Can the workplace industry ever embrace evidence-based systems?
In 2001, the Johns Hopkins Hospital in Baltimore, USA, announced that a five-point checklist had virtually eradicated central line infections in intensive care units, preventing an estimated 43 infections and eight deaths in 27 months. The checklist was later implemented at ICUs in Michigan, where it decreased infections by 66% in just three months. It proved that implementing cockpit-style checklist thinking into infection-control knowhow reduced bloodstream infections to nearly zero. The project’s central hypothesis was that even seasoned professionals need help making sure they apply the knowledge they have, consistently and correctly. In his must-read “Checklist Manifesto”, Harvard Medical School Professor of Endocrine Surgery Atul Gawande argues that “failure results not so much from ignorance (not knowing enough about what works) as from ineptitude (not properly applying what we know works)”. Tough talk.
The medical profession greeted the findings with equal measures of enthusiasm and resistance, suggesting checklists might well be useful for simple procedures such as central line insertion, but are hardly a silver bullet for the myriad ills of today’s patients. Patients are too varied, their physiologies too diverse and medicine’s knowledge is still too limited. But why the scepticism? In contrast, neonatologists and paediatricians have welcomed specially designed nightwear for premature babies, which has an infection-fighting thin silver thread running through the material to act as a “fly swatter” for harmful MRSA. Silver thread rather than a silver bullet, but perhaps more science-based than systems-based. Ultimately, when presented with evidence of measurable benefits, clinicians will put positive patient outcomes before their own egos. In clinical care, that is a universally agreed measure – but in the workplace, that universal outcome measure remains elusive.
In 2010/11, billionaire industrial designer Sir James Dyson supported the £6.1m redesign of the neonatal ward at the UK’s Royal United Hospital in Bath. As part of the work, wireless accelerometers were attached to babies’ nappies, allowing doctors to accurately measure sleeping and waking cycles – the first time this had been done. Consultant neonatologist and paediatrician Dr Bernie Marden described the results as “remarkable”. He said: “We collated vast amounts of data using new techniques to build up a really accurate picture of how babies respond to their environment. We found the design of the building is leading to better-fed and better-rested babies.”
Analysis revealed that regulating natural and artificial light levels – regardless of the time of year – coupled with reducing noise levels from an average of 65 decibels to 55, allowed infants to more swiftly align their circadian rhythms. Their sleep increased, on average, by 22%. And more sleep equalled faster recovery. But the benefits weren’t limited to the infants. The clockwise, sequential layout of cot rooms, starting with intensive care, leading to special care and finally ending up in a room designed to look more like a home, gave parents a clearer sense of an infant’s progression. The result? Lower anxiety levels, contributing to a dramatic increase in the time mothers spent breastfeeding. Staff were also fitted with tracking devices to investigate their efficiency. Again, results proved to be positive, with nurses spending 20% more time with their patients. Does this all sound a little familiar?
Evidence is amassing that will point to similarly common sense (retrospectively) design interventions having similarly positive outcomes on employees in corporate workplaces. And while it might not be as simple to pin a positive corporate outcome on basic design decisions, I do believe we will increasingly start to evidence common failings that consistently undermine employee wellbeing, happiness and their sense of being able to do what they are employed to do. Doctors resist checklists because they want to believe their profession is as much an art as a science. When Gawande surveyed members of staff at eight US hospitals about checklists, 20% said they weren’t easy to use and did not improve safety. But asked whether they would want the checklist used if they were having an operation and 93% agreed.
In a recent online article, Kirsten Sailer from University College London’s Bartlett School of Architecture probed how research can inform design, and noted worrying results from a survey of 420 architects and designers, with 80% saying more evidence was needed, but 68% claiming they never reviewed literature. 71% said they never conduct any post-occupancy studies, and only 5% said they formally undertake a POE, with just 1% doing so rigorously. Is it perhaps because they believe design and architecture is more art than science?
Tim Oldman | CEO | Leesman
As the Founder of Leesman, Tim sought to offer the workplace market, the first truly independent, unified and standardised pre and post occupancy evaluation tool. The Leesman Index is now recognised as the largest independent database of workplace effectiveness data, the outputs of which are supporting organisations in their workplace strategies.