Healthcare Design - March 2022 - 27

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thermal conditions, and other environmental factors are closely related to
occupant wellness. Exposure to daylight, in particular, plays an outsized
role in our overall well-being and mental health. Like almost all animals,
humans have a circadian cycle that regulates sleep, metabolism, heart
rate, and body temperature on a 24-hour cycle. Daylight is the main environmental
stimulus that syncs the body's internal clock with the external
world. When sleep schedules are altered to accommodate shift schedules,
the rhythm of the rest of these bodily functions are disrupted with clear
neurocognitive consequences. In fact, night shift work has been associated
with anxiety, depression, and cardiovascular disease and has been labeled
" probably carcinogenic to humans " by the International Agency for Research
on Cancer.
Studies have shown that daylight access can reduce stress, lower blood
pressure, and even improve a person's cognitive function. For example,
the Texas Tech University study " Exploring the Relationships Between
Perceived Visual Access to Nature and Nurse Burnout " examined the connection
between views of nature and burnout among 51 nurses in six intensive
care units at a large hospital. When their break rooms had no windows,
the nurses reported being 18 percent more stressed at the end of their shift
compared to the beginning. But when they had access to break rooms with
daylight and views of the outdoors, they left their shift no more stressed
than when they started. In addition, their emotional exhaustion, a state of
feeling emotionally drained as a result of accumulated stress, decreased by
26 percent, and their depersonalization, a condition that causes people to
feel like a robot, decreased by 40 percent.
Results of another recent study out of SUNY Upstate Medical University
a recent medical error and being involved in a
malpractice suit. Another study, " Nurse Staffing,
Burnout, and Health Care-Associated Infection, "
published in the American Journal of
Infection Control, found that burnout among
hospital nurses was linked with increased urinary
tract and surgical site infections in patients.
On top of health risks for patients, the legal
costs of medical malpractice can be significant,
amounting to $55.6 billion annually in the U.S.
(by two of the authors of this article), " The Impact of Daylight on Healthcare
Provider Burnout and Performance, " provided further corroboration.
Researchers measured the burnout of 20 medical professionals working a
three-hour shift in the same room on two separate mornings. During one
morning, the blinds on the windows were fully open; during the other, the
blinds were pulled down completely. Researchers found that when the participants
worked with the blinds up, their emotional exhaustion decreased
by 25 percent and their depersonalization decreased by 33 percent.
Additionally, when the participants worked with the blinds up, their
patient outcomes were better. On both days, participants' cognitive function
was assessed using MedThinker, a virtual, interactive training tool
that placed participants into a mock intensive care unit. For 45 minutes,
the participants had to provide appropriate care to a series of hypothetical
patients. Then, they were scored on their positive and negative outcomes.
On the day they worked with the blinds up, the participants' MedThinker
scores improved dramatically, resulting in a 69 percent increase in safety
and 79 percent decrease in errors compared to when they worked with the
blinds pulled down. Overall, participants managed patients more effectively,
made fewer errors, demonstrated safer behaviors, and were able to manage
multiple concurrent tasks.
Burnout, and the concomitant detriments to performance, presents a
major challenge to delivering quality care to patients, as well, as demonstrated
in two surveys of more than 7,000 U.S. surgeons by the Mayo Clinic.
The effort found that burnout was an independent predictor of reporting
DESIGN SOLUTIONS
Simple behavioral and design changes can provide
respite for medical workers. For example,
in existing facilities, providing staff with break
time and space can allow them to decompress
and recharge. Many facilities are using outdoor
space or break rooms to provide access to daylight
for circadian health and connection to
nature for mental health. When designing new
facilities, consider the access, clarity, and content
of views for staff by asking questions such
as, Do staff have access to daylight and views
during their shift or are they stuck off-stage
in the core of a unit? Are windows clear or obstructed
by blinds? Are views of something restorative
or something stressful?
Research indicates that simple changes to the
work environment can have a huge effect on staff
morale and well-being. Whether it's considering
how the orientation and layout of a site impact
daylight and view access during schematic design
or simply opening the blinds in an existing
facility, healthcare designers and organizations
are in a position to positively influence the wellbeing
of staff at every step of the process. 
Anjali Joseph is the Spartanburg Regional Health System
Endowed Chair in Architecture + Health Design
and director of the Center for Health Facilities Design
and Testing at Clemson University (Clemson, S.C.).
She can be reached at ANJALIJ@CLEMSON.EDU .
Usha Satish is a professor at the State University of
New York (SUNY) Upstate Medical University (Syracuse,
N.Y.) and visiting professor at Stanford School
of Medicine (Palo Alto, Calif.). She can be reached
at SATISHU@UPSTATE.EDU. Dr. Kaushal Nanavati
is an assistant dean at SUNY Upstate Medical University
and a practicing physician (Syracuse, N.Y.). He
can be reached at NANAVATK@UPSTATE.EDU .
MARCH 2022
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Healthcare Design - March 2022

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