Could transforming the healthcare environment help address staff stress and fatigue?

The Issue of Concern

The NHS loses around half a million working days each month to work-related stress, depression and anxiety among staff.¹ Chronic understaffing, long shifts, changing patient needs and economic pressures are increasing levels of fatigue and burnout, in what are already mentally and physically demanding professions. 

Clearly, this has serious consequences for the health and performance of the individuals and teams affected. Patient safety and satisfaction suffer when staff wellbeing is compromised. There are financial implications, too, with ongoing absences, vacancies and high turnover costing the NHS billions each year. 

With over 90% of NHS trusts expressing concerns about staff wellbeing, stress and burnout, and worker strikes looming large, there’s an urgent need for action. While change is impossible without high-level systemic solutions, small investments can have a big impact.

Transforming the healthcare environment is one such investment. Well-designed spaces and smart furniture choices can help reduce staff absences and turnover by increasing efficiency and improving morale. This paper looks at the role of the healthcare environment in addressing staff fatigue and stress, and offers healthcare leaders examples of innovative ways to create a workplace in which staff (and patients) can thrive.

COVID-19 Impact 

The NHS is the biggest employer in Europe. Over 1.3 million employees work hard to provide the best possible care and treatment to patients. But the organisation is facing a capacity crisis, and staff are bearing the brunt.

The COVID-19 pandemic put immense pressure on healthcare workers, who were already navigating the effects of funding cuts and rising operational costs alongside the changing needs of an aging population. Workforce growth has not kept pace with demand, placing remaining staff under increasing strain. As a result, staff are experiencing high levels of fatigue, stress and burnout.

NHS figures published in January 2023 show that absences attributable to anxiety, stress and depression have increased, accounting for over 521,600 full time equivalent days lost and 25.5% of all sickness absence in August 2022.¹

NHS Providers’ interim chief executive Saffron Cordery said this shows ​“just how much pressure our people are under from severe staff shortages, growing demand on services and the rising cost of living.”² She said the number of working days lost to anxiety, stress and depression ​“lays bare the psychological strain on staff right across acute, mental health, community and ambulance services.”

The pressure to do more with less is not new. But the impact on staff, and in turn, on patients, is becoming unsustainable as more than 400 workers leave the profession each week due to poor mental health.³

Staff wellbeing mustn’t be overlooked: front line workers need support to manage the changing needs of patients without sacrificing their own health.

Why the working environment matters

There’s no straightforward solution to the systemic challenges facing healthcare teams. But small investments can help ease the immediate burden on staff to reduce stress, fatigue and burnout. Transforming the physical spaces where staff spend their time – including the ward environment, offices and break areas – is one such example.

Without access to basic amenities such as rest areas, places to get food and properly equipped workspaces, staff morale and wellbeing will plummet. Faced with broken furniture and a lack of facilities, staff feel unappreciated and less likely to be able to perform their roles safely and effectively. Given the physical and mental toll on healthcare staff, it’s essential that their working environment is safe, practical and designed with care.

Urgent action is needed to address the problem of fatigue and burnout among healthcare workers. Could smart furniture choices create a workspace in which staff can thrive?

Sick and tired: the problem of fatigue and burnout among healthcare workers

Healthcare staff report higher levels of work-related stress, depression and anxiety than workers in other sectors, according to the Health and Safety Executive.⁴ Surgeons, pharmacists, nurses, midwives, GPs and consultants are all affected, with a third saying they feel ​“burned out because of work”.⁵ It’s a growing problem: the proportion of staff who reported feeling unwell as a result of work-related stress increased from 37% in 2016 to 47% in 2021.⁶

Clearly, the pandemic has taken a major toll on frontline staff: 92% of NHS trusts said they were ​“concerned about staff wellbeing, stress and burnout following the pandemic.”⁷ Nearly 30% of UK nurses and midwives experiencing symptoms of probably post-traumatic stress disorder three months after the first pandemic peak.⁸

But the pandemic is only one part of the story. Underfunding, regular restructuring and increasing demand predate the pandemic. These factors contribute to an ongoing recruitment crisis, which means fewer staff are available. Without any slack in the system, those remaining face long shifts, short breaks and heavy workloads.

“It seems to be a habit across my team. I see people doing it all the time. I think it’s an organisational thing. We do not take half an hour out of our day to get a breath of fresh air or anything like that“

nurse, quoted in 2020 study of NHS employees⁹

Longer working hours are associated with burnout, stress, fatigue and musculoskeletal injuries. Higher levels of staff illness and absence put additional pressure on the rest of the team. It’s a vicious cycle where stress and burnout are both cause and effect.

What happens as staff fatigue and burnout increases?

For individual staff, fatigue and stress can contribute to chronic disease, workplace injuries and unhappiness at work and at home. Tired staff may find their decision-making, reaction times and motivation to be impaired. 

Errors in patient care are also more likely when staff are tired.¹⁰ Staff worry about the standard of care, and a poor perception of patient safety feeds the cycle of stress. Patient satisfaction has been shown to drop as staff feel under pressure in their work, increasing when staff feel satisfied with the level of patient care they’re able to give.¹¹

For teams and managers, high staff turnover and longstanding vacancies can make it difficult to build and maintain a sense of team cohesion. It’s harder to attract and retain staff – currently 1 in 11 posts in the NHS in England are vacant.¹²

“The fall in staff morale is a real cause for concern, in particular in the numbers of staff who are considering leaving the workforce which has risen to just under a third (31%) since last year. There has also been a noticeable drop in the number of staff recommending the NHS as a place to work.”

Matthew Taylor, Chief Executive of the NHS Confederation (responding to NHS Staff Survey in March 2022¹³

Covering these vacancies comes with a cost: NHS England spent around £4.3 billion on agency nurses between 2016 / 17 and 2020 / 21.¹⁴ Management must also invest additional time and money into additional recruitment activities. Reduced productivity and an increased risk of adverse events can also put pressure on budgets that are already tight.

Poor staff mental health has even been shown to affect the wider community. Fatigued staff are at risk of being involved in car crashes through reduced focus and concentration, which has been compared to the risk posed by drunk drivers. 

Together, these figures make a powerful case for addressing the workplace pressures that contribute to staff stress and fatigue.

Transforming the healthcare environment transforms the staff experience

Tackling staff fatigue, stress and burnout calls for a systemic response, starting at national policy level. Organisational planning and investment, pay structures and shift patterns all play a role. While these are outside the scope of decision-makers in individual hospital departments, there are opportunities to make small investments at ward- and department-level to ease the burden on staff and improve staff wellbeing and patient care. The ward environment is a good place to start.

Below are a few examples of ways to create a healthcare environment in which staff can thrive:

1. Offer a variety of well-designed break areas

Sufficient breaks help prevent fatigue and burnout, but on busy wards staff don’t always find time to recharge. A well-designed break area can ensure they get as much rest as possible, even when time is limited. Including a variety of spaces will help address different needs. For example, social areas with bright colours and grouped seating give staff somewhere to chat and support each other.

Some staff may want quieter spaces to decompress after a difficult situation. Creating comfortable respite areas in alcoves and smaller spaces in corridors may be one way to give staff a private space to confide in each other or make a personal phone call. There, softer lighting and muted colours may create a more gentle, restful feel. 

“I’d like the idea of a quiet room, just to sit down for five minutes. If you’ve had a difficult call, you can go in and bring yourself back in and remind yourself that you’re okay and that person’s going to be okay” 

administrator, quoted in 2020 study of NHS employees⁹

And given that as little as 10 minutes in nature reduces stress and anxiety, ideally, break rooms will have windows overlooking green space, where staff may be able to go outside and walk. Even ​“very small-scale greening, including indoor green walls and potted plants, may provide effective help for stress relief”.¹⁵

2. Use colour, texture and smart furniture choices to elevate the workplace

The NHS People Plan recommends that ​“employers should make sure that staff have safe spaces to manage and process the physical and psychological demands of their work, on their own or with colleagues.”¹⁶ To maximize wellbeing and performance, this must go beyond simply providing a safe workplace, to creating one that’s comfortable and user-friendly.

As noted, specific colours can be chosen to influence perception, mood and morale, and set the tone in different spaces. Similarly, the texture and design of furniture can promote function and comfort during different activities:

• On the ward, furniture that’s ergonomic and easy to move and clean should be the priority.
• In break rooms, comfortable furniture should be chosen to allow staff to rest properly. This might include modular soft eating with removable cushions and backrests, which can be adapted to staff needs, while classic designs can be used to create a home-like feel, so staff feel relaxed and valued.

It also makes sense to choose antimicrobial vinyl to protect against germs, helping staff to avoid infections.

3. Maximise microbreaks and healthy micro-behaviours

When time and space are limited, small actions can have a big impact on staff health and wellbeing. ​“Microbreaks” can give staff a few minutes to catch their breath and process emotions. Spaces can be designed for quick rest stops, allowing staff to recharge, refuel and rehydrate. Providing access to healthy snacks in these spaces allows staff to keep their energy levels high and minimise the effect of stress.

“Micropractices”, such as mindfulness cues at hand-wash stations, have been shown to help staff build resilience on a busy ward.¹⁷ Access to relaxation and mindfulness apps are another option.

And small design decisions can influence levels of stress and fatigue, such as reducing background noise. Soundproofing materials and soft furnishings in break rooms help create a calmer environment for patients and staff, improving concentration and care. Quieter wheels on moveable furniture and equipment may also reduce the amount of buzz in a busy ward.

4. Involve staff in the design process

Evidence from The King’s Fund has shown that a supportive and compassionate workplace culture can help staff avoid feeling overwhelmed.¹² Actively involving staff in decision-making, proactively communicating change and supporting effective team-working can improve wellbeing and performance. 

For example, Nottingham University Hospitals NHS Trust’s Shared Governance Council empowers staff to influence and shape decisions, so they feel their voice is heard.¹⁸ Inviting staff to contribute ideas and share preferences when designing spaces and procuring new furniture can show staff that they’re valued, improve motivation and reduce workplace stress. This also helps close the gap between those making buying decisions and those using spaces in practice.

Smart furniture choices can reduce staff stress and fatigue 

Well-designed healthcare furniture can create a safe and supportive environment for staff and patients, helping to address many of the issues discussed above. High-quality, efficient and comfortable furniture in wards, waiting rooms and break areas can increase productivity and improve the patient experience. Staff feel appreciated and heard, and moral and motivation increase.

Making the business case for investing in healthcare furniture to improve staff wellbeing

With capacity and competition for investment tighter than ever, healthcare managers may worry about the upfront cost of these suggestions. In fact, there’s a strong business case to be made for investing in staff wellbeing, and specifically, in high-quality furniture.

Research shows that staff wellbeing improves quality of care, patient safety, patient satisfaction, productivity and service sustainability.¹⁹ Staff satisfaction will be higher, which will improve staff retention and thus reduce demand on individual staff.

By contrast, if staff stress and fatigue are not addressed, the problem will only compound. Failing to invest in comfortable spaces and quality furniture misses an important opportunity to improve wellbeing and minimize future cost of staff burnout. Investing in smart furniture choices can be a cost-effective way to drive efficiency, staff retention and morale. 

Case study: Imperial College Healthcare NHS Trust

Imperial College Healthcare NHS Trust invested £1.2 million in improvements to staff facilities, including ​“rest nests”, better changing areas, showering facilities and transforming breakrooms with new furniture and equipment. Chief Executive Professor Tim Orchard said, ​“ensuring high quality staff spaces is the start of a wide range of sustainable developments to improve our staff’s working lives.”²⁰

Case study: St Thomas’ Hospital

The Postnatal Ward at St Thomas’ Hospital approached Ocura for help in selecting the right furniture for their staff restroom. The Trust knew that providing a safe and comfy environment for staff to relax would have a positive effect on staff wellbeing. That meant getting rid of the old leftover patient chairs which were currently in the staff room, and replacing them with comfortable, attractive recliner chairs where staff could sleep.

By investing in the staff room, the Trust now supports hardworking staff to have a meaningful break, ensuring they head back to the ward recharged and rested.

“Since the room was completed, staff have commented on how much break times have improved, and are very happy with the new area.”

Case study: Orpington Hospital

Orpington Hospital worked with Ocura to create a Wellbeing Hub for staff to relax in during breaks, using funding from the hospital charity. The Trust chose Koko sofas and Aurora chairs in woodland-themed colours, to create a design that provides maximum comfort and convenience while looking inviting.

Professor Clive Kay, Chief Executive of King’s College Hospital NHS Foundation Trust, which runs Orpington Hospital, said, ​“I am very pleased that we have been able to create such a fantastic space. I hope staff will enjoy this facility for many years to come”.

Logic model: investing in the healthcare environment reduces effects of staff stress and fatigue

The above model shows how investing in innovative healthcare furniture and creating a safe and supportive environment leads to improvements in staff wellbeing. High-quality, efficient and comfortable furniture ensures staff feel appreciated and heard. This reduces the risk of staff stress and fatigue, which increases productivity and improves the patient experience.

Tips for successful implementation 

Often, new furniture is procured for staff areas only when the old tables and chairs are broken. But with staff at breaking point, investing in their wellbeing is becoming a powerful driver for investment in the healthcare environment. When staff wellbeing affects productivity and patient care, investing in well-furnished rest rooms can be as important as investing in medical equipment.

“Don’t wait until furniture is broken, when staff are already at breaking point” 

What should providers that want to create functional, comfortable and relaxing rest rooms for staff be looking for? The ​“6 Es” can offer a useful checklist:

• Ergonomic – perhaps the most important for the end user: are chairs and sofas comfortable to sit on? 
• Efficient – with space at a premium, streamlined and versatile furniture choices can offer staff plenty of room to relax while minimizing the overall footprint. Saving staff time is also important, so ready-to-use furniture is ideal.
• Easy – is the furniture straightforward to clean and move around? How much user support is available? For example, Ocura offers remote call support and out of hours self-accessible video trainings and user manuals. These options help staff get started quickly and easily when using furniture for the first time, no matter what time they need help. And all Ocura’s furniture comes fully assembled, so busy staff can put them to use straight away.
• Economic – while upfront costs can be a strong driver of purchasing decisions, buyers should consider the lifetime value of furniture investments to maximise ROI. Quality items will last longer and amplify the improvements to workplace wellbeing, delivering a greater ROI in the long-term. 
• Equality – can the furniture accommodate the different needs and preferences of staff? One example might be choosing adjustable chairs to suit staff of different heights, or choosing furniture with instructions in different languages for multilingual teams.
• Environment – more options are becoming available that align with NHS environmental and sustainability commitments. For example, Ocura now has several products that are carbon neutral. Choosing longer lasting quality pieces will reduce the amount of wastage.

Could transforming your healthcare setting help your workforce thrive?

By now, the links between workforce wellbeing, patient care and operational costs are well documented. There’s also clear evidence that the working environment greatly influences staff mental and physical health. While it would be impossible to eliminate all stress from health and social care roles, small changes to healthcare settings can help boost morale and reduce fatigue and burnout. Smart design decisions make daily life on the ward that little bit easier, so staff can care for patients without sacrificing their own health and wellbeing.

From wellbeing initiatives to well-designed break areas where staff can rest and recharge, prioritising staff’s mental health can help boost resilience and reduce anxiety and frustration.

Furniture procurement may not be top of mind in the context of an ongoing pandemic, changing patient demands and expectations, and ever-increasing costs. But the business case writes itself: the knock-on effects of investing in high-quality spaces and furniture include improved service performance, higher rates of staff retention and recruitment, and as many as half a million fewer sick days. 

And the result? A thriving workforce, a better patient experience, and much-needed financial savings. A small investment now could yield big savings later – whatever the future holds.

To find out how high-quality, innovative healthcare furniture could transform your healthcare settings and help build a happy, resilient and productive workforce, contact Ocura today.

REFERENCES

1. NHS Digital (January 2023) NHS Sickness Absence Rates, August 2022
2. NHS Providers (October 2022) Anxiety, stress and depression cause one in five NHS staff absences
3. Engage Britain (2022) Overstretched NHS and social care workforce major threat to nation’s health, as millions suffer poor care as a result
4. Health and Safety Executive (November 2022) Work-related stress, anxiety or depression statistics in Great Britain, 2022
5. House of Commons Health and Social Care Committee (May 2021) Workforce burnout and resilience in the NHS and social care, second report of session 2021 – 22
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7. NHS Providers (June 2020) What next for the NHS? The impact of the pandemic on the workforce
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11. NHS England (2018) Links between NHS staff experience and patient satisfaction: analysis of surveys from 2014 and 2015
12. The King’s Fund (September 2020) Written evidence submitted to the House of Commons Health and Social Care Committee
13. NHS Confederation (March 2022) Fall in staff morale a real cause for concern
14. RCNi (October 2022) Agency nurse bill for England tops £4.3 billion over five years
15. Gu, J. et al. (2022) Can even a small amount of greenery be helpful in reducing stress? A systematic review. International Journal of Environmental Research and Public Health. 19(16): 9778. Doi: 10.3390/ijerph19169778
16. NHS England (2020) NHS People Plan
17. Fessell, D. and Cherniss, C. (2020) Coronavirus disease 2019 (COVID-19) and beyond: micropractices for burnout prevention and emotional wellness. Journal of the American College of Radiology. 17(6): 746 – 748. Doi: 10.1016/j.jacr.2020.03.013
18. NHS Nottingham University Hospitals (2023) Shared Governance at NUH
19. NHS England (2018) Employee engagement, sickness absence and agency spend in NHS trusts
20. Imperial Health Charity (January 2022) Hospital heroes to enjoy better breakrooms, thanks to £1.2m staff spaces programme