Keywords

1 Introduction

The work of healthcare professionals in normal times is complex (Canouï et al. 2015). With the advent of COVID-19 as a world-wide pandemic declared in 2020, new measures against this global epidemic require healthcare professionals to work harder and longer than before, due to the high number of patients affected by this disease. With all the fatigue that healthcare professionals faced during this pandemic, policymakers, managers and designers need to pay more attention to healthcare professionals’ well-being.

In recent years, models have been developed with attributes of the hospital environment targeting different users of the hospital (patients or healthcare professionals) and describing attributes of the physical environment that influence the outcomes of health and well-being (Ulrich et al. 2010; Huisman et al. 2012; Zhang et al. 2019).

Given the complexity of the hospital environment, these models include many attributes, and yet, these are not exhaustive.

In office work environments, by comparison, there is ample research that has focused on employee well-being to improve business performance. More and more companies are incorporating design elements to achieve the goal of improving employee performance by promoting employee well-being.

In work environments, on the one hand, WELL certification (created by the International WELL Building Institute), attempts to improve occupants’ health, comfort, and well-being through environmental attributes (Lambert 2019). On the other hand, the biophilic design approach attempts to reconnect individuals to nature by introducing design elements that are inspired by nature (Akrami and Habibi 2018).

2 Towards Less Stressful, User-Centered Contemporary Hospitals

Healthcare professionals face a multitude and a diverse amount of stress-related. Literature reveals that in addition to other stressors, the physical environment is a stressor that negatively impacts healthcare professionals, their well-being, and their performance and quality of care, in addition to its impact on patient and visitor recovery and well-being (Canouï et al. 2015; Hammouni 2021).

The physical environment for healthcare professionals is not limited to functional aspects, even though these are more than essential to ensure the quality of care, but also to limit stress among these professionals. Considering the lived experience of these healthcare professionals, some attributes of the environment were identified to improve the quality of their work life by considering the hospital not just as a “healing machine”, but as a living environment with all that it represents for its users.

There is already evidence that built environment can have a positive or a negative impact on hospital users. However, several aspects remain to be developed based on healthcare professionals' perceptions (Hammouni 2021). The focus of the existing literature is on the patients’ perspective and not on the healthcare professionals' perspective. Some studies describe how some accommodations and features of working conditions improve staff working conditions. However, there is a lack of evidence on factors related to the physical environment and healthcare professionals’ well-being (Huisman et al. 2012).

In this perspective, this paper focuses on a contemporary hospital with an interest in the lived experience of healthcare professionals and the environmental attributes that promote their well-being.

3 Methodology and Setting

Within a constructivist approach, the study was conducted in two care units in a large hospital in a major urban center in Canada. Data collection was completed before the COVID-19 pandemic—from August to November 2018.

3.1 Data Collection and Data Analysis

A spatial evaluation of the two care units was conducted; understand the interaction of health professionals in their work environment and to understand their spatial behavior (Ziesel 2006) during the 3 shifts of a 24-h workday (day, evening, and night shifts). The observations of both the physical setting and the healthcare professionals’ behavior were conducted within 8 weeks (270 h). Subsequently, 44 semi-structured interviews (Gauthier 2009) were conducted with various healthcare professionals working in the two care units studied (physicians, physiotherapists, occupational therapists, nutritionist, pharmacists, beneficiary attendants, nurses).

During the observation periods, we invited and scheduled appointments with health care professionals to participate in the interviews. The questions asked were for example: 1. For your well-being at work, how do you find the design of this hospital and your care unit? 2. What attributes are/would be favorable for your well-being in this hospital? 3. Which attributes in the care unit/hospital generate stress during your work shift?

These interviews were completed by asking participants to create a mental map. Healthcare professionals were asked to draw environmental’ attributes whether they feel important as supportive or negative for them in the care unit or the whole hospital. These mental images validated the salient components of the hospital environment as perceived by the healthcare professionals.

Using a comparative and interpretive approach for data analysis, an inductive approach was used and that included emergent themes and categories (Gauthier 2009). Highlighted categories of themes were subsequently compared with existing data in the scientific literature. Emergent environmental attributes for healthcare well-being are listed in the Table 91.1.

Table 91.1 The well-being environmental attributes studied
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4 The Hospital Case Study

This mega hospital opened in September 2017 in a major metropolitan city. It is composed of several buildings connected by corridors and/or footbridges. The inpatient departments (care units) are in the same building stacked from the 8th to the 20th floor.

At each floor, circulation spaces (elevators, large corridor, and staircases), 2 family lounges and a bathroom, connect two care units (south and north one). Within a linear layout, two long corridors (79 or 90-m length) run along each care unit. Four other corridors are perpendicular to the 2 long ones and 3 of them serve the nursing workstations. Peripheral spaces include 36 single patient rooms, and the central area in the care unit is dedicated to staff spaces (Fig. 91.1).

Fig. 91.1
A diagram. 1. Central nurse workstation. 2. Secondary nurse workstation. The rooms are as follows. Break room within a care unit. Consulting room. Utility room. Health professional spaces. Patient's room.

Source modified from Hammouni (2020)

South care unit in hospital case study.

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Interior attributes include daylighting in the circulation spaces, waiting areas, and patient’s room. These spaces allow panoramic views, particularly, in the patient room.

This room (20 m2) includes large windows, a warm ambience, furniture for patients, and their family members and facilities for healthcare professionals.

The break room ((±) 12,7 m2) dedicated to the healthcare professionals is not provided with windows and daylighting with and include few furniture (Fig. 91.2).

Fig. 91.2
Two photographs. The care unit is on the left and the break room for staff is on the right. The break room has sofa and a table with chairs around it.

Source Hammouni (2021)

Left: View from care unit corridors. Right: Break room for staff within the south care unit.

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The staff lounge is a quiet place in the hospital and offers beautiful panoramic views of city. It is dedicated solely to the staff and includes a variety of furniture. In the peripheral zone, extendable chairs are oriented toward the windows allowing panoramic views. A system of blinds allows a control of daylighting and the sun’s glare.

A second are, in front of the bay window overlooking a small terrace, contains computers which can be used by the staff during their break. The other space of the lounge is dedicated to allow socialization among the staff, by integrating a variety of furniture (tables, seats, kitchenette area, sink) (Fig. 91.3).

Fig. 91.3
Two photographs of two different views of the outside staff lounge with circular tables, chairs, and sofas.

Source Hammouni (2021)

Staff lounge outside.

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The cafeteria located on the second floor of the care units building includes service space connected to a large room, a small dining rooms and a terrace (total capacity over 600 seats). It is arranged in two floors including these rooms and the agora located on the ground floor (Fig. 91.4). It offers views to the outside through curtained walls that let in natural light throughout the space and contains artworks as in all public spaces of the hospital.

Fig. 91.4
A photograph of the cafeteria with tables and chairs neatly arranged.

Source Hammouni (2021)

Agora/cafeteria.

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5 Results and Discussion

According to healthcare professionals' perception of the physical environment in the hospital, despite their positive evaluation of this environment, some attributes are not ideal for their well-being. Break areas are not very popular because of their distance from the care unit or lack of space, with the cafeteria located on the second floor in same building, and the staff lounge located on the 15th floor in another building connected to care units one. This lounge has access to one care unit in 15th floor, but it is used on a limited basis to reduce the number of people coming and going.

However, the observations we made revealed results that do not systematically align with the narratives of the professionals that we interviewed (Gauthier 2009). The use of the hospital cafeteria studied is a representative example of this dissociation of results. In our observations, we noted that this space is occupied continuously, specifically during the lunch hour period which runs from 11:00am to 1:30 pm. The cafeteria is very dense, and the seats are all occupied during this time interval. We also noted a reverberation of noise due mainly to conversations. In the interviews, the vast majority of healthcare professionals stressed that they do not use this space because they cannot always find available seats, and the noise in the cafeteria does not bring them well-being during their breaks.

The spaces dedicated to healthcare professionals do not have windows and do not offer views of the outside in the care unit, except for the trainee rooms in the north care unit. The colors and windows in the hallways are viewed positively by the overall healthcare professionals and are positive elements for healthcare professionals’ well-being in this hospital. The views from the workstations are also an element of well-being at work that was noted.

The healthcare professionals expressed their expectations of well-being in their work environment in the care unit. They emphasize the importance of providing them a larger break room within the care unit to allow them to recover from their fatigue and stress, even if these breaks are short. The current surface of this room does not allow to offer well-being and relaxation for the healthcare professionals.

In relation to the existing physical setting, a break room promotes socialization between different types of professionals. Social relationships that promote teamwork in a physical setting are the healthcare professional’s well-being expectations. But decentralized nurse workstations, which are functionally distant [08], do not promote socialization among healthcare professionals.

Access to daylighting and outdoor views is an important attribute of well-being during the professionals’ break periods (Zhang et al. 2019; Lambert 2019; Akrami and Habibi 2018; Hammouni 2021; Ziesel 2006; Gauthier 2009; Dalke et al. 2006; Alimoglu and Donmez 2005). Alimoglu and Donmez ( 2005) had pointed out that exposure to natural light for at least 3 h for healthcare professionals can limit burnout (Dalke et al. 2006; Alimoglu and Donmez 2005). Thus, daylight positively affects the quality-of-care services.

The analyzes show that daylight improves the relationship between professionals and the patient and his family. Healthcare professionals are positively affected by their exposure to daylight during their shift in the hospital as the previous studies have pointed out (Marberry 2006). When exposed to daylight, these professionals experience less fatigue and are more motivated in their work (Marberry 2006).

Noise is a negative attributor for the well-being of healthcare professionals and can generate stress. It is one of the attributes of the physical environment that needs to be further improved in the hospital work environment, particularly in the nursing stations and the consultant's room as they are open and very dense, especially during shift change periods.

Among the organizational elements, participants highlighted several factors that affect their well-being at work. The element most frequently mentioned by most healthcare professionals was the possibility of having a flexible schedule that would allow healthcare professionals to have the choice of changing their schedule by period and not staying on the same schedule (for example: a night shift only or having the obligation to work only between 8:00 am and 5:00 pm).

On the other hand, these healthcare professionals expressed a need for adequate staffing levels in relation to the workload. The lack of nursing and orderly staff generates stress among healthcare professionals and leads them to perform additional tasks. This agrees with (Canouï et al. 2015) who pointed out that the lack of nursing staff is a stressor. Increasing the number of nurses and orderlies and a professional-to-patient ratio that needs to be reduced could work to limit stress in the care unit workplace.

Another well-being attribute that was highly cited by the interviewed healthcare professionals was the management of patient records, because healthcare professionals spend a lot of avoidable time searching for displaced paper patient records. These records, which are stored in a cart at each nursing station, are often moved from their place.

One of the insights developed in this study pointed to issues related to the values attributed to healthcare professionals. It is obvious that healthcare professionals work for patients’ well-being, but they also need to benefit good conditions in their workplace. This issue emerges from the healthcare professionals’ narratives concerning their quality of life at work and their break areas and its impact on the perceived quality of care they provide to the patient.

Lastly, a physical environment in the hospital that considers the needs of different hospital users can therefore improve well-being (Bates 2018) and thus allows for healthcare professional satisfaction and staff retention (Hammouni 2021).

6 Conclusion

This study considered the lived experience of various healthcare professionals in a complex work environment of the hospital setting. It generated reflections on the important environmental attributes that can ensure their well-being while ensuring the patient's well-being. It is not enough to design hospitals that are esthetically more pleasing or more sophisticated in terms of introducing advanced technologies than existing traditional hospitals. The analysis reveals the importance of creating hospitals that help patients to recover by ensuring their well-being, but also that help healthcare professionals to perform better in their work by ensuring their well-being as well. This new crisis has demonstrated the importance of providing hospitals with sufficient break areas relative to the number of professionals working in an institution to allow them to quickly recover from the extreme stress they face even during short break periods.

This study is an exploratory one and therefore must be viewed with an appropriate understanding of these limitations. As a qualitative study, the sample size was intentionally small. Future studies could consider expanding the sample for generalization, dig deeper into the attributes that specifically promote well-being, as well as more explanatory assessments of the lived experience of healthcare professionals on the wards based on the results of this study.