experience for staff—beginning with limited access to daylight and compressed support spaces. This is especially true of stacked hospital designs, where much of the perimeter is dedicated to beds and leaves little room for staff. “It’s a conscious exercise of ‘how to spend the daylight,’” says Tonia Burnette. On floors with operating rooms (ORs), placing the OR inboard with corridors at the perimeter allows staff to have access to natural light during the day. For inpatient units, it is a matter of making a conscious decision around access to daylight from the start by incorporating space for staff respite on the perimeter or, in new buildings, applying creative geometry and providing opportunities for light to penetrate staff areas.
In addition, changing guidelines continue to increase room sizes. More space for patients can mean increased travel distances and the need to duplicate support rooms for staff, resulting in decreased efficiency. Another challenge is that of people working in the old building or portion of the hospital wondering why they do not have the same amenities and space that those in the new facilities do. “Ninety-five percent of what we are doing is renovations rather than new facilities, so small gestures go a long way,” says Doug Spies. Creating a standard for provisions in staff break areas on different units, refurbishing staff furniture and assessing access to daylight are simple ways to elevate the staff experience.
Encourage Healthy Choices: Nutritious and Convenient Food Options
Often rushed and faced with decision fatigue, choosing healthy food and setting aside dedicated time and space to consume it is rarely a possibility for healthcare workers. Encouraging healthy choices and providing quick, simple options for nutritious food that can be eaten at work or taken home can improve healthcare workers’ well-being.
In contrast to the corporate workplace, where amenities can serve as an incentive for people to step away from their desks or remain on the premises after work hours, “most healthcare workers would prefer to go home after a long shift rather than taking advantage of a gym or cafeteria,” says Amanda Mewborn. Healthy food options that can be ordered and delivered to a floor or unit, or grab-and-go meals to take home are more appealing. Some organizations are exploring solutions such as satellite food lockers, mobile ordering apps and meal programs that offer discounts for healthy food choices. “We started talking about the ability to get and deliver food before Covid, but the conversation has moved so fast in the past year and a half,” says Tonia Burnette.Comment Follow nbbX