A safe space for medical care that boosts resilience and recovery for all
It's been two years since the declaration of the COVID-19 pandemic and healthcare professionals have been battling the virus. As the pandemic prolonged, we have been practicing social distancing and self-quarantine in everyday life for the past two years. The unusual situations which people never experienced before became a new normal, and physical distancing and the Stay Home Stay Safe campaign were implemented to minimize direct contact with other people, which ushered into the “Untact” era. Meanwhile, frontline healthcare professionals that treat patients with COVID-19 are directly exposed to the virus and having a very challenging time. Healthcare workers have been known to have a very high level of stress and fatigue even before the pandemic, however, the outbreak of COVID-19 led to the huge demand exceeding the capacity of healthcare systems, and healthcare workers were put under extreme strain due to overwork and chronic stress.
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COVID-19 pandemic and mental health of healthcare workers
A report* published by the US Centers for Disease Control and Prevention in 2021 said that 53% of public healthcare workers in the U.S. experienced symptoms of mental health disorders including depression, anxiety, PTSD, and thoughts of suicide, and the report emphasized the need to establish a system that would drive a behavior change to improve mental health. According to Frontline19, a charity in the UK, 40% of health professionals in the nation suffer from PTSD as they witnessed patients in severe conditions suffer and deaths, and a report by Research Institute for Healthcare Policy of Korean Medical Association said more than 40% of doctors in Korea experienced burnout syndrome as a result of chronic stress due to COVID-19. Healthcare workers persistently experience isolation from daily life, increased physical fatigue, uncertainty in control over the situation while facing factors that cause substantial level of stress such as fear for virus infection, worries about their family’s health, sadness, and pain from watching patients suffer, and rise in deaths, anxiety, etc. The prolonged high physical and mental stress levels of healthcare workers are directly associated with the quality of medical service they provide. Therefore, we should encourage discussion in the society about the challenges facing the healthcare workforce and the healthcare system, think about how to improve space and environment they work in, and actively find solutions to protect both patients and healthcare workers.
Starting a social discussion to ensure the safety and wellbeing of healthcare workers
- Major proposal about a program to improve work environment for healthcare workers for a study of a Basic Plan of Social Problem-Solving Design of Seoul Metropolitan City
- A study report about supporting nurses and midwives by King’s Fund, a research institute about healthcare in the U.K.
- NHS, a national healthcare system in the U.K.’s People Plan and Guidelines (Welfare facilities for healthcare staff)
As the healthcare and medical systems have become overwhelmed at an unprecedented level, countries around the world, recognizing the seriousness, are making efforts to address this issue by having social discussions and taking practical approaches. For instance, a study proposal which was made in 2020 as part of an effort to establish a Basic Plan of Social Problem-Solving Design of Seoul Metropolitan City (2021-2023) includes major programs and key projects to improve a poor work environment of healthcare workers. The detailed action plans focus on creating a space for recess in terms of space and environment design and making and using a toolkit for recess and communication, which would create a “take a break” culture where healthcare workers can be fully detached from work and take a break. Looking at other countries, King's Fund, a royal healthcare research institute in the UK, stressed the need to support nurses and midwives for quality medical service and raised some points for social discussion. The report points out some chronic problems in healthcare and medical system which were endured by healthcare workers even before the spread of the infectious disease and sees that such problems are addressable to some extent by creating a culture of psychological safety in an organization. In addition, the report states that the treatment of nurses impacts the quality and expertise of medical services in the communities and therefore outlines major recommendations to meet their needs toward autonomy, sense of belonging and contribution to improve a poor work environment and work efficiency.
Another case in point is NHS People Plan (We ARE THE NHS: People Plan for 2020/2021 - action for us all) established in July of 2020. NHS is the U.K.’s national healthcare system and the plan aims to create an inclusive work environment for more healthcare workers. This strategy entails a guideline to support health, safety, and wellbeing of healthcare workers (Welfare facilities for healthcare staff) and the guideline document emphasizes the need to have a safe space for healthcare workers to take a break and recharge so that they can work more efficiently after the break. This is because a well-designed work environment can positively impact the mental health of workers, which is directly related to their work efficiency. The guideline assumes that all physical facilities from a dressing room and a space to have a simple meal or snack are critical elements that could contribute to better safety, infection prevention, and efficiency of quarantine works of all members. The guideline for recess facilities recommends that “a space to immerse in rest” where healthcare workers fully take a break should be secured and “physical exercise” be encouraged. Also, it emphasizes a physical separation of a break room from workstation, access to drinking water and establishment of hygiene principles for clean environment.
The above cases are about the essential elements that a medical care environment should have during normal times, not only during the pandemic situation. These cases all mention that having a space to protect healthcare workers from infection and contamination, building a network with colleagues, and taking a healthy and balanced rest are important for their mental health and wellbeing. Taking a step further from these discussions, what kind of approaches are needed to create a work environment that would practically provide resilience aid for healthcare workers?
Sleeping Pod for an independent space and recess
- The adoption of sleeping pod by UH Cleveland Medical Center in the US and the NHS in the UK
- An independent and safe space for sleep and recess
First, there is a case of creating an independent space by installing a physical construction. The UH Cleveland Medical Center in the U.S. announced its plan to pilot-run customized HOHM Sleeping Pods for frontline healthcare workers who worked day and night amid the spread of the COVID-19 pandemic. The center recognized the need to create a safe and comfortable space for overworked healthcare workers during the crisis situations and decided to adopt HOHM sleeping pods to support them. HOHM is a tailored sound-proof sleeping pod designed to protect privacy and offer comfort while providing a safe space for much-needed recess for healthcare workers. Booking or controlling the pod is done via tablet, and users can use a sunroof in the ceiling and various charging ports if necessary and there are also sound-proof curtains, which provides perfect conditions for recharge.
(Image source : hohm.life)
A similar case can be found in the U.K. as well. The NHS in the UK adopted sleeping pods by a US company MetroNaps in 2020 for dozens of hospitals in the nation, and recommended that all healthcare professionals including nurses, physical therapists, radiologists, etc. take a break during the day to maintain one’s mental and physical health. It turned out that the sleeping pod was a good solution for the sleep-deprived healthcare workers. In addition, comforting music and low illumination lighting of the pod helped users find peace of mind and recess. The sleeping pods received highly positive responses from people working in the hospital.
Flexible space design to create a space for rest
- Paper Partition System by a Japanese architect Shigeru Ban and Soft Wall by MOLO in Canada
- Use of transformable partitions, temporary walls, and furniture for efficient use of idle space
Due to the risk of the spread of virus, we focus more on a flexible space that includes elements of closure or separation rather than expandability or openness. Here, I would like to introduce a case that took a more flexible approach in space division by using transformable installation, not hard walls that permanently divide a space as in the conventional method.
The Paper Partition System of a Japanese architect Shigeru Ban and Soft Wall (Modular Partition System) by MOLO, a Canadian design studio, utilize temporary walls which are like partitions and maximizes the space' flexibility. Using temporary walls as in these cases, idle spaces in hospitals can be turned into a space for recess just as wards in hospitals are changed or expanded depending on the patient number, conditions, and other situations.
(Image source : adfwebmagazine.jp)
• Paper Partition System by Shigeru Ban
The Paper Partition System was created to ensure minimum privacy for people that needed to be separated. Following the Great East Japan Earthquake in 2011, residents in the damaged region had to evacuate and were housed in a temporary public facility. The prolonged exposure to an environment without any privacy put physical and mental strain to people. As such, architect Shigeru Ban proposed an idea to divide the space to protect individual or family privacy. The PPS system uses paper tubes which are combined to form columns and posts, which are then fastened with a safety pin or joints, over which fabrics are draped to divide up the space. It started as a simple solution to create a separated temporary space in a disaster shelter, but the advantage that anyone can easily assemble and have a space of one's own makes it an ideal solution not only for the disaster situation but also for any setting that needs flexible space division.
(Image source : shigerubanarchitects.com)
Shigeru Ban's Paper Partition System which has been used in shelters in different war and disaster zones around the world, first started when the architect proposed to the UN Refugee about building a temporary shelter for two million refugees during the Rwanda Civil War in 1994. Since then, the architect has been leading efforts to create temporary shelters around the world for victims of the Great Hanshin Earthquake or Kobe earthquake and disasters happened in China, Turkey, Italy, New Zealand, Haiti, Fukushima, etc. Also, the system has been deployed to set up temporary shelters in Poland, Paris city center, Slovakia to house refugees from Ukraine war. The usefulness and the value of this system lie in the fact that it can compartmentalize any space quickly and easily to provide war refugees with individual space to protect privacy and human dignity.
(A temporary shelter in Slovakia for Refugees from Ukraine / shigerubanarchitects.com)
(Gymnase Marie Paradis - Paris 10th district in in France / shigerubanarchitects.com)
(Former Supermarket in Chelm, Poland / shigerubanarchitects.com)
• Soft Wall & Soft Shelter by MOLO, a design studio in Canada
Another case in point is Soft Wall by MOLO, a design studio in Canada. Soft wall uses kraft paper to create partitions and can be re-used for various purposes as it is easy to install, break down, and move. The soft wall, when compressing both ends to the center, becomes as thick as a book but it can expand to over 4.5 m in length and therefore can be used like partition walls for space division. The pleated honeycomb geometry formed by the flexible paper materials creates a curved and a straight end. Also, each module can be joined together with a magnet, meaning one can be transformed and arranged to offer new vibe and functionality to the space.
(Image source : molodesign.com)
MOLO also used aluminum, textile materials, etc. for the same structure and folding mechanism and created expandable furniture elements such as stools, bench, and tables. In particular, the bench wall which combined partition with furniture can become a great solution for maximized space usage and efficiency as it meets both needs to divide spaces and set up a space for rest.
(Image source: molodesign.com)
A culture of taking a break that everyone builds together
- A need to develop and use tools, and improve awareness to establish a culture of taking a break
- Small Talk, a casual non-work talks for stress management and motivation of healthcare workers
What is just as important as creating a space for rest is to establish a culture that promotes or encourages healthcare workers to fully take a regular break. Break is a time to recharge for improved productivity, therefore, workers should be able to take a break freely and voluntarily to prevent overfatigue and emotional stress. In this regard, a study designed to establish a Basic Plan of Social Problem-Solving of Seoul Metropolitan City (2021-2023) proposes developing design tools for better recess for healthcare workers. Some of the ideas in the proposal include creating a marker and a sticker about recess and mandating healthcare workers to take a break by attaching the marker or the sticker to their uniform and using a game toolkit for rest, which are practical solutions to encourage people to take a rest.
Also, recently, companies increasingly recommend that employees have a small talk during a break, which is defined as light-hearted and superficial exchanges that are non-work, related to their day and hobby. Small talk is an intentional effort to exchange warm words to console colleagues under work or emotional distress and is known to boost employees’ productivity or motivate them. In a similar context, some mental health experts propose adopting group monitoring system to manage extreme emotional stress experienced by healthcare workers that treat patients with infectious diseases. It is because connecting and communicating with colleagues is instrumental in motivating them and giving emotional stability.
For the past two years, the world has witnessed the significant impact of infectious disease on our community and peoples' lives and recognized the importance of the role of medical system and healthcare workforce. Now it is time to recognize the dedication of healthcare workers, extend the society’s perception of them and support their safety and wellbeing. Ensuring a safe space to protect patients, their caregivers, and healthcare workers at once and having a plan for flexible space use can unleash the great power of utilizing a space in times of pandemic and disaster situations. Also, although it is not possible to completely remove stress in the patient care environment where emergencies take place frequently, the society should give more attention and take actions to care for the emotional wellbeing of healthcare workers. Most importantly, creating a space for recess that can mitigate physical and emotional stress of healthcare professionals and changing our perception toward taking a break will help enhance resilience of the medical workforce who are pivotal to our society.