The built environment and employee well-being: An investigation into the attributes and impacts of supportive physical work environments in long-term care facilities

Work demands experienced by long-term care (LTC) employees often far exceed opportunities for recovery in the workplace, resulting in poor worker well-being, high rates of burnout, and annual staff turnover that exceeds 100%. High-quality health-promoting physical work environments (PWEs) can provide workplace recovery opportunities. Unfortunately, there is limited existing research investigating the association between the quality of PWEs in LTC facilities and employee well-being. Our study sought to help fill this knowledge gap.In Aim 1 (Chapter 2), we performed a narrative literature review to identify the types of spaces and specific design characteristics that have been shown to be supportive of mental and physical health in LTC work environments. Five unique space types and 21 design characteristics were identified as supportive of employee health and well-being and relevant to long-term care physical work environments. In Aim 2 (Chapter 3), we used this information to develop the Staff-supportive Physical Environment Characterization (SPEC) audit tool. After beta testing, the final SPEC tool was used to assess the quality of PWEs in 10 LTC facilities in the Denver Metro area. Overall, the quality of both primary workspaces (PWSs) and staff-support spaces (SSSs) was poor, indicating an opportunity for significant improvement in these work environments.In Aim 2 (Chapter 4), we developed customized employee survey modules to collect demographic, employment, and PWE perception data from LTC workers. After validating these modules, we paired them with the NIOSH WellBQ survey tool. The composite employee survey instrument was electronically distributed to all LTC employees working in the 10 LTC facilities audited in Aim 2. We then analyzed our findings from the SPEC audits and the employee surveys to explore the relationship between the quality of PWEs and employee burnout. We found moderate positive associations between employee perceptions (subjective quality) of physical work environments (PWEs) and indicators of burnout and a small association between SPEC scores (objective quality) of primary workspaces (PWSs) and employee burnout.Our findings from Aim 1 and Aim 3 demonstrate that health-supportive physical work environments are positively associated with employee well-being and are potential intervention strategies that can be used to mitigate the high rates of burnout and turnover experienced by the LTC workforce. Identifying the specific design improvement strategies that will foster staff well-being will require decision-makers to consider the objective quality of the existing spaces, the desires of employees, and the needs of other building users (e.g., residents and visitors).