What is the relationship between the stairway and efficiency? Inverse? As technological advances produced elevators, we quickly relegated the stairs to the mostly infrequent (albeit vitally important) function of emergency egress. Who uses staircases anyway? Elevators are convenient to ride, move faster than what the human feet can achieve, and can carry more weight–hence, they are more efficient. Over time, we produced more-efficient elevators; during the same time period, we made the staircase less and less visible and approachable. Thus I was surprised when, back in 2006, I heard the word “staircase” from caregivers while collecting data on a study focusing on inpatient unit flexibility. My first reaction was that we were probably dealing with old-timers who don’t fully appreciate the efficiencies of elevator-enabled vertical transportation.
However, during subsequent data collection activities over the past years, in multiple hospitals and systems across the country, the staircase discussion has emerged so often that it deserves a separate blog post. Apparently, at least four types of caregiver and support staff use staircases over elevators for vertical commute, when the life-safety staircases are located within an approachable distance–not once in a while, but regularly.

It is much more efficient for nursing staffs in charge of more than one physical unit to sprint up and down the stairs than walk a considerable distance to the elevator bank, wait for the elevator, ride up or down, and walk an equal distance to the destination. In most instances, their destinations are immediately above or below their origin point. Similarly, respiratory therapists, who typically provide care on multiple units, find the same benefits with staircases. Who else could benefit? In a more recent study, we found that pharmacy techs use staircases (when available) for delivering drugs. It could reduce response time for urgently required medication supplies and equipment (those that could be transported in a staircase), and in turn influence safety. The materials management personnel in some hospitals have discovered that climbing down (as opposed to climbing up) the stairs is easier and more efficient than using the elevator to go down. An entirely different perspective on staircases emerged in a recent hospital visit. While considerable debate has focused on caregiver walking distances, there also are employees who are relatively sedentary. The CEO, having embraced the principle of living by example, explored the potential of creating a walking pathway within the hospital that would enable employees to get some exercise during breaks.

The health benefits of active living are well-documented, and she wanted to take the best advantage offered by the environment within which her employees work. The most conveniently located staircase—a key component of her plan—however, did not open up on all floors. What better way is available to contribute to our working population’s health without compromising on productivity?

It is perhaps time to reinvent the communicating stairway (without replacing the life-safety ones) in hospitals. Is it worth the initial capital investment?