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Stress and burnout are not new phenomena in the health care field and have consistently contributed to challenges with workforce shortages. The COVID-19 pandemic and other global events have only exacerbated pressure on care providers, resulting in physical and mental repercussions and causing increasing numbers of employees to consider making career changes.

In a survey of health care workers conducted from June through September 2020 by Mental Health America, 76% of respondents reported experiencing exhaustion and burnout. In a similar study by Berxi Professional Insurance in fall 2020, 48% were considering retiring, quitting or changing careers altogether.

One particular stressor is workplace violence. Incidences of violence against health care workers are rising, according to a National Nurses United survey undertaken in 2020. This increase has led to facilities increasing security measures. 

Workforce shortages and the resulting challenges suffered by those who stay are severe enough to have become top concerns for patient safety.  

Re-recruiting and reenergizing

In response, health care organizations are actively seeking methods of re-recruiting and reenergizing their workforces. For Kris Gaw, chief operating officer of Denver Health, a focus on strategies that help employees feel supported and appreciated in their workplace is crucial for employee retention and can be viewed as a top priority, long-term investment.

“Roughly 60% to 70% of most health care organizations’ expenses are labor-related,” Gaw says. “Adding to that is the cost of turnover in today’s labor market — it’s a real issue.” 

In addition to turnover cost reductions and knowledge retention benefits, employees who feel their work environment supports their well-being become unofficial recruiters of new talent, further bolstering a positive workplace culture and employee loyalty, a finding confirmed by an American Psychological Association article published in 2016 titled “Workplace Well-being Linked to Senior Leadership Support, New Survey Finds.” 

When deciding on the best course of action for employee retention, strengthening employee engagement should take precedence. According to a Gallup meta-analysis conducted in 2016, teams with high levels of engagement realize a 41% reduction in absenteeism, 59% less turnover and 21% greater profitability. Improved physician job satisfaction is also positively correlated with patient satisfaction and adherence to care recommendations, resulting in improved health outcomes, as supported by a 1993 medical outcomes study by RAND Corp.

Utilizing both operational strategies and improvements to the physical environment, health care organization leaders, people and culture facilitators, and facilities management can contribute immensely to the goal of improving retention. By empowering and enabling focuses on three broad outcomes — well-being, control and connection — these groups are strategically aligned to boost each other’s work toward a truly supported and elevated workforce. 

Additionally, during the design of any new capital project, focusing on these three outcomes is paramount to providing tangible reinforcement of a commitment to employee needs: 

Well-being. Well-being integrates physical, mental and emotional health. The World Health Organization defines mental health as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”

Though often referenced only when discussing a reduction in active distress, well-being pertains to holistic wellness and resilience. Individuals with high levels of well-being report enhanced job satisfaction, are more productive and are less likely to quit their jobs. 

• Promote comfort. Caregivers, maintenance employees and other health care workers have a high degree of movement integrated into their daily tasks. To compliment caregivers’ consistent motion, ergonomic, supportive and adaptable workstations, patient furniture and workforce tools should aim to reduce musculoskeletal stress and be highly adjustable to a variety of postures and body types. 

Superior acoustic design is another important factor for employees as well as patients. When spaces perform well acoustically, care providers can better detect subtle changes in breathing, pulse or gait. Additionally, improved sleep supercharges a patient’s healing process. 

Acoustic improvements will increase speech intelligibility, buffer respite zones from those of high activity and facilitate restoration. Lighting, too, plays a part. Setting standards for low glare and high color rendering index reduces strain while enhancing the ability of employees to notice the flush or jaundice in a patient’s complexion, or maintenance items requiring attention. Tunable lighting supports a healthy circadian rhythm during night shifts but also for any part of the health care population whose primary workspace lacks access to natural light during the day. 

• Support mental and emotional health. Employees’ sense of safety and security is foundational to a positive workplace experience. A core concept of biophilia (the innate tendency to seek connections with other forms of nature) is prospect and refuge (i.e., the ability to observe one’s surroundings from a protected position). 

From early in the project, planning should account for the absence of dead-end corridors and restrictive circulation paths, and clear avenues to safety. To enhance an employee’s sense of safety, project teams should utilize sensor-controlled lighting (which provides signals of occupant movement), glass panels in shared-office doors, and direct visibility to security stations, areas of high activity and traffic, and exit pathways. 

Given the demanding nature of health care, it is also critical to recognize the need and accommodate space for private respite away from the public eye. Wellness rooms, quiet rooms and private outdoor spaces aid in ongoing stress management and recovery from emotionally taxing experiences. Semipublic spaces, accessible only to limited populations and with a more relaxed feel in auditory, visual, haptic and other stimuli, provide stages for group cohesion and mutual support.

Control. In all aspects of life, a sense of control plays a crucial role in one’s overall level of satisfaction. Extending beyond the concept of variety, control is about individual agency. Spaces that place the locus of control in the hands of occupiers equip them to adapt their environment to suit individual needs and thereby enable them to perform their best work. 

• Design for individuality. It’s important to provide spaces that can accommodate a spectrum of work styles and balance the amount of collaborative and private workspaces. Project teams should provide a wide spectrum of places within both the individual and collaborative space types. They also should vary the stimuli between them — acoustics, texture and color, lighting levels and thermal control — and communicate these deliberately designed differences to all occupants. 

It’s important to include focus rooms and phone booths for heads-down work, dictation, virtual visits and personal calls. Separation into zones for quiet work, active collaboration and various levels of stimulation allow employees to control noise levels in their work area as well as temperature and even their desired level of social interaction. 

• Strengthen influence and agency. Providing a spectrum of places and flexibility only works if occupiers feel they have the power and agency to choose between them and adapt them to suit their needs. Just as providers gain a sense of influence when they feel they can deliver the quantity and quality of care their patients need, employees’ sense of agency in being able to change their environment is critical. 

Project teams should optimize providers’ ability to perform at their best by creating adaptable space, such as flexible exam room layouts that support collaborative discussions with patients and families. Consultation rooms with lounge furniture encourage further patient engagement, particularly for integrative behavioral health practices. Additionally, adaptable and mobile technology reinforces providers’ sense of control.  

Connection. Authentic and meaningful connection is central to building social vitality and community. Project teams should establish connection by creating a variety of spaces for different types of connection, programming to activate those spaces and instilling a sense of belonging and pride of place. 

• Inspire interconnection. Project teams should think through every type of employee routine, range of experiences and need in the workplace, and their level of access to various areas of the facility. It’s typical to have an employee breakroom, but project teams also may consider programming additional spaces that foster connections among employees. 

For example, unassigned “touchdown” workspaces and coffee bars in common areas allow for ad hoc interactions and relationship building. Enclosed team or conference-sized areas that, instead of the traditional table and chairs, provide lounge furniture and soft lighting can create a more relaxed connection and even inspire different conversations than those that occur in formal spaces.

• Promote recognition. Having an employer’s core values, rewards and stories relate to the work of every employee can be key to feeling a sense of meaning in one’s work, which positively correlates with satisfaction and engagement. Project teams should incorporate design elements that reflect and highlight the organization’s unique culture and internal dynamic. 

When considering “environmental branding,” project teams may include graphic treatments that celebrate not just the organization’s mission, values and culture, but also the accomplishments, value and contributions of teams and specific employees. This can go a long way in instilling pride of place for employees. Also, project teams should consider adding space or an element where employees can pass on their own kudos for a job well done to anyone working hard on the front lines or behind the scenes.

Applying the concepts

Health care facilities professionals involved with a new capital project must consider well-being, control and connection throughout the planning, design and construction process. The following steps by project teams will help them apply these concepts to a facility project:

Define the why. The project kickoff defines its trajectory, so teams should begin by identifying top priority goals and needs. Project teams should develop a project vision that will establish benchmarks for success and guide design decision-making. The benchmarks should be revisited often as key performance indicators for progress at regular intervals throughout the process.

Identify the populations served. Different occupants have different spatial experiences, access, agency and needs. Capital projects should identify the backgrounds, perspectives and needs of patients, but it’s also important to acknowledge inherent variety within the workforce. Project teams should build a picture of the challenges, opportunities and needs of each group — from nurses and doctors to administrative and operational employees, vendors and contractors.

Engage employees in the design process. According to an April 2022 blog post published by Salesforce Inc. and titled “You Can Fight Climate Change and Boost Revenue — See How These Ecopreneurs Do It,” employees who feel their voice is heard are 4.6 times more likely to feel empowered to perform their best work. Inviting input and feedback shows employees that leadership values their opinions and experiences and acknowledges that some individuals have expertise and knowledge outside of their own circle.

Consistent communication contributes positively to change management by setting intent early and by regularly acknowledging and responding to feedback throughout the design process, helping to acknowledge changed perspectives, manage expectations and combat uncertainty. 

Employees who participate in design develop a sense of ownership and become advocates of the project to other employees. This can accelerate activation by prompting a positive mental transition to the new space long before the physical move. Project teams should utilize employee surveys, focus groups, workshops and mock-ups to facilitate and deepen design discussions. As an added benefit, these strategies create a forum for employees to discuss processes and workflows, which could result in improvements beyond the built environment. 

Gaw of Denver Health advises project teams to have a strong emphasis on thoroughly understanding caregivers’ perspectives and needs: “Work on their unit with them. Put on scrubs and shadow them. Meet people where they are. Listen to the voice of the caregiver with the intent to take away their pain points.” 

At the end of the day, project teams and health care leadership can help employees feel valued by showing them that their experience matters. “If you say ‘just tell me what I can do to make your life a little easier,’ that caregiver will likely hug you,” Gaw says. “They just want to know that you care.”

Working together

Design and operational enhancements can work together to emphasize how much an organization values its employees’ experiences, making all the difference in how invested employees are in the organization. 

By keeping well-being, control and connection at the center of design decision-making, project teams can help health care leaders continue to establish their organizations as not only the provider but also the workplace of choice.

Sarah Moser, AIA, EDAC, is project architect; Aimee Burmaster Hicks, RID, IIDA, CHID, is principal; and Lida Lewis, RID, ASID, WELL Faculty, LEED AP, is associate principal/interior design director at Page. They can be contacted at, and