Three Ways Design Can Help Prevent Burnout in Healthcare
Even as the country moves forward from the worst phases of the COVID-19 pandemic, the issue of burnout persists. Though many of the solutions are systemic, there are things designers can do to address the issue.
Healthcare worker burnout is nothing new. Even before the COVID-19 pandemic, increasing patient volumes, changing regulations and growing demands left many in the field feeling overwhelmed, anxious and stressed. Physicians were at twice the risk for burnout compared to the general population, and many reported depression and suicidal ideation. Sadly today, the situation has only deteriorated further. U.S. News & World Report explained that since the start of the pandemic, some 60% to 70% of clinicians have reported symptoms of exhaustion, depression, sleep disorders and PTSD. The problem is especially notable among the nursing population, as the nation struggles to meet an ever-growing need for nurses against a backdrop of increasing physical and emotional distress – critical components to becoming burnt out.
Even as the country moves forward from the worst phases of the pandemic, the issue of burnout continues to persist. Though many of the solutions are systemic, there are things designers can do to address the issue. In working with our healthcare clients, we’ve gained a better understanding of the design solutions that can support the mental and emotional well-being of healthcare workers. Here, we look at three design solutions that come from our collaborations.
1: Designing to integrate technology. While integrating technology into healthcare spaces is a regular practice, the pandemic only heightened awareness around the need to design healthcare environments that are technology-rich and that can respond to the ever-changing needs of patients and providers. Before COVID, there was a certain level of resistance to telehealth; today, an increasing number of providers are implementing telemedicine as another, now-accepted way to connect with patients. Utilizing this technology can not only offer greater convenience for patients but also offer more flexibility to when and where providers have appointments. A key design consideration around telehealth is to look at whether the integration requires a space adjustment. Depending on the balance of in-person versus virtual appointments, a clinic may need to grow, contract or reimagine the way current spaces are being used.
Leveraging technologies like automation and remote diagnostics can allow practitioners to manage certain patient needs to free-up time and build in breaks. While medical devices can and should never replace person-to-person, advancements in automation, especially related to nursing, are easing the strain of round-the-clock patient care.
A new dermatology clinic in Omaha, Nebraska is one example of designing to integrate technology. For our design of this space, the number of exam rooms has been reduced and replaced by more telehealth-equipped rooms. These spaces allow providers to leverage asynchronous telehealth and provide patients with pre-recorded content as they prepare for a procedure. Likewise, the rooms allow for synchronous care to bring multiple specialists in at once to conduct consultations and provide a review of lab results, imaging scans, or input from other fields of expertise based on recently performed examinations and/or procedures.
2: Designing to emphasize mental and emotional health. Emphasis is usually placed on the patient and public spaces within the healthcare environment, and rightfully so. For healthcare workers, the clinic isn’t only a place where patients come to receive treatment – it’s also, fundamentally, a workplace. Taking into consideration the same growing emphasis on worker well-being we’ve seen in the corporate world and translating those elements into healthcare environments is an important step in supporting and encouraging positive physical, emotional and mental well-being for workers. One way to do this is by incorporating spaces for respite: lounge areas and wellness rooms designed for the entire staff and that incorporate opportunities for calm and decompression. These spaces might incorporate tools such as massage chairs, dedicated areas that can offer individual quiet time, aromatherapy and even walls where people can write encouraging messages to one another.
Spaces where people can go for invigoration, such as a place to practice yoga, are another option. In many cases, this room could be a self-serve area where workers can go in between shifts to stretch and do mobility exercises or even meditate. Lastly, elevated spaces for respite such as napping pods where workers can go before or after their shifts can encourage people to take a pause, reset and reenergize.
In a collaboration with Nebraska Medicine, we worked with the radiology department to design a respite room adjacent to the radiology resident lounge. This room provides a space where providers can go to regroup during a long shift or take a moment to reflect after delivering difficult news to a patient or patient’s family. Having access to this kind of amenity – where providers can remove themselves from the bustling clinic and imaging environment – has been an important asset to Nebraska Medicine’s Radiology Department, both as a place of reprieve for current providers and radiology residents and also as a recruiting tool for incoming residents.
In addition to dedicated spaces where workers can go to recharge, design elements within the primary spaces themselves offer a tool to foster positive mental health. Straightforward solutions such as updating finishes can make a big difference; additionally, lighting and lighting controls can play a key role in the well-being of healthcare employees. As my colleague, David Raver, IALD, MIES, MFA previously explained, light is the main driver of the visual and circadian systems. Given that people spend much of their waking time indoors, insufficient illumination or improper lighting design can lead to drifting of the circadian phase, especially if paired with light exposure at night. Lighting environments impact the visual, circadian and mental health of humans, and while most environments are designed to meet the visual needs of individuals, they often don’t take into account those other impacts. Considering the implementation of elements such as WELL Light concepts can provide lighting environments that reduce circadian phase disruption, improve sleep quality and positively impact mood. It can also help to provide some measure of autonomy around lighting control, including color, intensity and color temperature of the lighting within the environment.
3: Designing for flexibility and efficiency. The pandemic has shown us that we need to be prepared for the unknown. As such, designing spaces that are flexible and which can adapt to changing public health is critical both to responding to future unknowns and prevent the burnout that can come from unexpected increases in workload. The already noticeable shortage in staff is only further compounded when critical staff must attend meetings to discuss how to change rooms to make special accommodations for high-risk or highly infectious patients (e.g., converting standard hospital rooms into negative pressure or isolation rooms to prevent airborne pathogens from entering hallways and corridors). If rooms are designed to be flexible and can be adapted quickly, the need for meetings diminishes, thus easing the pressure on and helping protect the time of staff members.
Previous approaches had one central nurses’ station where staff would go to access equipment, patient files, medicines, etc. and where they would carry out administrative tasks. Given the ongoing nurse shortage in the U.S., however, it’s now imperative that we design healthcare facilities with distributed or decentralized stations and access to supplies or support spaces. This approach helps minimize time spent walking from patient rooms to the nurse’s station while also maintaining critical accessibility, visibility and ease of patient supervision. Nebraska Medicine is one example where we’ve seen this design strategy implemented and tested for feasibility and success. Offering open rooms and support spaces throughout, in place of larger more centralized facilities, helps alleviate the need to constantly move or travel long walking distances from one critical location to the next.
Across the board, there is an increased push for fewer private offices in favor of more of an open office configuration. This design approach allows more room for collaborative spaces such as huddle rooms and conference rooms but also emphasizes the need to incorporate dedicated support spaces. Because the private office often defaulted to a respite space, in an environment without these dedicated office spaces it’s more important to add support areas where people can go and get some peace, quiet and calm.
The future of healthcare design emphasizes cross-collaboration between modalities, professionals and students to encourage higher recruitment numbers. While we’ve certainly made strides in creating this world, many healthcare organizations still struggle to attract new workers and have had to shift more focus toward retaining existing employees. As designers, we can help our healthcare clients strategize to create spaces that support retention and remove some of the burdens on workers. It will continue to be vital that we design spaces that encourage social connection, and which also emphasize the importance of caring for those who care for us. What it really boils down to is seeing our healthcare workers as human beings who, like their patients, need comfort and calm to feel supported and thrive.
Katie Ramsbottom, AIA, LEED AP, NCARB is an architect with more than 10 years of experience working across multiple markets. As a designer in RDG’s Healthcare Market, Katie is driven by her passion to create spaces that foster healing and put patients, providers and caregivers at the forefront.