Clinician burnout is reaching epidemic proportions across healthcare. More than 50 percent of physicians are affected by burnout, while one-third of new registered nurses seek another profession within a year, according to the November 2018 report, “Seeking Solutions to Physician Burnout,” from the NEJM Catalyst Insights Council, a qualified group of U.S. executives, clinician leaders, and clinicians at organizations directly involved in healthcare delivery.

In the report, 83 percent of healthcare organizations surveyed said they thought physician burnout was a moderate/serious problem, citing issues such as workload, work/life balance, cognitive dissonance, and clerical work as drivers of the problem, while nurses more often suffer burnout due to compassion fatigue, moral distress, and work environment issues such as psychological safety and hostility.

According to the National Academy of Medicine, an estimated 400 U.S. physicians take their lives every year. Besides the personal toll, if clinicians are physically and emotionally exhausted, their overall performance and effectiveness threatens the health and wellbeing of patients.

At this year’s Healthcare Design Forum in Park City, Utah, guest speaker Dr. Danielle Ofri, attending physician at Bellevue Hospital and clinical professor of medicine at New York University School of Medicine, spoke passionately about “disrespectful medicine,” including humiliating, demeaning treatment of nurses, residents, and students and dismissive treatment of patients, saying that it’s so common in healthcare that it’s often accepted as normal.

She noted that the physical environment where physicians practice can contribute to their stress. For example, the clinic where she practices is in another building far away from the conference space where grand rounds are held, which contributes to doctors being late for appointments, frustrating both staff and patients.

In a 2004 PricewaterhouseCoopers study of NHS nurses in England, 56 percent of nurses surveyed strongly agreed that working in a poorly designed hospital contributes to increased stress levels. The primary factors affecting their retention were management attitudes, achieving positive patient outcomes, and having positive relationships with their colleagues.

However, other positive environmental contributors were access to enough parking or good public transport; public spaces that encouraged staff interaction and communication; ability to control the immediate environment such as ventilation; private space for staff offstage; and natural light.

Mercy Health in Grand Rapids, Mich., noted during a presentation at the 2018 Healthcare Design Expo & Conference in Phoenix that it costs the organization an estimated $500,000 for every physician lost and $1.5 million when they leave for another system. Its Innovation Hub, in partnership with Herman Miller, worked with clinicians to develop a new primary care model to improve the patient experience by also improving the staff experience.

The process involved creating patient personas to map their clinical journey as well as staff personas to address their concerns. Some of the unique features designed specifically to reduce clinician burnout at Mercy’s new center include:

  • Open workstations for physicians, other providers, and clerical staff that are collocated in a bright room with high ceilings and large windows. The room is close but acoustically separated from the exam rooms, and physicians are surrounded by a full team that can absorb many of the clerical tasks they find onerous.
  • Color-coded light wands above each provider’s desk signal their work status, so if they’re running behind, staff know not to disturb them
  • A respite room with a recliner, large window, and nature mural where staff can decompress after stressful encounters
  • A multipurpose conference space can be flexibly configured for different sizes, allowing teams to meet frequently to address staff operational concerns as they arise. The goal is to test protocols and to continuously improve productivity in an offstage space.
  • An onsite lab provides 90 percent of test results in-house, increasing provider productivity and reducing repeat visits by providing results to patients and physicians faster.

As healthcare facility planners, we need to promote design solutions that promote staff resiliency such as providing convenient access to healthy food, on-site exercise facilities, massage rooms, and convenient places to take a nap, relax, or meditate during long shifts. Additionally, we can include space in exam rooms for scribes to help with EHR input, relieving physicians of this task so they can more fully engage with patients. We can incorporate more embedded team rooms so clinicians can effectively delegate while still providing supervision and departments with maximum caregiver visibility, so staff never feel overwhelmed or alone.

Most importantly, we need to recognize that the patient and family experience is driven by staff and to acknowledge the problem of clinician burnout.

Sheila Cahnman, FAIA, FACHA, LEED AP, is president, JumpGarden Consulting, LLC. She can be reached at