A throbbing headache that starts between the eyes and then runs down into a tense neck and shoulders: Is this just a description of an editor with a rapidly approaching deadline? Actually, tension headaches are just one of the many symptoms workers can experience in an excessively stressful environment. Beyond a simple pain in the neck, stress in the workplace is related to a loss in employee productivity, worker injuries, and increased healthcare costs.Fatigue, irritability, difficulty in concentrating, difficulty in sleeping, upset stomach, low morale, and lack of job satisfaction are all signals of stress in the workplace. Senior-level facilities managers and building owners are beginning to recognize the damaging effects that stress wreaks on employees’ health. Along with health risks, facilities managers are seeing how stress erodes an organization’s profitability and functionality. Based in Cincinnati, the National Institute for Occupational Safety and Health (NIOSH) is responsible for making recommendations for the prevention of workplace illness and injury. Part of the Center for Disease Control, the agency is primarily concerned with conducting research and disseminating information rather than enforcement. The agency educates facilities managers and health and safety experts on the dangers of workplace stress by releasing easy-to-understand information in the form of documents, videos, CDs, and seminars. “Companies are more aware of doing things that are beneficial to their employees, and helping them to deal with stress is one of those,” says Naomi Swanson, chief, Work Organization Research Section, NIOSH, Cincinnati.Increased awareness of health issues and rising medical costs are resulting in a greater focus on understanding the causes of stress. “Awareness of stress is much higher than it was 10 to 15 years ago,” says Swanson. According to data acquired by NIOSH from a nationally representative sample of organizations, the number of companies with stress management programs has risen significantly over the past 15 years. Defining StressNIOSH has been greatly instrumental in helping companies understand the impact of stress in the modern workplace. For example, different work environments have different causes for stress. In the agency’s research on computer workers, heavy workload demands, time pressure, and computer system delays were examples of exposure to excessively stressful working conditions or “job stressors.” Conversely, in another NIOSH study of hospital employees, major job stressors – in addition to workload demands and time pressure – included patient care and stress related to patients’ families. In the last few years, facilities managers have seen waves of downsizing, churning, and company reorganizations. Corporations are recognizing the relationship between a stressful work environment and overall productivity. While awareness has increased concerning low morale and impaired productivity, finding solutions to combat stress is a complex process. Notes Swanson, “Stress is a hard topic to get your arms around and come up with solutions.”Job stress is defined as harmful physical and emotional responses that occur when job requirements do not match the capabilities or needs of the worker. There is some debate as to whether individual worker characteristics or working conditions are the primary cause of job stress. In terms of stress management, focusing on differences in individual worker characteristics leads to stress prevention strategies that center on employees and their coping skills. Along with the importance of worker characteristics, studies suggest that certain working conditions, such as heavy workloads, are stressful to most people. Due to its research, NIOSH favors the viewpoint that working conditions are primary in causing job stress, yet the agency recognizes that individual and situational factors can greatly impact stressful working conditions.One common theme that runs through job stressors for employees is a lack of control over their environment and tasks. While infrequent or brief bouts of stress pose little risk, continual stress in the work environment takes a serious toll on an employee’s body. In addition to the early warning signs, such as headache or fatigue, many studies reveal that stress can increase the risk of cardiovascular disease and the development of back and upper-extremity musculoskeletal disorders and can contribute to psychological disorders. There is also a growing concern over the relationship between workplace stress and workplace injury. Studies already show that high-pressure work environments are associated with increased absenteeism, tardiness, and low employee retention rates.According to NIOSH, studies suggest that organizations with policies to create work environments that benefit worker health, also known as “healthy environments,” benefit the bottom line. Characteristics of low-stress, high-productivity facilities include: recognition of employees for good work performance, opportunities for career development, an organizational culture that values the individual worker, and management actions that are consistent with organizational values. Typically, stress management programs cover education on workplace stress for staff and management, changes in policies to reduce organizational causes of stress, and employee assistance programs.Creating Healthy AlternativesParrish Medical Center, a 210-bed hospital, in Titusville, FL, has embraced the concept of healthy workplace design. Covering a wide range of medical services, the healthcare facility opened in November 2002 and was completely designed around much of the prevailing research on healing environments. “This facility was designed on what helps the patients heal, what is good for employees, and how to make the environment as warm and friendly as possible,” says George Mikitarian, president and chief operating officer, Parrish Medical Center. Before design and construction, the building planners compiled and reviewed numerous studies and theories.“Ultimately we had to make a leap of faith that certain things were worth expending resources on to create a healing environment,” says Mikitarian. The 375,000-square-foot facility took twice as much time to plan as to build. To create a welcoming feel, Parrish Medical Center was designed as a series of curves with strong references to the natural environment. A cascading waterfall and sunny four-story glass-top atrium conveys a sense of serenity for patients, visitors, staff members, and the general public.Taking cues from the hospitality industry, Parrish Medical Center features a concierge desk to escort visitors, make reservations, and answer questions. Instead of fixed meals and meal times, patients can also order food from a room service menu at their convenience, any time between 6:00 a.m. and 8:00 p.m. Patient rooms have ample space for family members and patients can control much of their environment, including beds, television, ventilation, air-conditioning, and lighting. The hospital is also responding to noise complaints by reducing overhead paging. Another way to address patients’ concerns is by instilling a host of security measures that are not obtrusive, including security cameras and biometric readers. “We are creating an environment where patients feel safe and can focus on getting healthy,” says Mikitarian. The hospital has also initiated art, clown, and pet therapy to reduce stress. By listening to patients’ needs and offering control, the hospital is hoping to minimize stress and encourage quicker recovery rates. To accommodate staff needs, the healthcare company has improved employee parking, enhanced assistance with daycare and childcare, and encouraged frequent breaks with a generous, well-outfitted lounge and atrium café. Visiting musicians add to the peaceful, enjoyable environment. The hospital is currently measuring staff members’ absenteeism and turnover rates to determine the new environment’s effect on its employees. To date, absenteeism and turnover rates are down. “I say to building owners, ‘Don’t just look at the initial costs because it could scare you, and do not let the architect drive it. Drive it yourself and find out what your staff and patients want,’ ” says Mikitarian. Post-changes, Parrish Medical Center does cost more to operate; however, the organization’s market share and volume have gone up. The healthcare organization also values the hospital’s continuity of care by retaining staff members.Spreading the NewsParrish Medical Center is working with the Center for Health Design, a non-profit organization based in Pleasant Hill, CA, to show that evidence-based design in healthcare facilities can improve the quality of healthcare. Part of the Center for Health Design’s Pebble Project research project, the hospital is comparing original facility data to new construction data on patient and employee health and satisfaction, including workplace stress. The Pebble Project was created in 2000 to improve healthcare quality; attract more patients; attract and retain staff; increase philanthropic, community, and corporate support; and enhance operational efficiency. Scott & White Memorial Hospital and Clinic, Temple, TX, is also working with the Pebble Project on the design of its 540,000-square-foot addition, the Center for Advanced Medicine (CAM). Scheduled to complete construction in 2006, the CAM addition will more than double the existing facility.Currently, the healthcare organization oversees a 1.5 million-square-foot hospital on its main campus and 17 regional clinics. “One of the major trends in healthcare is healing environments that are not just for patients but for staff members and visitors,” says Matt Maxfield, associate executive director, Operations, Scott & White Memorial Hospital.The hospital is committed to doing baseline research in its existing facility and applying that knowledge to new construction. “We try to incorporate those components to reduce stress from every vantage point,” says Tim Rafferty, director, Design and Construction, Scott & White Memorial Hospital. Especially focusing on alleviating stress in the built environment, the healthcare organization is creating a facility that is patient- and staff-centric.With some staff members sharing compact offices that once were housecleaning closets, the existing hospital is overcrowded and lacking in amenities. From the beginning, Scott & White determined the right-sized workspace for each responsibility and task. The new design will also feature additional, convenient break rooms to encourage frequent breaks. To reduce clutter, CAM will also provide personal lockers and adequate storage for medical equipment. To understand the complexities of staff stress, the hospital is working with Texas A& M University to research these issues. “To keep our workforce in place, we are going to have to find ways to reduce stress, and we think that the design of the building is certainly one way to do that,” says Maxfield. In addition to the physical environment, the healthcare company is considering flexible work hours, analysis of staff work, massage therapy for staff, and encouragement of frequent breaks. “With the planning of this building, we had extensive input from users and we asked them specifically about their stress and what they need[ed] in the workplace to relieve that,” says Rafferty. Scott & White plans to include rooftop healing gardens accessible to staff and patients as a way to bring the outdoors indoors. Another influence of nature is the hospital’s color palette, which was drawn directly from interior designer Roslyn Cama’s photograph of a Texas field in autumn. Operationally, the healthcare organization believes its addition will be comparable to other hospitals in terms of costs. The hospital planners see the new addition as a fresh start and it will lead to the creation of new interior product standards for the rest of the organization.Making ChoicesWhile the trend for healthy environments is strong in the healthcare industry, focusing on alleviating stress is a growing part in many commercial facilities. According to Shawn Walker Smith, furniture specialist, Boise, San Francisco, employers are increasingly looking to more proactive vs. reactive choices with regard to ergonomics. “In the past, if an employee was injured, [he/she] would consider a keyboard tray, chairs, or refitting a desk. Now they are seeing that there can be some tangible cost savings to getting ahead of the game,” says Smith. Now, instead of centering on one injured employee at a time, companies are beginning to host ergonomic seminars, offer generalized evaluations, and promote healthy work habits.“We will talk with employees about basic ergonomic principles and how to utilize the tools that you have and ways to make your work environment and workday more comfortable,” explains Smith. Smith encourages facilities management teams to interact with employees to discover the source of their complaints to reduce stress in the workplace. “There are a number of different ways [to] reduce complaints, depending on the overall physical environment. In areas where people want some nominal acoustics or [to] increase the nominal privacy, we have gone in and redesigned the space,” says Smith. For example, acoustics/privacy solutions might include baffles, sound-masking equipment, and taller panel walls.The No. 1 complaint Smith hears from end-users in a variety of building types is related to pain in the hands and wrists. He encourages facilities managers to gather employee feedback regarding pain, excessive noise, privacy, and lighting issues and to explore holistic solutions.Changing the corporate culture is easier in a work environment devoted to health and well-being. “In the end, you cannot take the building for granted and think the building is going to change all the other things for you. You still have to complement it with a cultural change,” says Mikitarian. He hopes his facility, created in conjunction with in-house architect Chris Mail, vice president, Parrish Medical Center, and facility architect Bill Swinson and Associates, Nashville, will serve as an example for other building owners.“I believe companies are really getting behind the theory that these are our human resources; to continue as a company, to move forward as a company, it is only possible by nurturing and supporting our workers,” says Smith. By recognizing the damaging effects of workplace stress on individuals and individual organizations, facilities managers can effect changes in their corporate culture for the better.Regina Raiford Babcock ([email protected]) is senior editor at Buildings magazine.