According to the Lucian Leape Institute’s National Patient Safety Foundation, "Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”¹

All images courtesy of Ecore

The correct specification of flooring in health-care settings can bring a multitude of benefits to patients, nurses, doctors, and staff as well as the bottom line.

As a result of the COVID-19 pandemic, 2020 could be seen as a year of awakening. We are now collectively awakening to and more aware of the state of public health, as well as the state of our health-care system. And this will surely lead into an era of change.

Changes are likely to occur in three main areas: 1) how we view public health with attention to increasing wellness; 2) how we deliver health-care services when people get sick; 3) how we value nurses, doctors, and other health-care providers and invest in their well-being. For architects and designers who specify products for health-care settings, the years and decades ahead will be informed by what we have lived through.

Public Health and Wellness

When the pandemic hit, Americans woke up not only to the shaky foundations of our health-care system, but also to the general lack of health and wellness of our citizens as a whole, which put even more strain on our system. As the earliest fatalities caused by the novel coronavirus were reported, the term “comorbidity” became inextricably linked to the statistics. It quickly became clear that those with such existing challenges as obesity, diabetes, and asthma had a harder time surviving the virus than did citizens without those conditions and illnesses. The prevalence of obesity in the United States is more than 42 percent, up from 30 percent in 2000.² According to the U.S. Centers for Disease Control and Prevention, “Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer that are some of the leading causes of preventable, premature death.” Even before the pandemic, the medical cost for people who have obesity was $1,429 higher than those of normal weight. This totaled $147 billion in 2008. Never in recent memory has the cost of poor public health been so starkly observed.

But improving public health is not an easy task. While a doctor might suggest more exercise to a patient, how possible is that? Are there sidewalks in the area? Are there bike lanes? Is it safe to walk at night? What if the patient lives in a highly polluted area where breathing outside is not healthy, as is the situation with many low income and people of color? What if the rental housing is in ill repair and contains mold spores that contribute to respiratory problems?

And while a doctor might suggest that a patient eat more fruits and vegetables, are there markets with these foods in the neighborhood? Or does the patient live in a fresh food desert with only junk food and sodas available at the local store? Are there community gardens where one could grow some fresh food?

Yet despite the challenges, a heathy population will be a key component in future battles with viruses. It is likely that wellness efforts will rise to the forefront of population health strategy. Exercise, nutrition, and emotional and mental balance contribute to the wellness initiative.

When the tally has been done to calculate the cost of ill public health on both individuals and society, it is likely that the impetus toward creating a healthier citizenry will move to the forefront.

The pandemic of 2020 demonstrated the connections between fitness levels and the ability to survive the illness.

Delivery of Health-Care Services

While a healthier population will certainly ease strain on the health-care system, the system itself is poised to undergo massive changes too. Fundamental shifts are already happening, as witnessed by a tremendous—and some would say long overdue—surge in telemedicine, using video conferencing for patients to consult with health-care providers. In this scenario, the doctor, nurse, practitioner, or specialist can intersperse video conferencing with live visits for patients that need in-person evaluation. With video, patients are spared the time and expense of traveling to the location, and they are not in danger of contracting viruses from other patients in the waiting room. The downside is for patients who do not have or cannot navigate a computer, Internet access, or both.

Valuing and Caring for Nurses, Doctors, and Health-Care Providers

Of all the images the COVID-19 pandemic created, perhaps most striking was the sight of exhausted and overwhelmed nurses, doctors, orderlies, and others in the COVID-19 wards. TV and newspaper images showing these truly essential workers serving long hours day after day, often without sufficient personal protective equipment (PPE), captured the country’s attention. Without their dedication, many more deaths from the virus would likely have happened.

Nurses were especially stressed by the pandemic, as they not only cared for an onslaught of critically ill and contagious patients, but they were also tasked with comforting the dying when family members were barred from rooms due to the virus. These stresses on nurses as witnessed by the country were gut wrenching. As a result, many changes to the nursing profession are expected.

Some new awareness of nurses as a result of the pandemic include:

• Nurses have been working with fewer resources because of budget cuts and staffing shortages.
• There has been increased retirement due to concerns of catching COVID-19 in the workplace.
• Nurses have seen an increase in compassion fatigue.
• There has been a decrease in self-care.³

Changes likely to occur in the nursing profession are:

• There will be a growing public awareness of lack of nurse safety.
• There will be a focus on wellness and well-being for nurses, both in the hospital or clinic setting and outside of work.
• Nurses could be taking on more responsibilities once relegated only to doctors.
• There will be more opportunities for nurses to deliver some care and consultation via telemedicine, perhaps saving them from being on their feet for 12 hours at a time.⁴

Even as the pandemic unfolded, nurses started adapting on their own to prevent infections and deliver compassionate care.

One example is nurses moving IV drips and other machines toward the doorways of patient rooms so that the nurses did not have to always walk in and out of patient areas. This simple technique helped prevent the spread of the virus.

In another example, as it quickly became apparent that the use of PPE covering nurses faces except for the eyes made it hard for them to convey the compassionate care they want to deliver, some nurses taped smiling photos of themselves onto the front of their gowns so that a patient would feel the all-important human connection.

While no one knows for certain how the future will unfold in public health policy and the health-care industry, there is certainly heightened awareness about these issues. For the architect and designer, creating health-care settings that promote the health and well-being of both patients and caregivers, and an improved bottom line, will certainly be a priority. In the next section, we look at the challenges in a health-care setting that savvy specifications can help alleviate. We will use flooring as an example of products that can make the situation better.