Abstract

Background

The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall prevention) or facilitative (i.e. hygiene‐related) variables. The importance of an atmosphere in the healthcare environment that promotes the health and well‐being of patients is evident, but this environment should not negatively affect healthcare personnel. The physical healthcare environment is part of the personnel's 'workscape'. This can make the environment an important determinant of subjective work‐related outcomes like job satisfaction and well‐being, as well as of objective outcomes like absenteeism or quality of care. In order to effectively build or renovate healthcare facilities, it is necessary to pay attention to the needs of both patients and healthcare personnel.

Objectives

To assess the psychological effects of the physical healthcare environment on healthcare personnel.

Search methods

We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials; Database of Abstracts and Reviews of Effects; MEDLINE; EMBASE; CINAHL; Civil Engineering Database and Compendex. We also searched the reference lists of included studies.

Selection criteria

We included randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after studies (CBA), and interrupted time series (ITS) of psychological effects of the physical healthcare environment interventions for healthcare staff. The outcomes included measures of job satisfaction, satisfaction with the physical healthcare environment, quality of life, and quality of care.

Data collection and analysis

Two reviewers independently assessed studies for eligibility, extracted data, and assessed methodological quality.

Main results

We identified one study, which adopted a CBA study design to investigate the simultaneous effects of multiple environmental stimuli. Staff mood improved in this study, while no effects were found on ward atmosphere or unscheduled absences.

Authors' conclusions

One study was included in this review. This review therefore indicates that, at present, there is insufficient evidence to support or refute the impact of the physical healthcare environment on work‐related outcomes of healthcare staff. Methodological shortcomings, particularly confounding with other variables and the lack of adequate control conditions, partially account for this lack of evidence. Given these methodological issues, the field is in need of well‐conducted controlled trials.

Author(s)

Karin Tanja‐Dijkstra, Marcel E Pieterse

Abstract

Plain language summary

Psychologically mediated effects of the physical healthcare environment on work‐related outcomes of healthcare personnel

Research has demonstrated that the physical healthcare environment can affect patients' health and well‐being. However, the healthcare environment affects not only patients, but also the people that work in these environments: nurses and physicians. Any changes that are made to the physical healthcare environment in order to benefit patients (e.g. renovation of hospital wards) must either benefit or have neutral impacts on healthcare professionals.

A review of the effects of changes to the physical healthcare environment on healthcare professionals was undertaken. Only one study was found which compared renovated wards of a psychiatric hospital to non‐renovated wards.

There is no evidence to support or refute the impact of the physical healthcare environment on work‐related outcomes of healthcare staff. This review does show that more work needs to be done in order to understand the effects of changes to physical healthcare environments on healthcare professionals.

Author(s)

Karin Tanja‐Dijkstra, Marcel E Pieterse

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

This review provides very limited evidence in support of the idea that architectural interventions in the physical healthcare environment affect healthcare personnel. Only one study was found that met the criteria for relevance and research methodology. It is therefore difficult to draw any conclusions regarding the effects of the physical healthcare environment on job‐related outcomes. Formulating evidence‐based guidelines for designing healthcare environments would be premature, given the presently inadequate research.

Implications for research 

This review suggests several implications for future research on this subject. When looking at the reasons for excluding studies, 19 studies were not methodologically eligible, mainly because they did not incorporate an adequate control condition. Future research should employ robust research designs. It can be argued that controlled trials are simply not suitable for this topic and that they can only be quasi‐experimental at best, as there are inevitably variables that cannot be controlled for. Related to this is the confounding of architectural changes with, for example, accompanying improvements in organisational climate. From a practical perspective, it is justifiable to simultaneously change working conditions when a renovation is being realised. However, when the aim is to determine the effects of the architectural changes, such confounding makes it impossible to draw conclusions on the effectiveness of the architectural intervention.

Considering these methodological issues, more well‐conducted controlled trials on this subject are certainly desired.The review by Dijkstra 2006 on effects of the physical healthcare environment on patients' health and well‐being included 30 well‐conducted trials. These trials can be used as a starting point for designing research on how the physical healthcare environment impacts healthcare personnel.

Research studying the effects of the physical environment in office settings demonstrated that the environment can affect worker productivity, mood and other work‐related outcomes (see for example Elsbach 2007; Kwallek 1990). This indicates that the subject remains a promising field for future research.

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