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Demonstrating the Effect of the Built Environment on Staff Health-Related Quality of Life in Ambulatory Care Environments

September 2016
EBD Journal Club


Wingler, D., & Hector, R. (2015). Demonstrating the effect of the built environment on staff health-related quality of life in ambulatory care environments. Health Environments Research & Design Journal, 8(4), 25-40.


Objective: To determine the impact of the built environment on staff health-related quality of life (HRQoL) in a federally qualified health center (FQHC).

Background: Staff within FQHCs face many challenges that can significantly impact their HRQoL. Design features directed toward reducing stress have been shown to improve staff health outcomes in acute care environments. However, minimal literature exists linking design features to health outcomes within FQHCs.

Method: A cross-sectional, observational study was conducted involving three FQHCs that contain varying levels of enhancements to their interior features. A total of 75 staff across the sites participated in the indoor environmental quality (IEQ) survey, measuring satisfaction and perceived productivity. Measurements for staff HRQoL were captured using the quality of well-being (QWB) scale, which was administered to 10 staff at each site. Standard regression diagnostics were used to examine fit and find influential observations.

Results: QWB scores were normally distributed, and a dose-response relationship was found between QWB scores and level of enhancements. As the categories of satisfaction and perceived productivity increased, the average QWB score increased. Regression models showed overall statistical significance and predicted between a quarter to a half of the change in QWB scores.

Conclusion: This pilot study suggests that the more enhancements included in the interior features of a FQHC, the greater the returns to staff HRQoL. Findings also suggest that staff with a lower QWB appreciate enhancements more. Design strategies associated with improved staff well-being should be evaluated in terms of the amount of HRQoL they contribute.

Keywords: ambulatory care; built environment; disparities; evidence-based design; health-related quality of life

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