Designing for Health: How the Physical Environment Plays a Role in Workplace Wellness

Abstract

Introduction

Only 33% of employees in the United States report being engaged at work,¹ 75% report that stress is their largest health risk,² and over half of adults in the United States currently have a chronic health condition.³ These striking statistics reflect a considerable opportunity to improve the lives of millions of Americans and the performance of thousands of businesses.

Employers have a growing awareness that the physical, mental, and social well-being of their employees impacts their company’s bottom line.⁴ This is likely a core reason over 85% of companies with 1000 or more employees offer workplace wellness programs.⁵ Many of these well-intended programs fall short of effectively promoting employee health and well-being, however. In fact, only 60% of employees report being aware of the workplace wellness program offered by their employer, and only 40% of those who are aware participate.⁶

Building features promoting healthy behaviors and choices create an indoor environment designed to support human health, requiring minimal effort on the occupant’s part—meaning they may benefit from just going into the office. This article will (1) address why improving employees’ physical environment is an integral component to supporting their health and well-being, (2) discuss key environmental parameters influencing human health, (3) summarize healthy building certification tools and frameworks that are predominately used in industry, (4) and share a case study of healthy building feature implementation.

Building Interventions for Health, Well-being, and Business Success

The typical full-time American employee spends 8.28 hours working, 1.68 hours watching television, and less than 15 minutes exercising on a typical workday.⁷ Only 12% of Americans consume the recommended amount of fruit, and only 9% consume the recommended amount of vegetables.⁸

Although much emphasis and funding have traditionally been placed on health-care systems to improve Americans’ health, focus is shifting toward the creation of healthier environments. According to the U.S. Centers for Disease Control and Prevention, “approaches that change the environment reach more people, are more cost efficient, and are more likely to have a lasting effect on population health.”⁹ Healthy People 2020 (note 1) also identifies the creation of social and physical environments that promote good health as one of their 4 overarching goals, and the National Institute for Occupational Health and Safety states that “designing out occupational hazards and risks is the most effective way to protect workers.” ^10,11

But what does a healthy building actually look and feel like? Findings from the fields of building science, environmental psychology, design, architecture, and public health (among others) suggest a wide range of building interventions can help support human health and well-being. These interventions typically address the following parameters:

Accessibility

Acoustical comfort

Air quality

Beauty

Biophilia

Community

Density

Ergonomics

Fitness

Layout

Lighting

Nourishment

Olfactory comfort

Safety

Security

Thermal comfort

Water quality

This wide body of literature generally suggests design that makes healthy choices more visible, convenient, and accessible for occupants is key. For example, active furnishings (such as sit/stand desks) and centrally located, highly visible staircases have been shown to increase physical activity, which in turn, can help prevent the leading cause of death in the United States—heart disease.^12

–15 Improvements to indoor air quality (specifically reductions in CO₂ levels) have been shown to improve cognitive function in laboratory studies.¹⁶ Reducing nighttime use of traditional artificial light has the potential to help prevent possible carcinogenic effects associated with melatonin supression.¹⁷ The outcomes of these interventions suggest that they not only have the potential to improve employee health but also improve business performance through increases in productivity and reduced absenteeism/presenteeism.¹⁸

This leads to the common question—what is the return-on-investment (ROI) for businesses that implement healthy building features?

The variety of both qualitative and quantitative variables that play into this calculation make a traditional ROI analysis challenging. For example, we know that the majority of American employees want their employer to take an active role in encouraging healthy lifestyles.² As such, in the ever growing quest for talent, workplace wellness programs are now being used as a tool to attract and retain top talent—something that isn’t usually captured in a ROI analysis.

Supplementing the typical return-on-investment calculation with a “value of investment” analysis that includes qualitative variables (eg, employee attraction/retention, risk, branding, and productivity) will likely become important for the examination of these metrics.¹⁹

Tools for Holistic Health and Well-being Building Design and Operations

Academic research that supports healthy building interventions has been conducted within a wide range of disciplines. Inconsistent terminology across disciplines has made both accessing and translating findings into design challenging. To address this issue, several organizations (Table 1) have developed principles, guidelines, and standards that can help building professionals address physical, mental, and social well-being in their projects (Figure 1).

Table 1.

Guidelines, Principles, and Standards Applicable to Corporate Commercial Buildings.

Name	Administrated by	Type	Description	Rating Method	On-site Performance Verification?	Access and Cost to Download
9 Foundations for a Healthy Building	Harvard T.H. Chan School of Public Health	Principles	Foundational building design principles that support human health and well-being. Core Themes : ventilation, air quality, water quality, thermal health, dust and pests, lighting and views, noise, moisture, safety and security, smoking policy, and active design	None	No	Free
14 Patterns of Biophilic Design	Terrapin Bright Green	Principles	Design principles targeted at increasing the human benefit of biophilia(note 5) in the built environment. Core Themes : visual connection with nature, non-visual connection with nature, nonrhythmic sensory stimuli, thermal & airflow variability, presence of water, dynamic & diffuse light, connection with natural systems natural analogues patterns, biomorphic forms & patterns, material connection with nature, complexity & order nature of the space patterns, prospect, refuge, mystery, risk/peril	None	No	Free
Active Design Guidelines	Center for Active Design	Guideline	Design strategies that increase physical activity such as stair visibility, stair prompts, and visually appealing walking routes. Core Themes : designating stairs for everyday use, stair location and visibility, stair dimensions, appealing stair environment, stair prompts, elevators and escalators, building programming, appealing and supportive walking routes, building facilities that support exercise, building exteriors and massing	Self-administered checklist (no scoring feature)	No	Free
Fitwel	Center for Active Design	Standard	Weighted checklist of predominately behavior-based design strategies that improve human health and well-being. Core Themes : impacts community health, reduces morbidity + absenteeism, supports social equity for vulnerable populations, instills feelings of well-being, increases physical activity, promotes occupant safety, provides healthy food options	Point based: Prerequisites not required One to Three star	No	Free
ULI Building Healthy Places Toolkit	Urban Land Institute	Guideline	Design strategies that are focused on both the building and community scale. Core Themes : physical activity, healthy food and drinking water, healthy environment and social well-being	None	No	Free
Universal Design Principles	Center for Universal Design at North Carolina State University	Principles	Principles developed to encourage “design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.” Core Themes : equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, size and space for approach and use	None	No	Free
WELL Building Standard	International WELL Building Institute	Standard	Building design features, programming and clearly defined metrics developed to support human health and well-being. Core Themes : air, water, nourishment, light, fitness, comfort, mind	Point based: Prerequisites required Silver through Platinum	Yes	Free

Figure 1.

Spectrum of tools used for healthy building design and operations.

Each of these tools offer different levels of application. Principles integrate numerous empirical studies into overarching “truths for healthy design,” while Guidelines typically suggest more specific design strategies. Standards that offer a certification not only act as a roadmap to healthy building design but also offer greater transparency to occupants, investors, and the general public. The most robust standards require ongoing performance verification that test building parameters such as air quality, water quality, and acoustical conditions. Businesses can decide which of these tools can best serve them based on their desired outcomes and current level of familiarity with the topic.

Building certification systems are not new and have been proven effective in other applications. Leadership in Energy and Environmental Design (LEED) certification, for example, has become ubiquitous around the world (with over 80 000 projects in 162 countries) and has contributed to increased use of environmentally friendly building practices.²⁰ The Building Research Establishment Environmental Assessment Method (BREEAM)—another sustainability certification tool—has over 2 million buildings registered in 77 countries, indicating widespread demand.²¹

Of course, these tools are only as good as the results they help organizations achieve, which is why it is important projects are evaluated in the field with rigorous research methods. The next section outlines and discusses the results of the case study of a project that pursued certification under the WELL Building Standard (WELL).

Healthy Building Case Study

Environments that support human health are now being designed and constructed in various countries around the world. It is a key time, therefore to start asking the question—How are these healthy building interventions working in practice? Delos created The Building Wellness Survey to analyze pre- and post-Certification data from WELL Certified projects in order to assess the impact of the transition to a WELL Certified space, on employees’ health, well-being, satisfaction, and productivity. The pre- and post-Certification surveys are distributed online to all employees who regularly occupy the pre- and post-Certification spaces using a web link unique to each organization. The survey weblinks are e-mailed to staff by an individual well-known and respected within each organization to encourage participation while keeping participants’ identities confidential. Basic demographic and background information (gender, age, hours worked weekly, duration of current employment) are collected and used to identify potential confounders.

The Building Wellness Survey aims to capture occupant perceptions of space, health, and well-being through questions in 4 primary domains:

Environmental Conditions: This section asks participants to report environmental satisfaction including indoor air quality, thermal comfort, physical comfort, light quality, and access to nature and natural environments. Environmental conditions satisfaction scores for each condition were scored with a Likert item range of −3 to +3. Mean and median differences in satisfaction scores were compared across pre- and post-Certification spaces.

Productivity: This section uses the World Health Organization’s (WHO) Health and Work Performance Questionnaire (HPQ). The HPQ, developed by Harvard Medical School, contains a psychometrically validated scale comprised of 11 items on productivity, work performance, and leave from work.^22,23 Absenteeism and presenteeism scores are generated from the questionnaire. Absenteeism scores are interpreted as a function of overall work performance with a value range of 0 to 100. Presenteeism scores are interpreted as the difference between actual time spent working and time spent working expected by an employer with a value range of −1 (ie, working less than expected) to +1 (ie, working more than expected).

Workplace Well-being: This section asks participants to rate their agreement with statements intended to measure organizational satisfaction including workplace pride, motivation, employer support, health and wellness culture, and workstyle accommodation. Workplace well-being items were scored with a Likert item range of −2 to +2.

Mental and Physical Health: This section assesses occupant perceived mental and physical health as separate constructs using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12v2). The SF-12v2 is an international psychometrically validated questionnaire used extensively as a health-related quality of life measurement tool.^24
–26 Perceived mental and physical health were scored with a range of 0 to 100, with a score of 50 representing the US national average score.

American Society of Interior Designers (ASID) (note 2)

In June of 2017, ASID headquarters office in Washington, DC became the first WELL Platinum and LEED Platinum Certified space in the world. The office features wellness design elements such as biophilic design, sound masking systems, advanced air, and water filtration, active design, adaptable workspaces, and circadian lighting. As part of a joint research initiative with Cornell University, Innovative Workplace Institute, and Delos, ASID performed a study of their transition from a rented coworking office space into their new certified space. ASID monitored indoor environmental quality parameters such as carbon dioxide levels, acoustical levels, light quality, and temperature (n = 15 regularly scheduled measurements taken by ASID through one work week during normal work hours in the coworking office space, n = 15 regularly scheduled measurements taken by ASID through one work week during normal work hours in the WELL-Certified space), and captured occupant well-being through subjective measures using the Building Wellness Survey (n = 22 pre-Certification participants, n = 19 post-Certification participants). Results from pre-/post-Certification surveys were compared. Scores from each domain were analyzed using t tests, Kruskall-Wallis tests, and Wilcoxon ranked sum tests to identify significant differences in domain scores pre- to post-Certification.

Key research findings from the ASID headquarters study (note 3) indicate:

Indoor environmental quality was significantly superior within the new space, with acoustical and CO₂ levels, respectively, 50% and 58% lower than in the previous space. Additionally, in the new space work surfaces received 63% more light than in the coworking space.

Better indoor environmental quality in the WELL Certified space was associated with significantly higher employee environmental satisfaction, particularily regarding satisfaction with air quality, physical comfort, light quality, thermal comfort, access to nature, and acoustical comfort.

83% of surveyed employees agreed that the WELL Certified space supports the sharing and exchanging of ideas compared to 39% in the coworking space.

ASID reported a significant improvement in employee productivity after transition into the WELL Certified space, with employees working 19.4% more than expected by their employers, and a 16.2% increase in average self-reported work performance. Based on this increase in productivity, along with employee retention and energy savings, ASID estimates that it should recoup its investment in the WELL project within the first half of its 10-year lease agreement.

Moving Forward With Strong Leadership

Studies conducted directly in real office spaces provide a unique opportunity to (1) validate ideas tested in controlled laboratory settings and (2) examine the efficacy of building products/programs developed to enhance employee health/well-being. The findings from this study suggest that the implementation of healthy building features can have a profound impact on employee satisfaction and well-being. Although, within the context of the workplace, subjective measures only provide a partial account of the environmental impact on health and well-being outcomes, the Wellness Building Survey provides a systematic way to capture the impact of the transition to WELL Certified spaces on employee’s environmental satisfaction. Convenience sampling—due to the survey being optional to all employees—may limit the representativeness of the data collected. However, this limitation can be mitigated with sufficiently large response rates. Although this study highlights a significant transition, from a coworking space to a WELL Platinum Certified space, preliminary analysis of survey results from larger additional case study sites (namely Strykers and Structure Tone, which are not published here) support these findings.

The case study findings may lead to further questions on how healthy buildings can go beyond the employee level and have resounding effects on the organization. Initial research suggests that organizations are using healthy buildings as a tool to recruit and retain talent, for example.¹⁸ The principles, guidelines, and standards discussed above provide a framework for designers to integrate this important research into their projects. Standards that require ongoing performance verification can also help projects detect and correct issues that may develop over time.

To this end, businesses need to prepare for the new responsibilities healthy buildings require. In particular, they can identify an office champion. This person needs an understanding of the physical environment, especially as related to human health and well-being and employee performance. He or she will also need to advocate for employees directly by promoting wellness design elements and programs in the workplace.

When asked, 60% of property companies/funds surveyed as part of GRESB’s Health and Well-being module said they designated responsibility for health issues to someone different than their sustainability manager—most commonly a Human Resources professional.²⁷ This trend could indicate this emerging new set of responsibilities will fall to human resources professionals (perhaps creating a hybrid professional role).²⁸ Or, it could indicate that there is an emerging new role (or outsourced service) for organizations to consider—Wellness Director—a person responsible for healthy physical environments and wellness programming. As was the case with environmental sustainability, health and wellness professionals will likely be most successful if they are aligned with functional roles within an organization, such as facility management and corporate real estate.

Of course, meaningful change does not come without significant challenges. Companies will have to set aside the necessary budget to implement these improvements, timing for implementation will have to be negotiated, and leadership support will have to be sustained. Integrative design teams should also be engaged to facilitate synergies between physical design and programming. For example, some companies that implement acoustical comfort elements may not actually improve occupant satisfaction with noise because cultural changes are not concurrently implemented.

As the healthy building movement grows, organizational leadership and education will be vital for effective implementation of the building principles, guidelines, and standards that help guide healthy design. Masters programs such as Cornell University’s M.S. in Human Environment Relations and industry credentials such as WELL AP are currently helping professionals prepare to meet this growing demand for healthy building education. In addition, Council for Interior Design Accreditation’s (CIDA) 2018 Professional Standards defines “student work [that] demonstrates understanding of standards and guidelines related to sustainability and wellness” as a core student learning expectation (note 4).²⁹

People spend approximately 90% of their time indoors, and over two-thirds of the workforce in the Global North are now considered knowledge workers.^30,31 This represents a large shift from just a century ago, when more workers were engaged in manual labor and spent more of their time outdoors. The health implications of this shift (eg, less physical activity, less time in nature) make implementation of healthy building features incredibly relevant. Continued research in this field is needed to further reinforce the importance of the physical environment and communicate the impact it has on human health and well-being, as well as on organizational goals. We are entering a new era of design where building professionals play a critical role not only in preventing injury and illness through design but also promoting well-being. Or, as former acting U.S. Surgeon General Rear Admiral Boris Lushniak put it—“architects are public health workers.”³²

Footnotes

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This article is authored by employees of Delos and the American Society of Interior Designers. The products, research, and ideas discussed may have business and/or financial impact on these respective organizations. We have disclosed these interests fully to American Journal of Health Promotion.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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