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There is a growing global interest in ensuring health care spaces are resilient in terms of flexible design to accommodate pandemic and surge capacity challenges yet also support resilience in health care workers. The Center for Health Design’s Knowledge Repository includes several papers on resilience, three of which are featured here.

In a 2022 study on flexible design, van Heel and colleagues explore design considerations used in Dutch health care facilities during the COVID-19 pandemic. Findings outlined the importance of planning for flexibility such as large single-patient rooms that might be used for two patients during a surge condition; technology to support virtual consultations; infrastructure to support remote work; and adaptability features that target staff. For example, researchers suggest that nurses in this study preferred cohorted units because they felt more control and could monitor patients without frequently donning and doffing personal protective equipment. The authors further noted that spatial features can potentially interfere with the ability of staff to modify care routines. 

Authors of another study focused on biophilia in a Romanian hospice facility during the pandemic. Untaru and colleagues used interviews with employees and a survey to identify relevant biophilic elements and explore relationships between biophilic design and workplace attachment. Researchers found hospice staff well-being was enhanced by attitudes about biophilic design green features and natural decor. Workplace attachment was indirectly influenced by these same factors, with emotional well-being the strongest factor. This finding highlights the importance of focusing on personal resilience. The authors urge designers to include ample natural features such as natural decor, living plants and larger windows to facilitate physiological and psychological well-being and enhance engagement. 

Prendergast and colleagues take staff well-being a step further by studying the impact of both active and restorative resilience rooms on intensive care unit nurses and other staff members. They used surveys and tracked room use via identification card swipes to determine that use of the resilience rooms was associated with significant decreases in emotional distress. Based on the findings, researchers recommend that use of resilience rooms may be of most benefit in the early stages of burnout. Although the restorative rooms were used most frequently, this single-site, preliminary study highlights two different strategies for approaching respite room design.

Each of these studies addressed resilience from a different perspective, yet all are relevant to the design of health care spaces. While building flexible rooms, including biophilia or incorporating restorative areas, can help the health care field to accommodate future challenges, there are also many other ideas to consider. 

More articles on this and other health care design topics can be found in The Center for Health Design’s Knowledge Repository.

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• L. van Heel et al., “Pandemic Resilience in Dutch Hospitals: Flexibility That Counts in a Crisis,” The Evolving Scholar | ARCH22 (ARCH22, ‘Enabling health, care and well-being through design research’, Delft, The Netherlands: Orvium, 2022).
• E.N. Untaru et al., “Biophilic Design and Its Effectiveness in Creating Emotional Well-Being, Green Satisfaction, and Workplace Attachment among Healthcare Professionals: The Hospice Context,” HERD: Health Environments Research & Design Journal, 2023, in press.
• V. Prendergast et al., “Resilience Room Use and Its Effect on Distress among Nurses and Allied Staff,” Journal of Neuroscience Nursing, vol. 55, no. 3 (2023): 80–85.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.

Yolanda Keys, R.N., NEA-BC, EDAC, is research associate at The Center for Health Design.