By Alison Huynh
Alison Huynh is a Sydney-based architect specialising in design for healthcare, mental health, master planning and urban design strategy for hospitals.
Creating environments that assist in reducing stress and avoiding burn-out in staff.
Understanding the impacts of stress and burnout
Working in healthcare environments is clearly understood to be stressful and demanding. Long working hours, shift-based work, high-intensity work, and exposure to pain, suffering and death can take their toll on psychological wellbeing. Burnout and poor wellbeing in healthcare workers are undoubtedly associated with poorer patient safety[i]. This is a correlation that has a significant implication for designers in healthcare settings. It indicates that by supporting staff wellbeing, we can support safer patient care.
As designers, we often highlight the importance of positive spatial experiences for patients, and the need to create environments that reduce stress and improve patient satisfaction. Meanwhile, staff spaces are often designed for efficiency, travel distances, infection control and logistics. Clearly, we need to go beyond physical safety in occupational environments to support holistic staff wellbeing.
We know that doctors and medical students have substantially higher rates of psychological distress and suicidal thoughts when compared with both the Australian population and other professionals. This disproportionately affects young doctors, female doctors and students, and indigenous students[ii].
Additionally, a cross-sectional survey conducted during Australia’s first COVID-19 pandemic phase in April-May 2020 indicated that healthcare workers showed significant symptoms of moderate-severe level depression (21%), anxiety (20%) and posttraumatic stress disorder (PTSD; 29%)[iii]. This is despite low levels of COVID-19 contact in Australia. This is consistent with early international reports that the pandemic had a considerable impact on the psychological wellbeing of front-line hospital employees around the world[iv].
Understanding the workplace
The workplace of many healthcare employees is highly varied and complex. It incorporates both the physical environment as well as virtual environments. For nursing staff and carers, there is a significant amount of multi-tasking and movement between spaces, from the bedside to the staff station. For other staff, such as consultants and allied health professionals, their experiences may be characterised by hybrid work, working remotely and utilising video conferencing to assess patients, share information and provide support.
Multi-modal working environments in the Hospital lead to significant amounts of multi-tasking and distracted work processes. Royal Children’s Hospital Melbourne by Bates Smart, Billard Leece and HKS. Photography © Shannon McGrath
During the COVID-19 pandemic, the pressure to effectively manage infection control through personal protective equipment and other risk management procedures added extra stress and fear of infection to the burden of care[v]. Another common challenge of the pandemic was the need for staff to quickly be redeployed into new environments. They may have put aside non-essential activities to meet urgent needs, compromising the holistic and therapeutic quality of care they would normally provide. This can lead to psychological distress and reduced job satisfaction, leading to a desire to leave the profession.
Now, more than ever, we need to consider how to improve support for staff wellbeing to enhance job satisfaction, reduce burnout and improve patient care. Fortunately, designers have powerful tools for ameliorating the environment and creating opportunities for staff wellbeing.
Welcoming and uplifting design in the Hospital can ameliorate the environment and support wellbeing for staff, patients and visitors. Bendigo Hospital by Bates Smart and Silver Thomas Hanley. Photography © Shannon McGrath
Design for quality respite
Regular breaks are essential to high-intensity work, especially when coupled with long hours and shift-based work. Improved design of respite spaces can support a range of activities relating to staff wellbeing. Respite spaces allow for a moment to take a breath without leaving the unit. These spaces facilitate peer support, providing a place for private conversations and debriefing during periods of high stress. By prioritising staff privacy, these spaces also encourage practical training by providing a safe environment for students to ask questions.
These spaces need to be more than tea and coffee stations. Ideally, staff respites need to be well-integrated and fairly distributed to encourage active use. A variety of spaces should be considered, from cheerful and daylit spaces with distance views and connection of nature to lift the mood and rest the eyes. Soft and darkened spaces can provide a sense of retreat and relief from the bright lighting and constant noises on the unit. They may accommodate two-four people, and they may be visually connected with other spaces. However, acoustic privacy and reduced distraction are of paramount importance.
Shared staff spaces that have good access to natural light and distance views can incorporate a range of seating options, including small group settings, or space to be alone. Rooftop terraces can provide private spaces close to acute services and other amenities. Workshop by Bates Smart. Photography © Brett Boardman.
Design for quality learning
The hospital is a learning environment for all staff and in all areas. Flexible and engaging training spaces that are embedded in the healthcare environment encourage attendance and support trainees on the job. Medical students and other trainees should have opportunities to talk to lecturers and connect with other students in formal and informal settings.
In a rapidly changing world, staff at every stage in their career need high-quality training and continuing education to develop their skills, advance their career and maintain up-to-date knowledge. Often in a busy work environment, it can be hard to carve out the time to dedicate to education. Staff often need to remain available on-call and have expressed concern that essential training and education might be reducing their time for caregiving duties.
In a fast-developing educational environment that is becoming increasingly reliant on remote training, it is important that hospital and university spaces are closely linked. This is supported by equitable and accessible room booking systems and the optimised use of multi-purpose spaces thus reducing departmental footprints and increasing flexibility.
Adaptable planning to support staff needs
In many cases, the spaces that healthcare workers need to rest, recover and learn are embedded in the floor plan, deprioritised as time goes on and sometimes lost in the planning process. Even a robust stakeholder engagement process can struggle to balance clinical, infrastructure and environmental priorities.
As designers we need to clearly identify these staff spaces as a part of a vital network within the hospital, ensuring equality of access and quality of spatial design. Often associated with the flexible fit-out zones of the hospital, staff spaces may occupy zones earmarked for future expansion, and therefore a strategy must be in place to ensure that they are adequately re-provided and continually refreshed.
Spaces for staff respite and learning don’t need to be large or expensive, simply thoughtful and well-designed. It is the attention to detail and appreciation for the human experience which encourage positive interactions with the environment.
Even when there are no windows or natural light available nearby, soft furnishings and lighting provide a restful retreat. Space for 1-2 people provides opportunities for individual respite or a quiet conversation. This can be located within staff zones or circulation spaces. Iglu Franklin St by Bates Smart. Photography © Peter Clarke
[i] De Kock, J.H., Latham, H.A., Leslie, S.J. et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health 21, 104 (2021). https://doi.org/10.1186/s12889-020-10070-3
[ii] Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB (2016) Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. PLOS ONE 11(7): e0159015. https://doi.org/10.1371/journal.pone.0159015
[iii] beyondblue Doctors’ Mental Health Program. National Mental Health Survey of Doctors and Medical Students, 2019, https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report—nmhdmss-full-report_web
[iv] Dobson H, Malpas CB, Burrell AJ, et al. Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic. Australasian Psychiatry. 2021;29(1):26-30. doi:10.1177/1039856220965045 https://journals.sagepub.com/doi/full/10.1177/1039856220965045#bibr3-1039856220965045
[v] De Kock, J.H., Latham, H.A., Leslie, S.J. et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health 21, 104 (2021). https://doi.org/10.1186/s12889-020-10070-3