The benefits of employee-centered design don’t begin and end with the employee. Efforts ranging from providing staff with opportunities for exercise to quiet places to work all contribute to a sense of self-worth and self-control, which can influence how patient care is delivered. Both patients and staff need to be happy and feel well-cared-for in today’s healthcare climate; A new focus on employee work and respite areas addresses both patient satisfaction concerns and employee recruitment needs. “[Providers] are wanting to be creative with how they do it. It’s not money-giving space, but it’s part of attracting personnel,” says Paul Strohm, senior vice president and global healthcare practice director for HOK
Now, evaluating what’s optimal and healthy for the employee and integrating and tailoring insights from those discoveries into the work environment are becoming part of the design process: for example, creating public gardens or employee-only outdoor spaces; integrating private, reflective spaces; establishing informal but productive colleague-to-colleague meeting rooms; and strategically locating dining options that respond to staff preferences for convenience and choice. Some design considerations are as simple as adding outlets for electronic devices in employee lounges or using whimsical colors in stairwells.
“All of these things recharge and are restorative in some way for the staff, who then transition back to the care environment,” Strohm says. The solutions being brought to fruition today are going well beyond the employee lounges and locker rooms of old, too. “One thing that’s changed is that we’re looking at [employee spaces] as a priority and not an afterthought. We’re not using leftover space,” Strohm says. “We’re now thinking this off-stage or rejuvenating space is just as important of a priority for how you design healthcare space.”
The employee experience
Employee-centered space represents any environment the employee moves through during the work day, from an exterior plaza to a fitness center to a parking lot or walking path. “I would characterize these spaces into two groups. The first is dedicated programmatically for employees, designed specifically for employees,” Strohm says. “The second group is where the space would have a public function: The employee gets equal benefit from this space but is not the sole beneficiary.”
Dedicated spaces include amenities such as courtyards, rooftop terraces, dining facilities, yoga studios, respite rooms, lounges, locker rooms, conference rooms, and smaller spaces for heads-down time. Other employee-focused spaces encompass clinical and administrative areas, team rooms on nursing units, conference spaces, and impromptu work areas. “It’s an appropriate selection of spaces for the kind of work people have to do in the moment—a mix of private and collaborative spaces,” says Sarah Markovitz, principal with NBBJ
Consider the academic teaching rooms primarily used by physicians and residents making rounds at Sidney & Lois Eskenazi Hospital
in Indianapolis, which opened in December 2013, with HOK serving as executive architect and the architect of record. The rooms are observable through interior glass doors and also from the street via exterior corner windows. There are two academic rooms on four of the building’s 10 floors, each featuring a central conference table, computer access to patient records, and a large white-board-covered wall. The move bucks the trend of teaching spaces often created from “a repurposed old patient room tucked away out of earshot” or even a closet, says Dr. Lisa Harris, CEO with Eskenazi Health. “We have spaces that will accommodate the team. The didactic teaching, the sharing of information, occurs in these separate spaces, but it also continues at bedside.”
Moving a department out of a windowless environment is another step toward promoting employee well-being. Such was the case at the Josie Robertson Surgery Center of Memorial Sloan Kettering
(MSK) Cancer Center in New York, designed by architect of record Perkins Eastman
(New York) with design firm ICrave
(New York), with MSK Design
, the hospital’s in-house design team, leading the effort. The newly built, 15-story, 181,000-square-foot freestanding facility opened early this year with a 12th-floor central processing department that has windows looking out from three sides of the building and providing natural light. The area continues to be functional but also speaks to the employees as human beings, says Suzen L. Heeley, executive director of design and construction at MSK. (For more on the project, see sidebar “Lofty Goal”.)
Some functions, however, out of necessity may remain in hospital basements, such as food preparation or maintenance. In these areas, then, care should be paid to feature brightly colored walls, patterned floors, art, and staff break areas where the facility’s color and furnishing themes continue rather than abruptly end, says Carolyn Blake, associate with Gresham, Smith and Partners
(Jacksonville, Fla.). Another best practice is to organize building programs by placing departments in the basement whose workers routinely travel to higher floors. “Having people work where they don’t know if it’s a beautiful day or a raging thunderstorm outside, that’s a (design) ‘don’t,’” Harris says.
Part of the plan
Despite growing recognition that providing appropriate spaces for employees should be a priority, hospital leadership is often also faced with scarce resources and the necessity to balance efforts with improvements to revenue-generating areas. To that end, dual-purpose design solutions are an easier sell: spaces available to patients, visitors, and staff, or staff-only spaces that nimbly swing between personal and professional applications. “Healthcare leadership is reticent about putting in employee-dedicated space, as anyone is, but they’re willing to put in flexible space to accommodate the array of activities that are already there,” Strohm says.
For example, at The Ohio State University Wexner Medical Center
(Columbus, Ohio), a 10th-floor space offers views to the Olentangy River and combines a corridor and a modestly programmed staff and student space. At times, the 1,200-square-foot area is a staff yoga studio; other times, it functions as a medical student and resident work area. And, in other incarnations, it offers staff respite thanks to comfortable, easily relocated furnishings. HOK and Moody Nolan
(Columbus) were the architects of record; HOK was the design firm for this building, which opened in December 2014.
As employee considerations are identified, the solution isn’t always designated or additional spaces; it might be in rethinking existing spaces, too. “It’s subtle things like not making the pharmacy a white box,” Blake says. “There are still people in that space. Just because they’re d
oing a scientific job, it doesn’t mean they don’t respond to an attractive work environment.”
Overall, employee-centered design should balance many factors: privacy, physical separation, public positioning, and shared spaces. At times, breaks away from work areas are critical—even minutes in a quiet spot permit staff to gain composure or to have a private conversation with a colleague. Other times, it’s important to be openly situated with easy access to coworkers while experiencing a ready line of sight to patients and families. “The intent is to provide better care for patients and be more efficient with communication and travel distances,” says Josie Briggs, senior associate and interior designer with NBBJ (Seattle). “We also consider the health benefits often associated with these shared spaces: typically, views and natural daylight are shared by more employees in this setting.”
Dramatizing workplace scenarios can lead to a better understanding of employees’ range of design needs, Blake says. “Imagining yourself in that space, trying to provide for a patient, maybe under pressure, with a lot of responsibility. That’s the most powerful thing you can do.”
Support now and later
Looking ahead, design that answers employee wellness, vitality, morale, and connectivity is expected to pay off. “Creating an environment that feels good for people and is an overall positive environment can retain people at that location,” Briggs says. And, when an organization is recruiting, particularly with specialized professionals, Blake says, the space needs to convey that it cares that the employees are happy and that its design supports how they conduct their professional activities and interact with patients.
With healthcare in a state of flux, designers will continue soliciting input about the evolving needs of the healthcare worker: How can staff be supported through efficient, but thoughtful, work spaces? How can rest areas truly offer respite? And when should spaces permit and promote time away from public work environments? Rising acuity levels in the inpatient environment, for one, are inspiring future design, as lower levels of care transition to ambulatory spaces.
“The acuity of the patients is greater and the pressure on staff is greater. How can we support those caregivers?” Heeley says.
SIDEBAR: Lofty goal
Opportunities for staff to leave the Josie Robertson Surgery Center of Memorial Sloan Kettering (MSK) Cancer Center in New York for breaks aren’t always feasible. “Because of the nature of this particular type of service, there’s a constant turnover of patients and we need all hands on deck. Breaks are tight,” says Suzen L. Heeley, executive director of design and construction at MSK.
The building’s solution is The Loft, an employee-dedicated floor featuring dining, respite, conference areas, and a garden terrace. Two sides of this floor-wide space offer extensive views of the city.
“Large planters on the terrace contain lovely birch trees, which look full and green in the warm-weather season and elegantly sculptural in the cold-weather months; uplighting highlights the plantings and illuminates the terrace in the evening,” Heeley says.
The Loft’s interior and exterior combined offer 8,200 square feet of diversely used spaces ranging from purposeful solo to casual communal to professional collaborative options. Inside, among The Loft’s divided zones, is The Soapbox, a central, convertible, multipurpose space accommodating up to 40 people for presentations or meetings. When not hosting a conference, this area adds to the dining options.
Other zone names speak for themselves: Open Kitchen, Living Room, Market Café. The Open Kitchen features a full-service kitchen and areas to store and prepare food brought in from home.
“The whole 14th floor is exclusive for employees. That’s extraordinary,” says Dr. Arthur Brown, chief and medical director of employee health and wellness services at MSK. “It’s a large area, but it has corners. It has cubbyhole spaces. You can find a shaded corner and perhaps take a cat nap. There are moments in the employees’ day when they need to be by themselves and not be interrupted.”
And the space is open to all employees; gone are physician-only dining areas. “This is very democratic: Everybody comingles,” Heeley says. “The space can foster great discussion and collaboration about patients, operations, and personal matters—communication opportunities that did not happen in the past.”
While this is a new design concept for MSK, Heeley adds, it could become a model for future buildings.
SIDEBAR: Open Concept
The San Carlos Medical Center, an outpatient site for the Palo Alto Medical Foundation
(PAMF), part of Sutter Health
, was designed by NBBJ and opened in November 2014. The 192,000-square-foot facility, just north of Palo Alto, Calif., showcases an open staff collaboration concept, emphasizing a work atmosphere conducive to team-based care. Specifically, leadership there requested a deliberate departure from the old design model of private, interspersed physicians’ offices.
“Our intent was to create an inviting work space. Even though it’s not private and it’s not individual, it’s still personal and attractive,” says Dr. Alireza Shafaie, the center’s physician leader. “There was certainly a fair amount of hesitancy to this in some circles,” Shafaie adds. “What happens sometimes, at the onset of change, people translate the need for respite with a private office space, and that’s not the case.”
The four-story building has room for approximately 60 employees per floor, 25 of those being physicians. A systems furniture solution was designed to provide a thick work wall along the corridor, creating a buffer from patient corridors, says Josie Briggs, senior associate and interior designer with NBBJ. Each four-person pod offers designated seating and open work spaces. Low acoustic partitions between pods maximize communication among the 12 to 17 pods per floor. A white noise or sound-masking system is installed around each teaming area.
“It provides an even, almost imperceptible level of background noise that masks adjacent conversations. This system is used in both the open work pod areas and at the exam rooms, where the system dampens sound from adjacent exam rooms,” Briggs says. “Sounds may still be heard from adjacent spaces, but they are audible, not intelligible.” The pod system allowed the walls to have fewer layers of drywall and didn’t have to extend to the underside of the floor slab above, thereby saving cost and preserving flexibility. “It protects you from the hubbub of the clinic,” Shafaie says. “We’ve laid it out where we can make modifications with furniture change, rather than structure change.”
From their work pods, team members directly observe patients in exam rooms, quickly determining when the patient is ready for a medical assistant
or a physician. Patient histories and preliminary intakes are collected and discussed between the medical assistant and the physician before the physician enters the exam room. From the pod vantage point, staff may spot and promptly intervene when the patient lingers post-appointment, perhaps wanting to talk further with the doctor or to receive assistance exiting the area. Other before-and-after staff conversations occur in real time thanks to impromptu huddles among staff situated in the four-person pods.
“Workspaces that support employee efficiency—that make their work easier, quicker, leaner—provide direct benefits to patients and the public. Staff’s ability to work more productively means they have more time to give to the patients and families,” says Sarah Markovitz, principal with NBBJ.