Office work is a relatively large component of what takes place in healthcare settings. In addition to administrative offices, many office-type settings for input and retrieval of electronic and paper-based medical and financial information, telephone communication, and face-to-face meetings are found in and near patient- care areas.

Knowing how office design affects work effectiveness is useful for all healthcare activities dependent on information and interaction. For the past 30 years, BOSTI Associates has developed office design strategies for clients based on research about their values, business goals, work activities, technology use, and future directions of change. These project-by-project data provide some common findings about office-type spaces that transcend individual projects, organizations, and industries.

How does office design affect healthcare organizational effectiveness? How can the concept of a healing environment be extended to all facility users by creating a healthier and more satisfying place to work? What are the most important office design features to consider? This article shares BOSTI's research findings and their design implications, with insights from healthcare designers concerning workplace design in their projects.

Office Design's Impact

BOSTI's research shows that office design has substantial effects on job performance, teamwork, job satisfaction, and other business-specific outcomes. In healthcare, these effects can be related to such goals as improving information accuracy, coordination of services, efficiency, and employee retention and recruitment. Behavior change, such as team-based care and enhanced communication between administrative and clinical functions, can be greatly influenced by design.

BOSTI's project data since 1994 have included questionnaire responses from more than 13,000 office-based employees and managers in multiple industries and job classifications, representing a total population of 45,000 people across these projects. Quantitative analysis of these data shows that office design directly accounts for, on average, about 5% of the total effects that all factors have on individual performance by office-based employees, with even stronger effects on team performance (11%) and job satisfaction (24%)core goals for improvement in most organizations1 (Figure 1).

Average effects of the workplace. Katherine Meacham, BOSTI Associates

A Healing Environment for All

“A holistic perspective to facility design is to align its core business mission, products, competencies, culture with the facility,” notes Bob Osgood, senior vice-president and director, strategy and planning, VOA Associates. “We start with asking: How does the facility seek to enhance, serve, what this organization is about? How can the environment support the most important aspects of your business?”

Renee Petersen, director of business development for Daniel P. Coffey and Associates, cites the impact of a healing-environment philosophy on focusing facility design to meet people's needs. Promoting healing, reducing stress, and supporting care delivery involve all staff, as well as patients and their families. Factors such as teamwork in patient-focused care, mobile information technology, cost accountability, and concerns for employee retention affect how, where, and with what tools work is done.

For administrative and office-based staff, a healing environment includes the office spaces. “If you believe in wellness, it needs to be reflected in the workplace, too,” says Rebel Roberts, president, VOA Associates. According to Roberts, Northwestern Memorial Hospital, Chicago, “walked the walk” in its facilities with attention to sustainable and nontoxic materials, lighting, ergonomic support for technology use and physical comfort, accessibility to food, and common areas for informal interaction within and between groups. “Just as healing environments are concerned with serving the whole person, so should workplaces be concerned with serving the whole population,” Roberts adds.

A top source of employee stress is a lack of tools and support needed to do their jobs effectively. BOSTI's findings show that the work environment is one of those tools, affecting 24% of job satisfaction when compared to all other factors. It is important, therefore, to “get it right.”

Most Important Design Features

Looking across projects since 1994, BOSTI measured 70 aspects of the workplace to find which design features most affect job performance and satisfaction. They found remarkable consistency across different types of organizations and job types. The two factors with the strongest impacts are: (1) support for concentration by limiting noise distractions in individual workspaces, and (2) the ability to have impromptu interactions anywhere (Figure 2).

Workplace qualities ranked by strongest effects

Doing focused work alone accounts for more than half of an employee's time in the office, and is rated as the most important work activity for most job types by employees and their managers. Increases in work complexity, information, integration, and rapid changes in technology requiring continuous learning are contributing to the rising need to be able to concentrate. At the same time, frequent interaction is necessary for collaboration, peer learning, customer service, and effective teamwork, and accounts for 25% of employees' in-office time. Interact- ing by phone or face to face occurs primarily in or near individual workspaces, where people spend more than 75% of their time.

Noise and Concentration: The Open Setting

Noise distractions are common in open offices, which house the majority (65 to 70%) of office workers in the United States. BOSTI's data show that 65% of open-office occupants “are often distracted by others' conversations,” as compared to only 29% of those in private offices (Figure 3). And offices are becoming noisier. Future trends indicate there will be more noise from speaker- phones and voice-activated computers, more interac- tions throughout the workday, and greater integration of teamwork areas among workspaces.

Acoustic pathways. Su-Hyun Yi, BOSTI Associates

Other research shows that besides affecting concentra- tion and job performance, workplace noise contributes to physical stress. A recent study by Gary Evans and Dana Johnson at Cornell University2 showed that even low- intensity (background) noise in open offices resulted in higher stress levels (measured physiologically), lower task motivation, and poorer coping with ergonomic work- place problems. Clearly, a noisy environment is not healthy, either for people or organizations.

Supporting Privacy and Interaction

In his healthcare design practice, Roberts of VOA finds that clients want “an enclosed, open environment” to meet privacy and interaction needs. Solutions have in- cluded more workspace enclosure through the use of glass and partial openings for visual access to waiting areas, coworkers, and natural light.

Roberts also stresses the need to provide natural gath- ering areas for administrators and practitioners through- out healthcare facilities. “There need to be places of common ground, common floors, lobby spaces, circula- tion with seating, and amenities that people will use so they will naturally meet each other and stop to talk,” Roberts says. He stresses the importance of providing seating near places where people are likely to encounter each other, such as near elevators, circulation bridges, and common spaces such as cafeterias and information centers.

Enclosure Supports Communication

Business goals of “needing a more open organization” with more and better communication are often simplis- tically translated into a call for physical openness. BOSTI tested whether open-office environments increase the frequency and quality of communication. The reverse was found: Ease and quality of communication are high- est for those in private offices and lowest for those in open spaces (Figure 4). Those with open offices were found to have fewer and shorter impromptu meetings, less candid discussions, and frequent distractions caused by others' conversations. Only 20% found overhearing others' conversations useful. “With acoustic privacy, people can speak frankly, without fear of being overheard, and can more effectively avoid interruption and disruption of the discussion,” says John Olson, vice-president, BOSTI. A high degree of enclosure, such as that found in a small private office, can support both concentration and good communication.

Enclosure and support for communication. Katherine Meacham, BOSTI Associates


Given these findings, the most important features for effective office design are those that support distraction-free work and easy interaction without compromising each other. Design needs to enable an easy flow between solo and interactive work without disturbing others' concentration. Encouraging face-to-face encounters by designing natural gathering places within and between group areas, with seating and meeting space for extended discussions, is important. Support concentration by acoustically protecting individual workspaces from each other and from high-activity areas through physical enclosure, spatial zoning, and absorbent ma-terials. Where appropriate, sound-masking systems can be considered as one part of the total solution, with frequent tuning to meet changing conditions.

Office space is a tool that, when used intelligently, can yield measurable benefits for job performance, job satisfaction, communication, and a healing environment. Carefully designed settings for office-type work throughout healthcare facilities are investments that pay off in both organizational effectiveness and positive support for healthcare values. HD

Ellen Bruce Keable is vice-president of BOSTI Associates, Inc., which provides clients with research-based workplace analyses and consulting: To reach her, phone (716) 835-0353 or e-mail Dr. Sue Weidemann, BOSTI's president and director of research, can be reached at (716) 837-7120 or, and John Olson, vice-president, at (203) 438-1611 or


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  2. Evans GW,, Johnson D.. Stress and open-office noise. Journal of Applied Psychology 2000; 85:779-83.