Leverage RetentionEmployeeEnvironmentsPhysicaltoBoostHealthand One of a series of white papers by Page professionals Sarah Moser, Lida Lewis and Aimee Burmaster Hicks
The Page portfolio consists largely of complex projects that benefit from our integrated disciplines and that make a significant impact on the communities they serve. We are guided by the three core values of creativity, collaboration, and commitment, and through the force of these ideals, we live up to our promise of design that makes lives better.
Visit our website at pagethink.com With roots extending back to a two-person partnership formed in 1898, Page is one of the most prolific and enduring architecture and engineering design practices. Page architects, engineers, interior designers, planners, strategic analysts and technical specialists provide services throughout the United States and abroad. Our diverse, international portfolio includes projects in the healthcare, academic, government and science and technology sectors, as well as civic, corporate and urban housing projects.
University of Texas Medical Branch Clear Lake / Clear Lake, Texas
are not new phenomena in the health care industry and have consistently contributed to challenges with workforce shortages. The COVID-19 pandemic, among other global events, has only exacerbated pressure on care providers, resulting in physical and mental repercussions and causing increasing numbers of staff to consider making career changes. In recent surveys of healthcare workers, a startling 76% of respondents reported experiencing exhaustion and burnout, with 48% considering retiring, quitting, or changing careers altogether. One particular stressor is workplace violence; incidences of violence against health care workers are rising, leading to facilities increasing security measures, such as supplying panic buttons for workers at all levels. Workforce shortages and the resulting challenges suffered by those who stay are severe enough to have become top concerns for patient safety.
In response, health care organizations are actively seeking methods of re-recruiting and re-energizing their workforce. 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 staff retention and can be viewed as a top-priority long-term investment: “Roughly 60-70% of most health care organizations’ expenses are laborrelated. 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 wellbeing become unofficial recruiters of new talent, further bolstering a positive workplace culture and employee loyalty.
When deciding on the best course of action for employee retention, strengthening employee engagement should take precedence. 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 Utilizingoutcomes.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 foci on three broad outcomes—wellbeing, 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.
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/ Austin, TexasThe Center for ENT / Houston, Texas
Baylor Scott & White Austin Barton Creek Hospital
Leverage Physical Environments to Boost Employee Health and Retention
Wellbeing Wellbeing 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, wellbeing pertains to holistic wellness and resilience. Individuals with high levels of wellbeing report enhanced job satisfaction, are more productive, and are less likely to quit their job. Here are just a few ways design can specifically support wellbeing by encouraging holistic wellness and minimizing environmental stressors:
Promote comfort: Caregivers, maintenance staff, and other healthcare workers have a high amount of movement integrated into their daily tasks. To compliment caregivers’ consistent motion, ergonomic, supportive, and adaptable workstations, patient furniture, and workforce tools should be highly adjustable to a variety of postures and body types and aim to reduce musculoskeletal stress. 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, and improved sleep supercharges patients’ healing process. Acoustic improvements will increase speech intelligibility, better buffer respite zones from those of high activity, and facilitate restoration. Lighting, too, plays a part. Setting standards for low glare and high CRI (Color Rendering Index) reduces strain while enhancing the ability of staff 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 healthcare population whose primary workspace lacks access to natural light during the day.
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Support mental and emotional health: Employees’ sense of safety and security is foundational to a positive workplace experience. A core concept of biophilia 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 provide clear avenues to safety. To enhance an employee’s sense of safety, 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 roles, 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. Semi-public spaces, accessible only to limited populations and with more relaxed feel in auditory, visual, haptic, and other stimuli provide stages for group cohesion and mutual support.
Department of Veterans Affairs Austin Outpatient Clinic / Austin, Texas Pheobe Putney Memorial Hospital Meredyth Medical Office Building II / Albany, Georgia
Control In all aspects of life, a sense of control plays a crucial role in our 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.
Advanced Heart Associates Medical Office Building / Plano, Texas
University of Texas at Dallas Brain Performance Institiute / Dallas, Texas
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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. 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. Consult rooms with lounge furniture encourage further patient engagement, particularly for integrative behavioral health practices. Additionally, adaptable and mobile technology reinforces providers’ sense of control.
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. Design to provide a wide spectrum of places within both the individual and collaborative space types. Vary the stimuli between them—acoustics, texture and color, lighting levels, thermal control—and communicate these deliberately designed differences to all occupants. 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 allows staff to control noise levels in their work area as well as temperature and even their desired level of social interaction.
Authentic and meaningful connection is central to building social vitality and community. 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.
National Domestic Violence Hotline / Austin. Texas Dell Medicacl School Health Transformation Building / Austin. Texas
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. Incorporate design elements that reflect and highlight the organization’s unique culture and internal dynamic. When considering “environmental branding,” 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, 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.
Connection
Leverage Physical Environments to Boost Employee Health and Retention
Inspire interconnection: Think through every type of employee’s routine, range of experiences and needs in the workplace, and their level of access to various areas of the facility. It’s typical to have an employee breakroom but 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 which occur in formal spaces.
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Engage employees in the design process: According to an April 2022 report published by Salesforce, “You can Flight Climate Change and Boost Revenue” 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 there are those with 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 staff. This can accelerate activation by prompting a positive mental transition to the new space long before the physical move. Utilize staff surveys, focus groups, workshops, and mock-ups to facilitate and deepen design discussions. As an added benefit, these strategies create a forum for staff to discuss processes and workflows, which could result in improvements beyond the built environment.
Application If you’re involved with a new capital project, consider the following recommendations: Define the why: The project kickoff defines its trajectory, so begin by identifying top-priority and needs of patients, but it’s also important to acknowledge inherent variety within the workforce. Build a picture of the challenges, opportunities, and needs of each group—from nurses and doctors to administrative and operational staff, vendors, and contractors.
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Texas Children’s Hospital West Campus / Houston, Texas
Design and operational enhancements can work together to emphasize how much an organization values its employees’ experience, making all the difference in how invested employees are in turn. By keeping wellbeing, 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.
Kris Gaw 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, designers 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. They just want to know that you care.”
Beheshti,BibliographyN. (2019). 10 Timely Statistics About The Connection Between Employee Engagement And Wellness. Retrieved from Forbes: engagement-and-wellness/?sh=5ab4d8c222a0nazbeheshti/2019/01/16/10-timely-statistics-about-the-connection-between-employee-https://www.forbes.com/sites/ Berger, E. (2021). US hospitals outfitting nurses with panic buttons amid rise in assaults. Retrieved from The Guardian: nurses-panic-buttons-to-securityhttps://www.theguardian.com/us-news/2021/sep/30/hospitalsChaunie Brusie, B. R. (2020). Survey of Healthcare Workers Reveals High Levels of Burnout, Stress, & Thoughts of Leaving Their Jobs. Retrieved from Berxi: 2020-survey-resultsresources/articles/state-of-healthcare-workers-survey#the-state-of-healthcare-workers-in-https://www.berxi.com/ Crosson, F. J., & Casalino, L. (2013). Physician Practice Satisfaction: Why We Should Care. Retrieved from Health Affairs: https://www.healthaffairs.org/do/10.1377/ hblog20130509.031046/full/ DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, Kaplan S, Rogers WH. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993 Mar;12(2):93-102. doi: 10.1037/0278-6133.12.2.93. PMID: 8500445. Harter, J., & Mann, A. (n.d.). The Right Culture: Not Just About Employee Satisfaction. Retrieved from Gallup: https://www.gallup.com/workplace/236366/right-culture-not-employeesatisfaction.aspx Sable-Smith, B., & Miller, A. (2021). ‘Are You Going to Keep Me Safe?’ Hospital Workers Sound Alarm on Rising Violence. Retrieved from KHN: Mentalgoing-to-keep-me-safe-hospital-workers-sound-alarm-on-rising-violence/https://khn.org/news/article/are-you-HealthAmerica.(2020). The Mental health of healthcare Workers in COVID-19. Retrieved from Mental Health America: https://mhanational.org/mental-health-healthcare-workersWorldcovid-19Health Organization. (2022). Retrieved from https://www.who.int/data/gho/data/majorthemes/health-and-well-being
A double-story water feature—a source of both audial and haptic biophilic cues—welcomes patients and staff alike. Roof gardens, extensively detailed to be universally accessible, provide both private staff and public patient gardens. A sculpture garden connects the campus, provides an extension of the internal art program, and provides a public community Naturalbeautification.lightand
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Designed for LEED Gold, careful research ensured low-maintenance, healthy materials, while providing an unusually highly textural and nature-inspired experience. Twelve patient rooms are designed with small adjoined “family rooms” for extended family support. Artificial lighting was constructed to be hidden or shielded in every possible instance to ensure light provided a soft glow rather than harsh glare. Medical gasses and equipment are shielded, adding to the soothing nature of the overall aesthetic, and aiding in providing a calmly restorative care
Forestenvironment.Park Austin Community Hospital Texas Case Study Wellbeing - Promote Comfort Wellbeing Support Mental and Emotional Health Strengthen Influence and Agency Engage Employees in the Design Process
views pour in from every angle, with respite areas for caregivers and families given prime access to the best nature connections. Even operating rooms, pre-operative spaces, and PACUs are outfitted with clerestory windows to filter light and its circadian enforcing and restorative properties throughout the facility.
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When the project’s developers set out to create a world-class community hospital intended to be at the hub of a fledgling community in fast-growing North Austin, recruitment of top physicians and staff was the initial goal. The team at Forest Park Austin Community Hospital challenged Page to create a “Five Star” hospitality experience to draw in the community - “I want to work here” and “I want to go here for care” were sought-after statements for the leadership team. The desire for an elevated, hospitable environment inspired a “Modern Hill Country” aesthetic—rich and timeless for Central Texas, and a theme that would help patients and caregivers feel right at home.
Additionally, the dual-exam room model, with a door for patient access and another door directly to staff work areas, enhances a sense of safety for caregivers because they cannot be put in a position of having their back to the door or their path to a door potentially restricted.
Baylor Scott & White Austin Barton Creek (New Community Hospital) Austin, Texas Case Study Related Sections: Wellbeing – Support Mental and Emotional Health Control – Design for Individuality Connection - Inspire Interconnection
A centrally located cafeteria serves as the heart of the facility and provides a touchstone space for community and social interaction. This and other public spaces are designed to be flexible and multi-use with different types of lighting, furniture, and consideration for multiple acoustic scenarios. This is key, as these spaces also provide a “stage” for community events in additional to staff all-hands gatherings. Built upon the success of the initial Barton Creek design, Page and Baylor Scott & White have expanded the impact of this facility. Three additional facilities have been developed and constructed throughout Central Texas. Adaptations were necessary for local codes, site constraints, and community needs—but the initial deep collaboration helped ensure the connections built between these facilities, the staff and patients they serve, and the communities in which they are housed are kept as a guiding principle in all developments.
The Baylor Scott & White Austin Barton Creek facility is a community hospital that balances creating connection between caregivers, patients and their families while providing a variety of spaces specifically for caregivers. The journey started with an intense integrative design partnership between the leadership, design team, and a wide range of stakeholders. The project was seen as a critical prototype for a new design typology in a full-service hospital, which offers a range of medical and surgical services, as well as an Emergency Department open 24/7.
Recognizing that an individual’s state of mind as well as the type of space they require varies throughout the day, there are offstage areas planned to encourage connection by allowing open communication and knowledge-sharing between caregivers. Glass features at conference rooms and offices, as seen above, allow for transparency and interconnection. In addition, glass in doors to shared spaces reinforces a sense of safety, particularly for doors that are lockable.
The on-stage / off-stage model is widely recognized as a model that supports a sense of connection, privacy, and safety for caregivers, allowing them a clear separation between public/ patient and staff-only areas. Within the staff-only areas, the model naturally provides private space for employee heads-down work and quiet areas for respite.
About the Authors
Aimee is a registered Interior Designer actively involved in all phases of projects specifically for healthcare and corporate clients. She has worked with numerous corporate and healthcare clients including Baylor Health Care System, Saint Francis Health System, Department of Veterans Affairs, Bickerstaff Heath Delgado Acosta and JP Morgan Chase. Aimee realized at an early age that she had the talent and ambition to work as a creative professional. “Being an interior designer is all I’ve ever wanted to do,” Aimee explains. With that goal set, she prepared for her career by graduating from Texas Christian University with a Bachelor of Science in Interior Design, a program accredited by the Foundation for Interior Design Education Research (FIDER). Her dedication to learning earned her membership in the Phi Upsilon Omicron National Honor Society. Aimee’s strong commitment to the creative and collaborative process results in unique design solutions, holistically thought-through with all team members.
Sarah is a Project Architect who has spent her entire career designing healthcare and senior care environments. She is passionate about human-centered design and leadership, and strives to improve the ways in which people experience and connect with our world. Her excitement for architecture shows most when developing client relationships, space planning, and working with users to help them discover their unique vision for their project. Sarah is certified in evidence-based design and utilizes myriad research methods and lean principles to develop a deep understanding of each client’s values and needs, discuss their current and ideal processes, and design a space that enhances the experience of all users.
Lida is an architect by training and interior architect in practice with a focus on sustainability and design’s impact on people. Director of Interiors at Page’s DC office, she is also currently serving on the global WELL Mind Concept and Health Equity Advisories and is an ASID “One to Watch”, and regularly seeks out opportunities to present and publish. A firm believer that the design of space has a profound impact on wellbeing, she is an avid reader on a wide variety of topics related to wellbeing design (lighting, acoustics, engineering integration to interiors, and more), mental health, culture, community+connectivity, DEI, women at work, sustainability, resilience, and more (just ask her about her database—it’s ~2,400 articles strong and growing every day). She’s a lover of design, strategic thinking, and connecting people—and how we all can leverage design to elevate the occupant experience.
Sarah Moser, AIA, EDAC Project Architect / Healthcare Planner Lida Lewis, RID, ASID Associate Principal / Commercial Interiors Director Aimee Burmaster Hicks, RID, IIDA, CHID Principal / Interior Designer
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