Wellness at Work
Create an environment that energizes the mind and nourishes the body
I once worked at an advertising agency, with major retail accounts including Coca-Cola, Starbucks, and Target. I loved my job and gave it everything I had, working weekends and running on coffee. But, after 3 years, the coffee was no longer enough. I was burned out.
The experience inspired me to research burnout, productivity, and well-being. How can we get a lot done and maintain our health and happiness?
Four Key Areas
In one of the first productivity studies of knowledge workers of this scale, I examined workplaces in the Netherlands, where burnout is on the rise despite a strong cultural emphasis on work-life balance. In a highly detailed, 7-month study of 120 subjects, we were able to identify areas that affect productivity and stress — areas that you can enhance to improve the work environment in your practice or ASC.
- Nutrition. No surprise here! We found that people were more productive and less stressed when they cut back on sugar, decreased their caffeine intake, ate nutritious foods, and stayed hydrated.
- Lighting. In many workplaces in our study, the lighting was golden, dim, and located only in the ceilings, so it wasn’t hitting the back of the eye. It was telling people’s brains, “Relax. Take it easy. It’s the right time to be tired.” We added wall lighting and adopted a circadian lighting schedule to match people’s natural sleep and wake patterns, from warm color temperature in the morning to cool in the afternoon and again to warm at the end of the day. During peak work time, lighting intensity was almost doubled. This lighting communicates to the brain, “It’s afternoon! Be alert and get busy!”
- Biophilia. This is the simple idea that surrounding ourselves with nature can be healing. Make sure the office has images of nature. If possible, create an inviting outdoor break area for staff.
- Activity and posture. We’ve all read that sitting is the new smoking. Doctors and their staff tend to move more than office workers, but it’s still important to remember to walk and stretch throughout the day. You can map out walks for your staff. I suggest 15- to 45-minute routes to encourage walking during breaks, or before or after work.
Remind staff that when sitting or standing repetitively or for long periods, make sure their body posture is comfortable and doesn’t create stress on the back or neck. Adjust chairs and equipment for each individual’s comfort.
It All Adds Up
When these changes were made, workplaces were transformed. People already showed high levels of intrinsic motivation, meaning their jobs meant a lot to them, but the office changes increased external motivation more than 17% over baseline among employees who were healthy (not approaching burnout) at baseline. Health scores, task efficiency, and workflow increased and productivity went up 18%. ■
Designing ASCs for Productivity and Well-being
Six experts share their advice for reducing stress on surgery center staff
In intense work situations where our success depends on how well we execute our goals, stress is unavoidable. Here, doctors, consultants, and a healthcare architect discuss how a healthy environment can reduce burnout and enhance the experience of both staff and patients.
Defining Burnout
Bradley C. Black, MD: The term “burnout” is used in many ways. Could you define the term for us?
Elizabeth Nelson: That’s a great question. In the U.S., there isn’t an accepted medical definition; it’s considered a social disorder. Burnout is often defined as when people consider leaving their field entirely — in this audience, leaving medicine. That’s rare.
In the Netherlands, we use a very long, detailed set of questions about stress, sleep problems, inactivity, lack of empowerment, and other factors that can tell you where you are on the spectrum of feeling healthy and fulfilled with your work or showing signs of burnout. So, it’s not a clear-cut definition. However, I think it helps to look at all the elements of burnout and evaluate it by degrees.
Jeffrey Whitman, MD: I think of burnout as stress and anxiety — both at work and at home — that affects your performance.
Cathy McCabe, MD: I struggle with defining burnout as an endpoint that we reach. I experience it in a way that’s more like Liz’s description. Some days, I feel like I’m totally burned out, and I want to be a barista at Starbucks. The next day, a patient tells me how something I did really changed her life, and I feel like I have the best job in the world — why would I want to do anything else? So, to me, burnout is not a static state.
Bruce Maller: I’m not crazy about using the term burnout because I don’t think it does justice to the issue. Whether you’re a consultant, physician, or administrative leader, the truth is that our jobs are hard and we lead very busy lives.
The key is how we manage the challenges in our lives and limit associated stress and anxiety. For me, being with people who make me happy at work and at home helps prevent burnout, but it’s a work in progress every day for each of us to find the right balance. I think the most important thing is to be aware that there actually is an issue, and to create an environment that makes you happy.
Dr. Black: I haven’t heard anyone say that avoiding burnout is about having money and no stress. There are always going to be stresses in life. I think burnout depends on how we handle stress and the support structure we have in place. I spend more waking hours at my office than I do at home, and I think it’s important that I like the people I work with and approach that as a choice.
If we’re actively involved with staff and set expectations, we end up creating a happier, less stressful workplace for everyone. For example, I love to perform surgery, but I’m not going to say it’s never stressful. A good support staff reduces the stress level and makes it easier to relax when I’m done with the day.
FACULTY
Bradley C. Black, MD (moderator), is founder of Dr. Black’s Eye Associates in Jeffersonville, IN.
Jeff Eckert, AIA, is president of Eckert Wordell, an architecture, engineering, and interior design firm in Kalamazoo, MI.
Bruce Maller is president and CEO of BSM Consulting in Incline Village, NV.
Cathleen McCabe, MD, is a surgeon at The Eye Associates in Bradenton, FL.
Elizabeth Nelson is coauthor of “The Healthy Office Revolution,” head of research and innovation at Learn Adapt Build in Amsterdam, and a PhD candidate in biosensors and biomedical engineering at the University of Twente.
Jeffrey Whitman, MD, is president and chief surgeon of Key-Whitman Eye Center in Dallas.
Creating the Right Environment
Dr. Black: Are you thinking of preventing burnout, or rather supporting a healthy work experience, when you make decisions about the physical work environment?
Dr. McCabe: We strive to elevate our environment for everyone. We can manipulate the environment with a focus on a satisfying patient experience — and what that might mean for reimbursements in the future with regard to patient satisfaction surveys — or to make staff or doctors happier. The results benefit all of us.
For example, baby boomers are coming in for cataract surgery, and we’re conscious of enhancing their experience. At the same time, many of our new hires are millennials, who care a great deal about their environment and work-life balance. The improvements we make for one audience benefit the other — and us.
Mr. Eckert: You make an interesting point. As architects who design healthcare spaces, we’re constantly considering the patient experience. Some of the things that Liz brought up, such as daylight, plants, nature, and color choices, are stress relievers for patients, but it’s important to bear in mind that they also reduce stress for everyone who works there.
Mr. Maller: At our team’s recent planning retreat, we focused a significant amount of time on the work environment. What could we do differently or better to create a healthier, happier workplace? We ended up forming a small work team comprised primarily of our younger employees who might have a fresher perspective. They had great ideas, which I respected, and I loved that they took control of the project. Encouraging that level of participation and engagement helps to create a healthy environment that leads to improved production and job satisfaction.
Dr. McCabe: Along the same lines, we started asking staff, “What do you want to do differently in our surgery center to improve our environment?” We started with simple things. We put up a thank-you note bulletin board, which made a huge impact. Every staff member had been doing things that other people didn’t recognize, and they love having colleagues applaud their hard work. I asked my CRNAs who work at multiple surgery centers what they’ve seen and liked. They liked having water coolers with different kinds of fruit in them to help staff stay hydrated all day long, so we’re adding that, too.
Fixing A Dysfunctional Culture
Dr. Black: I see surgery centers with what I’d call a dysfunctional working environment based on the culture. Senior physicians might show up once a week. Other surgeons are there the rest of the time, and the culture is different. If owners or senior managers want to improve the office culture, how would you suggest they do that?
Mr. Maller: I think a dysfunctional culture is always multifactorial. We have to do some exploration to diagnose the core problems. Objectively, you might focus on patient satisfaction, staff satisfaction, turnover — all the sources of feedback that can help you identify problems. But perhaps the most important factor for this audience is the role of leadership.
Ultimately, it’s always a leadership issue. It’s our responsibility as leaders in a practice or surgery center to choose to foster a happier work environment. So, you figure out the core problems and address them.
Dr. Black: One of the most important things is communication within your surgery center. Maybe a certain surgeon comes in every Tuesday afternoon and disrupts everything. Maybe everybody is on pins and needles around that person but keeping it to themselves.
You need to have an open environment where that information reaches management, and then I think it’s appropriate that the director ask the board to take the physician aside and discuss it.
Unless it’s truly an HR problem, you can frame it in a positive way. Make it about getting the best performance possible from the surgery center, which might mean avoiding certain things someone is saying or doing in the work environment that negatively affects other staff members.
Dr. Whitman: The empowerment that Bruce mentioned is important in these situations. Have an open dialogue, let staff know that you’re hearing their problems, and work together to set some strategies for improving the workplace. Give staff the self-satisfaction of working on a team as part of the solution.
In the end, you should have a successful environment in both your surgery center and your clinic. In the surgery center, I also think it’s very important to acknowledge that it’s a very high-stress situation, with human beings nervous about surgery and their eyesight. It’s a major thing for them. We need to do everything we can to reduce stress.
Treating Burnout
Dr. Black: Liz, I’m curious about how burnout is treated in Amsterdam. If they encourage time off for burnout, how does that work? Is it paid time off? How does the business contend with the absence of a key employee?
Ms. Nelson: When employees burn out, they are paid by insurance carried by the company. Those insurance companies are very interested in the kind of work we’re talking about — making workplaces healthier and preventing burnout — to reduce those payouts, which can last up to 2 years. The position is usually filled with an interim replacement for a certain amount of time. This practice is more common in the Netherlands, where many new people join companies during employees’ 4-month maternity leave periods.
Dr. Black: Whether someone has burnout or needs time off for whatever reason, we need to take each situation on its own and always try to focus on doing what’s right for the employee without compromising the integrity of the workplace. We have a policy for the financial approach, but we evaluate each case and try to do the right thing. The same thing could happen to any of us.
We often rally our team and say, “This person is going to be out for the next 6 weeks. We can do this. We just need to work together and figure out the best approach.” When challenged in the right environment and culture, teams will do amazing things.
Reducing Stress in the OR
Dr. Black: Has anyone tried to reduce stress in the OR? For physicians, as well as for patients?
Dr. Whitman: In a darkened OR, the physical environment isn’t much of a consideration for me. It has helped to have music in the room, and sometimes patients even hum along. Another intangible way to decrease stress is to educate patients in advance about their procedures. When patients know what to expect in the OR, they more readily cooperate with looking the right way, not moving around, and so on, which makes the procedure less stressful for us.
Mr. Eckert: Although we don’t add windows for natural light or “nature” inside the operating suite itself, it still helps surgeons, surgical staff, and patients to have views of nature or the outdoors down the clean corridor, in the public access areas, and where staff are working. This can be accomplished in restricted areas by hanging pictures of nature over the washbasins or at the doctor’s desk, placing that healthy environment within easy reach or sight. We even retrofit offices with small, inexpensive skylights, about 12 inches in diameter, to improve access to natural light and reduce energy use.
Return on Investment
Dr. Black: Has anyone looked at the return on investment for making these changes? I imagine it must vary significantly, from water coolers to lighting systems.
Ms. Nelson: Naturally, this is always at the top of everyone’s mind, especially for the larger expenses. We’ve studied it quite a bit. One of our nutrition efforts — replacing soda with water jugs containing sliced fruit or cucumber — actually saved money because water and fruit are cheaper than soda.
The new lighting system we installed was extremely expensive because it was an established building. In a new building, the healthy circadian rhythm lighting might not cost too much more than a standard system.
We estimated that with a 10% improvement in productivity, it would take 1 to 3 years to recoup the expense. It seems to be a good investment when you’re battling low productivity or losing employees to burnout.
Dr. Whitman: In our new office and surgery center, we got rid of Styrofoam cups for environmental reasons. We bought every employee a large Yeti cup that keeps beverages hot or cold. They’re personalized with “[Name] makes a difference,” so it’s a positive message and you know it’s your cup. It’s a greener, more attractive choice, and the investment is paying off while we keep countless cups out of the landfill.
Dr. McCabe: Sometimes the investment is inevitable anyway. For example, we had to replace the flooring in our surgery center. We decided to use wood-like flooring, and it has made a big difference in how the environment feels. We can’t measure the return on investment for changing the environment, but the need for that investment was part of our regular budget.
Mr. Maller: I think one way to evaluate return on investment is to calculate turnover. The cost of turnover is between 100% and 150% of the employee’s annual wages, so it pays to minimize turnover whenever possible. We do that in many ways that cost us money, including paid time off and subsidized healthcare, and I believe that creating a healthy, energizing environment can help as well. I think we can measure the return on that investment in our low rates of turnover.
Small Changes, Big Improvements
Ms. Nelson: In my research, I’ve found that when these changes — nutrition, lighting, activity, and so on — were made, workplaces were transformed. Health scores improved and we saw an increase in task efficiency and workflow, as well as productivity. ■