Outdoor Spaces That Heal
From large hospital campuses to small outpatient settings, green spaces offer therapeutic benefits at all scales.
Caring for Healthcare’s Greatest Asset: Caregivers and Staff
By Kari Thorsen, NCIDQ, LEED AP®
Over the past two years, many of us have felt isolated at one time or another. Whether stuck at home, away from family and friends, or unable to visit a loved one who was sick at the hospital. Perhaps you’ve gotten sick yourself and could only see visitors through a window or screen. For those of us in healthcare design—who, for the most part, have had the privilege of working remotely—it has provided a window into what many patients, families, and frontline staff go through: spending day after day in the same environment, separated from the people and things they cherish most.
Designing for the unknown
Now in the third year of an ongoing pandemic, the novelty of the coronavirus has worn off and many of us are simply feeling overwhelmed. Overworked. Over everything. I can see the impact this is having on our healthcare clients. Faced with burnout and fatigue, it’s more challenging than ever to make design decisions about new processes and ways of working that won’t be operationalized for months or even years—especially when they’re just trying to survive another week.
I have also observed this among our user groups. In design workshops, for example, ICU staff are especially depleted and have a difficult time thinking beyond their current state. Emergency department staff, who are always adjusting to the ebb and flow of hospital chaos, are more likely to leverage their current state as an opportunity to innovate. Yet it’s hard for them to get beyond “worst case scenarios.” There’s no going back to pre-pandemic normal. It’s all about preparing for the future, and building in the bells and whistles, to ensure that history doesn’t repeat itself. As our circumstances continue to evolve, our expectations of each other during the design process must shift too.
Designing for the unknown has always been one of our guiding principles, but it has taken on new meaning during COVID. As designers, we are in a unique position to guide clients through the decision-making process when we don’t have all the answers ourselves. Building trust and connection with the organization is critical to create spaces that feel safe for occupants now and in the future—despite the unknowns—so end-users are ready to operationalize the changes in a way that meets their needs in that moment. By approaching the design process with empathy, we can achieve this.
Staff support space was a top priority for the Critical Care Building expansion at Cincinnati Children’s, as their existing space had been sacrificed over the years to accommodate patient growth. Staff have their own lounges and respite spaces on each floor and a private staff garden where they can decompress outdoors.
Space for caregivers to care for themselves
We hear from healthcare staff that sometimes they just need a quiet place to sit alone, take off their mask, decompress, and even cry. The next frontier in empathetic design is ensuring that caregivers have the spaces they need to care for themselves—a consideration that is often well-intentioned but gets compromised somewhere in the design process. Staff support spaces are allocated in a new building’s program, only to be reduced later in exchange for more patient-care space.
Frequently it is the caregivers themselves that tell us to put patients first, and that their break space can be in the same room where they have report-outs at shift-change, hold staff trainings, and also eat a meal. Even in these discussions, caregivers put their patients first and are reluctant to push for space for themselves. But these support spaces are not luxuries; they are essential and reflect the complexity of the jobs our caregivers are doing.
More than ever, our designs and allocation of space must equitably consider the needs of frontline staff who have had the toughest job of all during this pandemic. When a nurse is dealing with hospital crowding in tandem with staffing shortages and barely has time to take a sip of water, it is important that respite spaces are close by, embedded throughout the unit, so they don’t need to travel far for a quick break. It’s about having the right tools needed to do their jobs, when and where they need them. Regardless of how big or small a respite space is, staff must be able to step away from patients and families even if just for a moment. Access to daylight and fresh air can also provide the support they need to continue their shift.
We often think about how welcoming wayfinding and transition spaces offer patients and families breathing room as they orient themselves and shift gears before proceeding to an appointment. The same thinking applies to staff: How can we support their journey to and from work, giving them the space and tools to provide care but also care for themselves and their own families? How do they access the site, what spaces do they travel through, and what support do they need at the end of a long shift?
During the design of Seattle Children’s Building Care, set to open this spring, we heard from staff that some of the existing back of house corridors felt cold and uninviting, making the already-complex campus less enjoyable to navigate. By adding the same design treatment as public circulation paths—paint color, wayfinding, lighting—these simple enhancements go a long way in making staff feel welcome and appreciated.
Staff break areas in the Cedars-Sinai Playa Vista Physician Office & Urgent Care Clinic are infused with upscale materials such as marble, brass, reclaimed wood, and subtle pops of color—more reflective of a tech office than a typical healthcare setting to encourage staff respite and socialization.
Hybrid future that fosters human connection
The future of work for outpatient care providers, staff, and researchers, must also look a little different. The adoption of remote work and telehealth has enabled providers to join virtual meetings and opportunities for interaction they might have otherwise missed in person. They no longer have to travel from clinic to clinic, or across a campus to get to their office, freeing up more time for connection outside of patient care. With these changes also come the same challenges as the rest of the remote workforce: Zoom fatigue, retention issues, and uncertainty about the future.
When staff can come together in person again, their motivations for going into the office will shift. They will be looking for human connection and collaboration with other likeminded individuals who can enhance each other’s work. They will also expect a new level of scheduling flexibility, such as the ability to choose which days they go into the clinic vs. conduct telehealth visits from home. As designers, we must consider how the hybrid model applies to healthcare, including spaces for informal meetings, where they can grab coffee and chat on the couch, instead of formal conference rooms where everyone is looking at a screen. It is an exciting opportunity to transform the workplace side of healthcare—a cultural shift that has been challenging for many organizations.
Leading with empathy
While the COVID pandemic has accelerated these discussions around new ways of delivering care and working together, which have been years in the making, it has also highlighted the importance of leading with empathy, continuing to have honest conversations with our clients, and ensuring our healthcare providers and staff have a voice in the care that they give and receive. Design can be the tool that brings us all together again.
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