Nurturing Healthcare Work Environments


(Aviva Health Teaching Clinic in Roseburg, Oregon | Photos by Sally Painter)

Trauma-Informed Design for Staff Retention

In the ever-evolving healthcare landscape, one critical challenge continues to command the attention of healthcare administrators and providers: staff retention. The heartbeat of any healthcare facility, from bustling hospitals to rural clinics, is a dedicated workforce. It is no secret that these jobs are both physically and mentally taxing. So, it is vital to develop environments that support staff by preventing secondary traumatic stress and creating sustainable working environments. It’s not just the patients who deserve the best care possible — it’s also the dedicated professionals who provide it.

We see our clients struggling to recruit and retain staff. Oregon is short 36,000 behavioral health care workers according to the Alcohol and Drug Policy Commission. To assist in recruitment and retention, we provide thoughtful design solutions that consider space for staff and patients equally.

Ensure Voices Are Heard

The first step to staff retention is ensuring the staff’s voices are heard in the design process. Designers typically rely on department heads to provide input, but they may not ask the questions we need. Our team uses various tools tailored to each client to garner feedback from all staff. Examples include employee online surveys, open houses, collaborative meetings, and presentations. Designs benefit from input from as many users as possible, from the janitorial staff to the doctors and nurses. Showing images of different spaces is a way to hear what staff like and don’t like. It’s our job as designers to show options and help our clients think outside their normal to improve the future space.

Recently, we kicked off a project where we’re consolidating mental health services that are currently spread across 5 locations into one building. After touring all the facilities, we met with multiple staff members from each office. Staff in different roles (not just management) needed to participate to understand specifics and find overlap for space saving. In addition, we met with all front office staff to explore how they’d be working differently under one roof. We talked with all groups about their needs and showed inspirational images for feedback. Many people can’t visualize what they need, so we showed multiple individual office layouts from our proprietary prototype planning guideline and talked through how they use their space daily. Our design team then met with the client’s leadership team to layer on the organization’s long-term plans and goals.

A Space of Their Own

The breakroom of yesterday was typically leftover space in the center of the building, leading to small, dark spaces. Today, we plan employee spaces with natural light, proven to lessen fatigue and associated headaches, eyestrain, and vision issues. Connecting employees to the outdoors and nature is evidenced to promote well-being. The employee breakroom at Aviva Health Teaching Clinic in Roseburg provides indoor and outdoor space to relax and rejuvenate during breaks. Natural flooring and soft color palettes can calm the occupants.

Leveraging Theraputic Gardens

A University of Michigan study found more time spent outside near plants can help increase memory retention by up to 20 percent. A garden area for employees to prune, pluck, or water during breaks can relieve stress, promote physical activity and social interactions, and provide fresh vegetables and fruit for the breakroom.

Flexible Use of Space

Physical activity directly correlates to our well-being. Even ten-minute bursts of exercise can increase alertness and reduce stress and anxiety. Many hospitals and clinics include a physical therapy room in their program. A physical therapy room can double as an employee gym outside of patient hours without adding additional employee-specific space. At Hearts for Health Integrated Clinic in Enterprise, Oregon we included a small room with warm LVT floors that can easily be used for multiple wellness activities based on the staff’s input. Ideas included:

  • Meditation room with cushions and bean bags
  • Yoga studio with mats and other equipment
  • Workout space with mobile equipment like straps and free weights
  • Library with soft seating and bookshelves
  • Mother’s room

Mitigating Secondary Traumatic Stress

Healthcare staff are prone to experiencing secondary traumatic stress, the emotional duress resulting from hearing about firsthand traumatic experiences of another. Its symptoms mimic post-traumatic stress disorder (National Child Traumatic Stress Network). Pinnacle approaches minimizing secondary stress by designing spaces that support staff and consider the diversity of everyone’s experience — avoiding a design that inadvertently causes emotional and physiological stress. This consideration is essential as we are experiencing staffing shortages, and the facility’s success hinges upon the ability to retain and recruit staff.

With a foundation of trauma-informed design rooted in research, we engage in conversations with staff, patients, executives, and facilities teams to identify shared experiences that dictate the prioritization of trauma-informed design features incorporated into the facility. We consider how the staff approach the exterior of the building and enter the space, how they start their shift, how they use space for quiet work and break time, and their options for exiting the building. Our team incorporates trauma-informed design into healthcare facilities in the following ways:

  • Well-lit parking lots, common areas, bathrooms, entrances, and exits
  • Signage that is approachable and easily understood by anyone using the space (i.e., including multiple languages, accounting for neurodiversity, and people of varying abilities and disabilities)
  • Independent access for staff and patients (providing the ability to enter and exit without crossing paths)
  • Wide hallways
  • Generous amount of natural light
  • Interior and exterior biophilic design (i.e., water features, open spaces and curves, vegetation)

The workspaces for medical and mental health workers at Hearts for Health in Enterprise Oregon provide a variety of focus spaces. Access to natural light and different seating options allows staff to choose what works well. Comfortable seating, quality acoustics, and relaxing color palettes can help recharge and increase productivity.

Workspaces Designed Around Staff Workflows

Whether designing a new facility or renovating an existing one, Pinnacle talks with the staff teams to understand how they work — inviting the team to do some creative exploration into how their workspaces can better serve their workflows. In our experience, healthcare teams have difficulty explaining how designers can improve workspaces and instead adapt to the workspaces they have. With a wide array of healthcare spaces and types in our portfolio, we provide examples of other healthcare solutions and flows to help arrive at the best solution for each facility. For example, having a centralized patient check-in versus individual departments has a direct effect on staffing requirements and patient flow. Centralized check-in might alleviate staffing requirements but could create an issue if your facility provides diverse services with different provider groups. It is essential to have these conversations with all levels of staff to glean insight into potential problems and develop solutions in the design.

In the dynamic world of healthcare, where the tireless dedication of the workforce fuels the engine of patient care, the issue of staff retention has taken center stage. As the heartbeat of healthcare facilities, staff deserve environments that safeguard their well-being while they provide compassionate care to patients. The challenge lies in creating spaces that prevent secondary traumatic stress, promote sustainable working conditions, and cater to the diverse needs of each facility. Through our innovative design solutions, we’ve embraced this challenge, bridging the gap between staff and patient spaces, mitigating secondary traumatic stress, and optimizing workspaces based on staff workflows. By merging research-backed principles with the insights of healthcare teams, we have crafted spaces that heal and comfort patients and honor and protect the invaluable professionals who bring healthcare to life. In this era of evolving healthcare demands, supporting staff isn’t just a choice — it’s an imperative for the industry’s resilience and growth.

If you are curious about how you can implement some of these design principles within your facility or want to talk about healthcare design solutions, reach out.

Briana Manfrass is an Evidence-Based Design (EBD) certified professional. She bases decisions about the built environment on credible research to achieve the best possible outcomes. With more than 17 years of experience designing healthcare environments, she thrives on working with her clients to explore unique design ideas and integrate proven design solutions. Briana is a firm owner and actively involved in the Central Oregon community, currently serving on the Bend Development Advisory Board. • 541-388-9897 x22


About Author

Briana is an Evidence-Based Design certified professional and Managing Principal at Pinnacle Architecture. She bases decisions about the built environment on credible research to achieve the best possible outcomes. With more than 17 years of experience designing healthcare environments, she thrives on working with her clients to explore unique design ideas and integrate proven design solutions.

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