Professional Documents
Culture Documents
What type of hospital building makes the healthiest work site? And how can a job candidate tell
if their potential new hospital gets a passing grade? Providers and others seeking long term
hospital work should look for design features that will contribute to their satisfaction and
success.
Healthcare workers face the unique safety challenges presented by dealing with pathogens and
other bio hazards. Those aspects of worksite well-being are highly regulated -- the Joint
Commission is required to inspect healthcare institutions for everything from removal of snow
and ice to the safety of the break-room microwave oven. Any candidate would be wise to ensure
their potential employer is in compliance.
Other significant factors that create a healthful working environment are part of the social world,
e.g., work flow processes and employee relations. Working at the Right Hospital, another article
on the HealtheCareers Network, discusses how to determine if a worksite is a good social fit.
But even when other aspects of job satisfaction are accounted for, a supportive and comfortable
physical environment will always contribute to job satisfaction.
Is it really important?
Surveyed in 2009 by the Center for Health Design (CHD), 75 percent of providers said the
inability of hospital design to meet the needs of staff was "a major problem."
Consider this: in the United States, the average annual nurse turnover rate is 20 percent. Working
conditions -- including matters of workplace safety and stress -- are among the key reasons
nurses leave their jobs.
There is strong evidence that design changes that make the
environment more comfortable and aesthetically pleasing will
increase staff satisfaction. Design features that encourage
positive staff interactions, such as gardens and lounges, could
promote greater job satisfaction (Agency for Healthcare Research
and Quality, AHRQ).
A seminal report: The Role of the Physical Environment in the Hospital of the 21st Century was
published by the Robert Wood Johnson Foundation (RWJ) in 2004. In it, the authors wrote
Jobs by nurses, physicians, and others often require a complex
choreography of direct patient care, critical communications,
charting, filling meds, access to technology and information,
and other tasks. Many hospital settings have not been rethought
as jobs have changed, and, as a result, the design of hospitals
often increases staff stress and reduces their effectiveness in
delivering care.
Noise, Air Quality, Light
Any indoor workplace, but perhaps especially a hospital, is enhanced by control over noise,
clean air and appropriate light.
Noise
Reduced noise levels have been demonstrated to improve workers' job satisfaction, yet the
AHRQ reported that hospital noise levels frequently rise above the recommended guidelines set
by the World Health Organization - in some cases 50 percent above. Healthcare providers
perceive higher sound levels as stressful and report difficulty having conversations with
colleagues, patients and patients' families.
St Louis's SSM Cardinal Glennon Children's Medical Center has an award- winning NICU with
private rooms. Controlling noise was a primary reason the hospital chose private rooms. Since
the remodel, the percentage of staff who consider noise an issue on the unit has plummeted from
92 percent to nine percent. Cristie Rossel, RN, MSN is director of the NICU. She said the staff
can take care of patients better now and experiences "less hubbub…the whole unit is quieter. It
feels more controlled because staff who aren’t involved (in a particular patient’s care) don’t have
to hear about it."
Air
Proper air circulation is important to infection control as well as general health and well being.
Older hospitals may find their circuitry not entirely up to the task of cooling a hospital filled with
warmth-generating electronics on a summer day. During winter, the warmth of a tightly enclosed
building may come at the cost of air freshness or humidity.
In the CHD survey, two-thirds of providers in both hospitals and ambulatory care centers called
indoor air quality “a major problem.” In fact, it was singled out as the most urgent design
problem.
In extreme cases, inadequate ventilation may cause "Sick Building Syndrome," defined by the
EPA as "situations in which building occupants experience acute health and comfort effects that
appear to be linked to time spent in a building, but no specific illness or cause can be identified."
Hospitals are not immune, according to RWJ.
Light
A report in 2009 confirmed a truism: it’s nice to have a view. More formally stated, research
results confirmed the important role of window access in satisfaction with lighting, particularly
through its effect on satisfaction with outdoor view.
At Skagit Valley Hospital in Mt. Vernon, Washington, the open, airy environment is intended to
counter the gray skies of the Pacific Northwest. A central garden courtyard provides respite in
good weather and views regardless.
Windows and glass doors inside their NICU provide the sight lines that caregivers at Cardinal
Glennon asked for. Task-appropriate lighting also contributes to their satisfaction with the built
environment. "We don’t have a lot of natural light but we paid special attention that each room
had enough and different kinds of lighting," Rossel said.
The NICU rooms were designed with enough overhead light to perform procedures and more
than a dozen combinations of "can" lights that can illuminate a smaller area. For example, the
nurse's computer work area has dedicated light. "The nurses really like that," she said.
How to assess a hospital
The Joint Commission recommended "The Hospital of the Future" be designed with the needs of
patients, families, doctors, nurses and other healthcare providers in mind. But in times of limited
funding and strict regulation, the hospital as a workplace may not be a designer's top
consideration.
Here's what to look for in a hospital built environment:
1. Are health and safety violations being overlooked?
2. Are the rooms and lavatories orderly, clean and dry?
3. Do signs and lighting make it easy to find one’s way within the hospital?
4. Are exits well marked and unobstructed?
5. Are ergonomic work areas available and accessible?
6. Are work areas lit adequately and appropriately?
7. Is there access to natural light?
8. Does the design support good ergonomics during patient transfers?
9. Are unnecessary sources of noise being ignored?
10. Are there areas where noise makes conversation difficult?
11. Is the HVAC (heating and air conditioning) system working properly?
12. Are there unpleasant or chemical odors?
13. Is there access to fresh air?
14. Is there a view of nature, or something organic such as potted plants?
15. Is the breakroom clean and inviting?
16. Are there additional spots for respite, for example, a garden or chapel?
17. Are the clinic’s decorative design choices agreeable?
18. Will the floorplan and storage strategies help minimize extra steps during your shift?
Adapted from the U.S. Department of Labor and Oregon Occupational Safety and Health
Administration