In 2008, Spectrum Health Systems of Grand Rapids, Michigan, noted an interesting finding in its staff satisfaction surveys: Employees were generally unhappy with the quality of their break rooms. To respond to this piece of information, the health system initiated what it called an “Extreme Break Room Makeover” competition, encouraging departments to nominate their respite areas for a facelift. Out of 60 entries, three were selected.

Spectrum Health wanted the renovation process to be grounded in a human-centered design research approach and asked Steelcase’s WorkSpace Futures research group to guide them through the process. Aside from designing a better, human-centered break room, the organizations wanted to measure the impact of the project on the users. In order to conduct the study, Caroline Kelly, a senior design researcher for Nurture by Steelcase, Karen VanderLaan, senior nurse researcher for Spectrum Health, and Karyl King, who at the time worked for Spectrum Health’s Center for Exceptional Experiences, joined as co-investigators, to design and execute a study on the makeovers.

Now the findings, as well as the details of the individual renovations, will be shared with attendees at the HEALTHCARE DESIGN.11  conference being held November 13-16, 2011, at the Gaylord Opryland in Nashville. Kelly, VanderLaan, and King will present the study in a roundtable session titled “The Impact of Design on Healthcare Staff Rest & Rejuvenation” at 1:45 p.m. on Monday, November 14, 2011, in Canal C of the Gaylord Opryland Resort and Convention Center.

Kelly discussed the research and offered a preview of what she and her co-investigators will be discussing at the conference with HEALTHCARE DESIGN Managing Editor Jennifer Kovacs Silvis.


How did the study begin once the three winning departments were selected?

The three projects that had been chosen were a large break room for the perioperative department at the Butterworth Hospital, which serves more than 100 users every day; a smaller break room for a med/surg floor at Blodgett Hospital, which is another Grand Rapids, Michigan, location for Spectrum; as well as the health information management system at Blodgett. They were interested in picking three different areas because of the merit of their cases, but also because of the different types of work these users performed.

In the case of the med/surg unit, its nurses, by and large, are on their feet all day, on the run, and there’s very little downtime to their work, whereas the periop staff, while they’re on their feet, it’s on a very case-by-case basis and is a lot more structured and predictable, but with very intense and focused amounts of time that they’re working. Then in the health information group, it generally is a sedentary type of activity. As we were thinking about how to design these break rooms and, more importantly, about the design principles that needed to be created for them, whether it was going to be the same for all of them; could you have a basic set of criteria and principles from which we could tailor the solutions for each area according to their differences in both size, number of users, and type of work that they do?

We engaged with folks from Spectrum Health, their Exceptional Experiences Group, representatives from each of the departments that had submitted projects, as well as the architects and designers that support Spectrum, and the different resources here at Steelcase (design researchers as well as some interior designers)—and we started going through our six-step process, which is understand, observe, synthesize, realize, prototype, and measure. So with this group we started off by saying, “OK, what is rest and rejuvenation? What do we mean by ‘respite’? Why does this matter for healthcare?” I’m sure designers would agree that it’s not usually a space that clients are asking them to give much attention to. There is rarely a lot of dollars associated with or assigned to these spaces. They get the leftovers, the old mismatched furniture, and there’s not usually much natural light; there is usually a lack of consideration with these spaces. So why is this important?


What did you discover?

We looked at rest and rejuvenation and what it means, and what the surprising things were that we found. For a lot of people, resting has to do with lying down on a couch and putting your feet up when, in fact, exercise provides a lot of benefits; getting up and moving, even when you’re tired, is a way to reenergize you. We did that kind of literature review. We also benchmarked great examples of other types of places we called “lateral observations,” places like spas or yoga studios and great cafés that we looked at to get inspiration and to see some of the qualities of those spaces. Of course we’re doing this in our observation phase, so as a group, we went through this process. The group then co-created design principles for the project, and these were general, for all of the spaces.


What were the design principles that you created?

We spent a couple of days in charrettes, creating these design principles, some of which had to do with things that maybe come more to mind when you think about designing a space—like light and ambiance, bringing nature in, and creating a soothing environment or thinking about sound, for example. But other things that came up were not specifically about the design of the space but were about protocols or operational concerns that really affected the quality of the respite space. One example is protocols around posting information. I think we’ve all been in break rooms where you see mailboxes overflowing with fliers and bulletin boards with layers and layers of paper. They do have design implications; we can design a beautiful space and it could be plastered with all of this material.

The notion then surfaced that these different groups could think as a community about how they wanted to address these issues, and in periop, for example, they decided to find a new location for their mailboxes. They didn’t want it in the break room anymore. There also was talk, and it has to fit in a bigger initiative by Spectrum Health, of looking at using electronic bulletin boards instead of posting things up on a board.

We touched on a lot of different issues in the creation of the design principles. Other ones included addressing sustainability, and something, again in our observations, that we saw was lots of Styrofoam cups that the nurses, especially, would leave. Someone would come in, they’d get a drink, they’d have to go back out onto the floor and they’re not allowed to bring their beverage, so they leave it there. Then when they have a quick minute, they’d come in and take another break—five minutes, 30 seconds sometimes—and they get a sip out of their drink and put it back down on the table and leave. Should we be encouraging all these Styrofoam cups? Are there other ways to provide more storage for people to use their personal mugs or cups? And so those were notions that we explored as well.

From these design principles we then created new design concepts for the spaces. This did not include getting more space or moving to a different location; they were going to renovate where they were. And so we had a lot of constraints we had to work with, but we were able to think about all of these design principles and think a lot more intentionally about zoning. I think that was one of the big design findings that came out of all of this was the intentional use of zoning and understanding what the activities and the rhythms of these break rooms were. In fact, one of our post-intervention survey questions was about the size of the break room. In the pre-condition, in both periop and med/surg, they said the break room was not large enough. After the redesign, they reported it was large enough. We didn’t give them any more square feet, we just gave them smarter square feet.


What kind of data did you collect and what were some of the highlights of your findings?

We collected data before the renovation and then again afterwards, and we did that through surveys that asked questions about not only the experience of the break room—what they think about it—but also what kinds of breaks were they taking, were they getting interrupted, were they feeling rested and rejuvenated afterwards, were they ready to resume work afterwards? In addition to that, we installed video cameras that were stop-motion, so every time somebody entered the room or there was some kind of motion in the room, it would snap an image every three seconds. There was no audio being recorded, as we didn’t want to completely invade the sanctity of their break room space. We did that for a week before the renovation, and we did it for a period of a week one month after the renovation and then again six months after the renovation, so we could see differences in patterns of use and responses to the questions.

When we evaluated the responses (once from before the renovations and then twice after the renovations), we found sustained and statistically significant differences, and an improvement in 20 of the 24 domains that we questioned them about, which included the design principles as well as the quality of their rest and rejuvenation and their readiness to resume work: after my break, I feel better, this is helping me take a more restful break and I’m ready to resume work. There are tons of findings; we have a 150-page summary report, and we’re planning on sharing some of this at HEALTHCARE DESIGN.11 as well as submitting it to different peer-reviewed journals to share with different audiences we thought will be interested.


How will this translate into your presentation at HCD.11? What can attendees expect?

As a researcher, when I go to conferences, I’m always interested in what kinds of methods people are using to collect their data, because in our world of evidence-based design, the how-to—how to conduct these kinds of studies in an operational healthcare facility, not in a lab somewhere but in a busy, functioning hospital—and the ins and outs of getting something like this set up is imperative. It’s going to be a combination of the findings, the data collection methods, and then some ideas about how people can leverage what we’ve learned and our experiences on this project for themselves. Because it’s a roundtable, we really want to engage and hear from people who maybe have attempted similar things. This is a great opportunity to bring some well-developed thinking to the value of spending effort, money, and time on these break rooms. We want to help people when they go to look for support to do these kinds of spaces; we want to give them some useful information about what to do and what not to do, but also a way to communicate with all the different stakeholders involved about why this is a valuable thing to do. HCD


The roundtable “The Impact of Design on Healthcare Staff Rest & Rejuvenation” will be among dozens of sessions being held at the HEALTHCARE DESIGN.11 Conference in Nashville November 13-16, 2011. For more information, please visit