Inclusive Environments for Neurodivergent Healthcare Workers
Hospitals aren’t just sanctuaries for the sick. They’re also workplaces for more than 6 million Americans. These healthcare workers are often called upon to put in long hours, with constant activity and the immense pressures of navigating life-and-death situations and decisions. In the aftermath and stress of the COVID-19 pandemic, our healthcare providers remain on the front lines, delivering compassionate care often at the expense of their own emotional and physical well-being. A 2022 survey by Elsevier Health revealed that 20% of U.S. healthcare workers left their jobs in 2021. Another 47% of healthcare workers indicated they intend to leave by 2025.
An Industry in Crisis
To combat the mounting staffing challenges facing our healthcare system, HOK’s Healthcare designers are working to create inclusive, welcoming workplaces that accommodate the needs of all employees, including those have a heightened sensitivity to stimuli in the built environment, which includes those who are neurodivergent and neurotypical. While neurodivergent individuals possess diverse attributes and critical capabilities that allow them to be highly valuable employees in the healthcare workplace, there are some aspects of working in healthcare that may pose significant challenges for them.
"While neurodivergent individuals possess diverse attributes and critical capabilities that allow them to be highly valuable employees in the healthcare workplace, there are some aspects of working in healthcare that may pose significant challenges for them."
For instance, healthcare workers often have limited control over their work environments and lack the flexibility afforded to corporate office workers to choose how and where they work. The rhythms of each day vary, with the need for quiet, stimulation and collaboration. They must rapidly process and act on information, moving quickly and efficiently through their day. Breaks can be scarce, and opportunities to recharge are rare. In addition, harsh lighting, limited access to the outdoors, disruptions to circadian rhythms due to shift work and constant noise can be particularly triggering for all healthcare workers but especially challenging to those that are neurodiverse.
In this article, we delve into the daily lives of three healthcare workers and discuss ways the built environment can better accommodate neurodivergent providers, clinicians and caregivers.
The Child Life Specialist
Child life specialists help children and their families navigate their time in the hospital, and help to integrate play and normalize the experience as much as possible for children. They prepare children for various experiences, from testing to treatment, using education, preparation and play.
Our child life specialist, Gabriela, is neurodivergent. She works 12-hour shifts, arriving slightly before 7 a.m. four days a week. Gabriela starts her day by reviewing patient charts and taking part in change of shift reports with the nurses on the inpatient unit she is assigned to. Despite the challenge of engaging in large group conversations, this time is crucial for learning about the particular challenges her patients are currently facing and preparing and connecting with colleagues.
Once Gabriela has checked in and scheduled activities for each of her assigned patients, she gathers information on children scheduled for hospital admission in the coming weeks from pre-admission surveys. She gathers resources, including pamphlets and videos, to share with patients and their families in advance and develops a plan for their arrival experience. A hospital lobby can be overwhelming for a young, neurodivergent child or adult. Gabriela arranges for these patients to arrive via a back entrance and elevator, minimizing the risk of overstimulation before the child reaches their hospital room.
After completing her paperwork, she begins making rounds, checking in with each patient and their family. Gabriela brings an activity cart that enables kids to connect through play, offering options like a sensory bin with various textured items for the children to explore or other engaging activities. She also helps coordinate virtual learning for patients with longer hospital stays. Fortunately, patient rooms in the pediatric wing feature ample natural light (1) and individualized lighting and temperature controls (2), providing both her and her patients some control of the environment.
Next, Gabriela prepares to host a support group for children ages 3-8 with cancer. She has developed a short activity for the children to participate in to identify emotions before she facilitates a conversation and playtime.
Finally, overwhelmed by the weight of the diagnoses facing the kids in her support group, Gabriela takes a moment after their time together to step out onto one of the hospital’s outdoor patios. She grabs a bite to eat, enjoys some sunshine and reflects on her morning.
When she returns from her break, Gabriela meets with children to prepare them for their tests and operations. Her hospital recently built a playroom with child-size equipment, including an MRI machine (3). She helps her patients role-play, placing their stuffed animals in the equipment while simultaneously preparing them for their experience. Before she ends her day, Gabriela rounds on her patients once more, helping them process their experiences and emotions.
The Night Shift Nurse
Carlos, the third shift ER nurse, begins his work at 6 p.m. and, after changing into his scrubs, enters an active environment, since evenings are when ER volume is typically highest. He attends a quick shift change meeting, discussing transitions to care plans for existing patients in the emergency department. As a neurodivergent nurse, Carlos finds it difficult to process information in large group settings, so he arranges a one-on-one meeting with the nurse he is taking over for to discuss any specific needs or concerns. This allows him to focus better and to avoid any misunderstandings that might occur in a larger group setting.
Carlos starts his evening by rounding on patients. Since his patients change daily, he introduces himself, takes vitals and monitors progress. As he moves from room to room, Carlos appreciates his hospital’s incorporation of biophilic design—even in the ER. As he’s wrapping up his rounds, the ER becomes inundated with traffic following a fire at a local apartment building. Carlos goes to meet the arriving ambulances and helps triage and assess the needs—and priorities—of incoming patients.
Once he’s helped stabilize and find space for each of these patients, Carlos becomes overwhelmed by the surge of activity. Fortunately, the hospital’s staff lounge (1), which functions as a respite space for all workers, is integrated within the ER. He steps inside and gives himself five minutes to decompress. The lounge features lush plants (2), quiet meditation rooms (3), healthy snacks, peaceful music and a lighting system that simulates natural circadian rhythms, which is essential for third-shift workers.
Carlos then receives a page that one of his patients needs assistance. His hospital has an individual paging system integrated into his badge with RFDI tracking. This minimizes overhead noise of days gone by, allowing him to respond to requests pertaining to his patients and keeping him and his patients from becoming overstimulated.
After helping to stabilize his patient, Carlos continues to round on patients, responding quickly to each patient’s unique medical needs and problem-solving in real-time with his colleagues. Continuous patient monitoring technology and bed-side charting stations allow him to capture all important patient information directly at the point of care so that he does not have to rely on his memory for important note entry.
When he can, Carlos takes short breaks at the nurse’s station, which features comfortable, ergonomic seating (4), plants, nature-inspired wall coverings (5) and muted colors. As he sees the sun rising outside a patient’s room, he realizes his shift is almost over and it’s time for some much-needed rest.
The Cardiac Surgeon
Upon arriving at the hospital, the cardiac surgeon, Evelyn, heads straight to her office space, which she has designed to minimize distractions and create a peaceful environment. The space is outfitted with comfortable furniture, ambient lighting and a window overlooking the medical campus. These features enable her to focus on her work and perform at her best.
Evelyn starts her day by reviewing the scheduled surgeries and meeting briefly with her nursing staff to discuss any intricacies of the cases. Today, she has three surgeries scheduled, ranging from a 5-hour operation to a 90-minute procedure.
Her first patient has already been prepped for surgery. Evelyn reviews the patient’s chart and visits the pre-op room to discuss the surgery with the patient and family, answering questions and setting expectations for recovery. She understands the importance of involving the family in decision-making and providing them with the necessary information to help them feel at ease.
Next, Evelyn heads to the operating room (OR) with her support team. They are well-accustomed to her preferences in the OR, which helps ensure she doesn’t become overstimulated while operating. The lighting is adjusted, and music is selected according to her tastes (1). These minor adjustments help Evelyn focus on the task at hand and perform the surgery with precision and care.
Upon completing the surgery, Evelyn enters a dual-access consultation room (2). One entrance connects to the surgical staff area, while the other leads to the family waiting room, enabling her to discuss the results with the patient’s family without traversing the larger waiting area. The waiting room features warm lighting, a diverse array of seating options, a subdued color scheme, and nature-inspired graphics, cultivating a tranquil and inviting atmosphere for the family. Just adjacent to the OR is an expansive hallway with floor-to-ceiling windows and bench seating (3), connecting practitioners and families to the outdoors.
Although these conversations with the family can be the most challenging part of her job, the space helps put both the family and the cardiac surgeon at ease. Evelyn then proceeds to move forward with her second operation of the day, moving through the same processes and steps as the first. When she finishes discussing results with the second family, Evelyn takes a short break to recharge and eat in the hospital’s rooftop garden, surrounded by nature.
Evelyn returns from her brief break, refreshed and ready for her final operation of the day. Her dedication to creating a work environment that supports her needs helps ensure that her patients receive the highest level of care.
Toward a More Inclusive Healthcare Ecosystem
From child life specialists to night shift nurses and cardiac surgeons, the healthcare system relies on a diverse array of workers with different skill sets and experiences. Many design strategies tailored to neurodivergent providers and patients prove beneficial for all users. By designing inclusive and humane spaces that address the needs of every individual, we can help establish a more supportive and effective healthcare system that benefits providers and patients.
Note: Portions of this article describe composite experiences of fictional neurodiverse individuals. Neurodiversity is a term used to describe a broad range of conditions, some of which likely will be unresponsive to design solutions. HOK’s approach to inclusive design is based on our experience as designers and architects with the objective of providing a wide range of options for users with different needs. Any attempt to address the needs of neurodiverse individuals should also include review of human resources policies, implementation of technology solutions and building operations among other considerations. HOK does not represent that any design solution discussed in this article is capable of achieving any specific outcome for an individual user.
