Image by Faequa Uniza Rahman
I have seen so many heart-breaking stories recently about healthcare workers across the world stretched to the limits of their capacity – providing patient care in incredibly difficult conditions while concerned for their own safety and that of their loved ones. A recent WHO report titled, “Keep healthcare workers safe to keep patients safe,” found that across the world, COVID-19 infections were far greater among healthcare workers as compared to the general population. Burnout among healthcare workers is a persistent and ongoing problem in the United States and worldwide. When we add the immense stress of caring of highly infectious patients and being asked to manage with limited personal protective equipment, it threatens to stretch healthcare workers and our system to breaking point. According to an AHRQ report, more than 50% of clinicians report burnout, and there is an increasing concern regarding this rising trend.
Clinicians experience burnout due to the stressful work environments; a recent report from the national academies of science identified excessive workload, administrative burden, workflow, interruptions, and distractions as factors leading to clinician burnout. Burnout in healthcare providers affects both mental and physical health and leads to high turnover; burnout also impacts hospital outcomes and leads to lower patient satisfaction. A recent survey by Medscape suggests that COVID-19 is increasing physician burnout.
Clinicians utilize many methods to deal with work stress and prevent burnout. According to the literature, clinicians primarily use mindfulness and cognitive training to prevent burnout. Other interventions to prevent clinician burnout include spirituality training, mediation, music therapy, resilience training, and yoga. Although found helpful, these methods also require additional time for training and fitting into the clinician’s already busy schedule. The physical environment is an important factor impacting stress and many other factors contributing to burnout. Thus, we must actively consider the role of the physical environment in reducing burnout among healthcare providers.
As designers, we can potentially impact clinician’s burnout directly through improving nature views, daylight access, and improved acoustic conditions in the hospital environment. Designers can also improve workspace ergonomics, and the unit design. Further, environmental design can impact clinician burnout indirectly by helping reduce interruptions, distractions, perceived workload, and work-related injuries.
Window views to nature have restorative and healing effects on patients. Clinicians who have higher access to nature views in their workspace, experience better mood, and lower stress levels. Walking in hospital gardens during clinician breaks has also been associated with reduced burnout levels. Indoor plants, artwork representing nature views, and materials suggesting a link to nature are also among elements that decrease stress and improve clinician job satisfaction. Improving visual quality was more highly valued in hospital break areas in comparison to working spaces.
Daylight and exterior views also impact clinician outcomes; operating room staff who had access to exterior views and daylight had considerably lower perceived stress. Exposure to windows and daylight has been linked with reduced blood pressure, improved circadian rhythm, and a restorative effect on acute care clinicians. There is also an indirect relationship between daylight access and clinician burnout. According to research, daylight exposure impacts work-related stress and job satisfaction and is found to impact clinician burnout.
Excess noise in clinicians working and resting environments can lead to getting distracted, interrupted and can result in added job workload. A noisy environment can also impair concentration and communication and increase clinician stress levels. Design decisions regarding improving acoustical conditions both in the clinician’s work environment and their resting area may improve outcomes for clinicians.
Work-related physical discomfort is prevalent among clinicians and especially surgeons; work-related injury and pain are among factors impacting the surgeon’s burnout and turnover. An ergonomic workplace ideally would provide an appropriate setup for clinicians to conduct their tasks comfortably. Another example of furniture design is improving visual and tactile discrimination in the clinicians’ work area by selecting appropriate materials. Selecting proper materials can help clinicians reduce work-related errors. Suitable furniture design can also create a sense of privacy to minimize visual distractions and interruptions. Studies show that back pain and back injuries among clinicians due to movement and transfer of patients is highly prevalent in healthcare settings. Installing ceiling mounted lifts and providing adequate space around patient beds can help in reducing these injuries and improve staff retention.
The physical layout of the healthcare facility can help reduce clinicians’ stress and burnout. Providing a private escape and a personal space for clinicians close to their working space could help reduce the adverse effects of a stressful work environment’s for both physicians and nurses. Communication and teamwork are among the factors that impact clinician burnout and are also impacted by the design of the physical layout. Hospital unit designs that result in clinicians walking large distances every day could contribute to fatigue and burnout.
While special design changes have been implemented in healthcare settings during the Covid-19 pandemic to minimize the spread of infections from patients to caregivers; there is a critical need to focus on physical environment features that may help reduce stress, fatigue and burnout among clinicians during this stressful time. Access to nature and daylight, improved acoustical conditions, comfortable setup and ergonomic conditions in workspace, and physical layout of space are all among the factors that could potentially ameliorate the effect of added stress and workload and therefore, could prevent clinician burnout.
