-By Moira Gannon Denson and Anton Villacorta

"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's article focuses on age in the healthcare workplace.

The American workforce is aging, and according to the Bureau of Labor Statistics data provided in 2006, the labor force participation rate of older workers (55 years and older) is projected to increase significantly in the next few years. It is estimated that by 2016, workers aged 65 and over are expected to account for 6.1 percent of the total labor force, up sharply from the 2006 share of 3.6 percent. Trends showing to affect and accelerate this change: increased life expectancy allowing employees to live longer, lower birthrates in past years reducing new entrants into the workforce, economic pressures, and the push to prevent loss of the knowledge and skills of workers as they retire, are evident across all industries.

These statistics are especially relevant for healthcare organizations seeking to recruit and retain the older and more experienced worker. Healthcare organizations understand (or should understand) the value of this important cohort in transferring knowledge and expertise to younger, less experienced cohorts, especially in an industry where tacit, on-the-job learning is critical. Unfortunately, transfer of knowledge can be hindered by intergenerational conflict revolving around different approaches to and beliefs about how work should be accomplished. A neglected fact isn’t necessarily the how it “should” be accomplished, but the how it “can” be accomplished. As current and evolving technology shapes the healthcare workspace, the younger generations—Gen X and Y, with their seemingly innate computer affinity—are in the perfect place to receive and implement the knowledge being delivered from their older, more experienced colleagues.

Hand in hand with the challenge of an aging workforce is the challenge of providing healthcare settings to support four different generations working together, which is the growing industry trend. This is important because environments can enable as well as hinder work. Furthermore, the environment can interfere with this transfer of knowledge by creating stressful workplaces for older workers who experience more physical limitations than their younger counterparts. Workplace design that can help eliminate environmental stressors experienced by the aging workforce will ultimately support the needs of the multigenerational workforce. Transfer of knowledge and skills is more easily tasked in a less stressed environment.

Understanding the environmental stressors experienced by the older worker better positions healthcare designers to provide supportive work environments while enabling knowledge exchange. According to L.S. Perry in “Designing the Workplace for the Aging Workforce: How to Use Ergonomics to Improve Workplace Design,” aging workers experience a number of physical limitations by the time they are 65 among which are: strength (25-30 percent decrease), flexibility (18-20 percent decrease), balance (1/3 will fall each year), sight (all aspects deteriorate), reaction time and speed (decreases), hearing (1/3 of 65-74 year olds have problems), manual dexterity and tactile feedback (motor skills deteriorate), and body fat (increases).

Many of these limitations are relieved with ergonomic equipment, such as motorized beds and adjustable furniture. While the designer can specify these requirements, it misses the opportunity to improve the broader work environment. As an example of this broader opportunity, consider one often neglected yet pervasive elements of the work environment—lighting.

Lighting touches every aspect of space and affects every user. However, it is frequently at odds with actual space function. Improper lighting (insufficient or simply misdirected) can impact physical limitations and increase chances of medical workplace errors. Additionally, balance and sight are directly tied to light levels.

Natural light is generally superior to artificial for most applications, and also provides collateral health benefits. Appropriate lighting improves task execution, while inappropriate lighting hampers it. Lighting provisions should match both task and user. The importance of using features such as light switches on dimmers or 3-way switching helps to address the fact that different ages do require different light levels.

Achieving a healthy mix of natural and artificial lighting is a basic tenet for projects pursuing LEED Certification. In a typical nursing unit appropriate light levels are critical, but glare (commonly associated with light) should be avoided.

Winchester Medical Center, located in Winchester, Virginia in the scenic Shenandoah Valley, is embarking on a $160 million campus expansion project. The interior design will employ window shades with the 3-5 percent ideal openness factor and flooring with minimal “sheen” to help diffuse the light from windows with direct sun exposure. Double-sided indirect cove lighting, strategically placed soft basket overhead lighting, frosted decorative films on interior windows, and task lighting tucked under transaction counters, seek to provide an even layering of light, thus reducing eye strain and glare commonly experienced by all workers whether on monitors, laptops or other computer equipment.

Healthcare work environments, notably nursing units, are characterized by their 24-hour-7-days-a-week use, requiring constant sharing of seating and equipment. An increasing multigenerational workforce means that diverse body types (size and weight) are demanding alterations to the workspace. Improper make-shift use of seating and equipment, often necessary to compensate for shorter reach distances and limitations with motor skills and balance, can result in unnecessary damage to both the environment and the user. It is critical to incorporate proper counter and worksurface depths, supportive chairs, and keyboard trays with multiple height/angle adjustments that meet any body size and fragility.

“Most nurses are choosing to work 12-hours shifts to create a balance between family and work. Whether the longer hours are spent moving quickly around equipment while on their feet or sitting in chairs and viewing monitors, all tasks benefit from an ergonomically supportive environment,” states Ellen Yoder, R.N., senior administrative director at Winchester Medical Center. Furthermore, with the average age of a nurse reported in 2004 by HRSA to be 46.8 years, Yoder adds, “it is paramount that healthcare environments are designed to help protect the eyes of the aging nurse.”

Many other applications and opportunities exist to improve the work environment for all users. Going forward, these applications should begin accounting for the new parameter of a multi-generational work force. While solutions for how to pay for quality healthcare are still uncertain, solutions for improving its work environment are clearer and, hopefully, will be realized.

Moira Gannon Denson, ASID, LEED AP, is the program coordinator and full-time faculty member of interior design at the Community College of Baltimore County in Baltimore, Md. She can be reached at mgannondenson@ccbcmd.edu.

Anton Villacorta, LEED AP, is a workplace consultant with the Washington, D.C., Planning+Strategies group of Perkins+Will. He can be reached at anton.villacorta@perkinswill.com.


Citations
http://www.bls.gov/spotlight/2008/older_workers/

Chilcott, J., R. Mattaliano, L. Perry, A.V. Riswadkar, and C. Shoup, “Turning ‘Silver’ Into ‘Gold’: Strategies for Working with The Ever-Growing Aging Workforce,” John Liner Review: The Quarterly Review of Advanced Risk Management Strategies 22, no. 4, (Winter 2009)

http://newsroom.hrsa.gov/insidehrsa/Jun2008/survey.htm

Perry, L.S., “ Designing the Workplace for the Aging Workforce: How to Use Ergonomics to Improve Workplace Design”

Past installments of "Designing for Health" include (click on title to access the full article):
• Medical Teaming Centers
• Integrating Security in Hospital Emergency Departments
• We Eat What We Build
• Evidence-Based Healthcare Design Forum
• Designing the Ideal Space