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An Integrated Approach to Healthy Universities Interdisciplinary Center for Healthy Workplaces University of California, Berkeley Cristina Banks, PhD Sally Augustin PhD Siw T. Innestrand, PhD Caitlin DeClercq, PhD Isabelle Thibau, MPH PROPERTY OF ICHW DO NOT DISTRIBUTE

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Page 1: An Integrated Approach to OF Healthy Universities PROPERTY ... › sites › ...(“without fear of being called out for talking to them”) • Connection of ideas , comfort to collaborate,

An Integrated Approach to Healthy Universities

Interdisciplinary Center for Healthy WorkplacesUniversity of California, Berkeley

Cristina Banks, PhDSally Augustin PhDSiw T. Innestrand, PhDCaitlin DeClercq, PhDIsabelle Thibau, MPH

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Presentations• Cristina Banks, PhD University of California, Berkeley

“The Healthy Workplaces Model”• Sally Augustin, PhD Design with Science

“Designing, Literally, for Well-Being”• Siw Tone Innstrand, PhD Norwegian University of Science and

Technology “Healthy Universities: Exploring Basic Psychological Needs and Health Among Academics”

• Caitlin DeClercq, PhD University of California, Berkeley“Health-Promoting Innovations in Office Design”

• Isabelle Thibau, MPH University of California, Berkeley“Graduate Student Experience Impact on Health and Academic Success”

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The Healthy Workplaces ModelCristina Banks, PhDUniversity of California, Berkeley

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PROPOSITIONS

We can make the work experience a source of joy, pride, meaning, satisfaction, and well-being.

We can help employees become healthier and happier with their lives at work.

We can re-invent the workplaceto create these outcomes.

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Interdisciplinary Center for Healthy

WorkplacesUniversity of California,

Berkeley

Repository | Convener | Catalyst

Societal ImpactPublic Health

NutritionPhysical ActivityDemographics

Human NaturePsychologySociologyEconomics

Mind & the Body

Medicine Neuroscience

The WorkOrganizational

Design Human Resources

The LawPublic Policy

Employment Law

Work DesignEngineeringErgonomics

SoftwareAutomation

ToolsTechnologyHealth Tech

Sensors

The Built Environment

Physical Environment

IEQDesign

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Organizational Context

Healthier Employees

Improved Personal and Organizational Outcomes

Organizational and Societal Sustainability

Prevention

Mitigation

Promotion

Organizational Support

Individual Behavior Change

Physical and Psychological

States

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Meaning/Purpose

Engaged/Accomplishment

PositiveEmotions

Belonging/Social

Connection

Autonomy

Competence/Mastery

PersonalGrowth

Safety

Physical WB/Vitality

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What are the “drivers” of need satisfaction that can be built into the work environment?

• Privacy • Flexibility • Predictability • Equity • Comfort • Connection • Safety

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Designing, Literally, for Well-BeingSally Augustin, PhD

Principal, Design With Science

Editor, Research Design ConnectionsPROPERTY OF

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Mood matters, a lot

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Wellbeing is

“People’s evaluations of their lives—evaluations that are both affective [emotional] and cognitive. People experience abundant SWB [subjective wellbeing] when they feel many pleasant and few unpleasant emotions, when they are engaged in interesting activities, when they experience many pleasures and few pains, and when they are satisfied with their lives. . . . there are a number of separate components of SWB: life satisfaction (global judgments of one’s life), satisfaction with important domains (e.g., work satisfaction), positive affect (experiencing many pleasant emotions and moods), and low levels of negative affect (experiencing few unpleasant emotions and moods).”

(Diener, 2000)

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Design in wellness by:

• Reducing stress and improving mood• Encouraging healthy eating• Supporting sleep and napping• Building in activity

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Reducing stress and improving mood

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Encouraging healthy eating

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Supporting sleep and napping

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Building in activity

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Sally Augustin, PhDPrincipal, Design With Science

Editor, Research Design Connections

[email protected]

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Norwegian University of Science and Technology 27

Healthy UniversitiesExploring basic psychological needs and health among academics

Siw Tone Innstrand, PhDNTNU Center for Health Promotion Research

Cristina Banks, PhDChristina Maslach, PhDChristopher Lowenstein, MPH PROPERTY O

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Norwegian University of Science and Technology 28

A health-promoting university

“creates a learning environment and organizational culture that enhances the health, well-being and sustainability of its community and enables people to achieve their full potential”

www.healthyuniversities.ac.uk

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Norwegian University of Science and Technology 29

AimWhat are the most important psychological needs that influence the health positively or negatively as perceived among employees in university settings?

– Gender differences – Occupational group differences(Academics / Technical-Administrative staff / Doctorial research fellows)

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Norwegian University of Science and Technology 30

SEM model

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Norwegian University of Science and Technology 31

• Norwegian acronym for work environment and climate study

• Health promoting intervention program in the university setting

• 18 universities and colleges in Norway (N>15.000) • KIWEST (Knowledge Intensive Work Environment

Survey Target) questionnaire

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Norwegian University of Science and Technology 32

Measures– Autonomy – Job autonomy. e.g., “I have a sufficient degree of influence in my work”

(Näswall et al., 2010)– Competence – Task completion ambiguity. e.g., “I know when a task is completed”.

(Hellgren et al., 2008)– Belongingness- Social community at work. e.g., “There is a good atmosphere between

me and my colleagues” (Pejtersen et al., 2010)– Psychological safety - Trust in unit management. e.g., “My unit management is always

reliable.” (Näswall et al., 2010) – Fairness - Recognition. e.g., “I am treated fairly by the unit management.” (Pejtersen et

al., 2010) – Meaning – e.g., “My work is meaningful” (Pejtersen et al., 2010)– Positive emotions - Utrecht Work Engagement Scales (UWES) e.g., “At my work, I feel

bursting with energy” (Schaufeli, Bakker, & Salanova, 2006)– Health- “My work has a positive/negative influence on my health”

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Norwegian University of Science and Technology 33

Sample

• Employees with regular payroll for minimum 20% position (N=12,170)– 4,562 Academics (research and teaching)– 1,452 PhD students– 5,519 Administrative/technical staff – 637 Leaders

Men: 46%

Women 54%PROPERTY O

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Norwegian University of Science and Technology 34

Statistical analyses

The data analyses proceeded in three steps. 1. Confirmatory factor analyses (CFA)2. Structural equation modeling (SEM) 3. Multi-group analyses in SEM*

*As latent variables are not associated with measurement error, latent mean analysis is more sensitive than traditional statistical techniques like and is more likely to detect between-group differences (Hancock, Lawrence, & Nevitt, 2000; Hong, Malik, & Lee, 2003).

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Autonomy

Meaning

Positive emotions

Safety

Negativehealth

Positivehealth

Fairness

Belongingness

.07*-.19***

.23***-.09*

.25***

-.23*** .11*

-.13*

.19***

-.23***

Gender and occupational differences?

Competence

1. Strongest relationship?

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Norwegian University of Science and Technology 36

2a. Gender differences in the level of needs(Multi-group analyses: Female used as reference group)

ns.ns.PROPERTY O

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Norwegian University of Science and Technology

2b. Gender differences in the relationships

(Female/Male)

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Norwegian University of Science and Technology 38

3a. Occupational differences in the level of needs(Multi-group analyses: Academics used as reference group)

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Norwegian University of Science and Technology

3b. Occupational differences in the relationships

(Academics/PhD/Technical-Admin)

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Summary and practical implications

Needs relate differently to positive and negative healthMechanisms for promoting health are likely to differ from those for preventing illness

Gender and occupational groups differ in the level of needsWhy these differences exist needs to be explored further

There are gender and occupational differences in how needs are related to positive and negative health

Different interventions are required to address the specific needs associated with different gender and occupational groups to create health and wellbeing

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Norwegian University of Science and Technology

Thank youPROPERTY O

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Caitlin DeClercq, Ph.D. Interdisciplinary Center for Healthy Workplaces, UC Berkeley

[email protected] Work, Stress, & Health Conference | Minneapolis, MN | June 2017

Health-Promoting Interventions in Office Design How Students Define and Envision Healthy Workplaces

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The built environment matters for health

How design impacts health outcomes: • “aspects of design can [directly] impact health”• “the design of the environment influences behaviors, actions,

and interactions”• “some aspects [of design] can be healing, health promoting”

Schweitzer, M., Gilpin, L., & Frampton, S. (2004). Healing spaces: Elements of environmental design that make an impact on health. The Journal of Alternative and

Complementary Medicine, 10(S1), 71-72. PROPERTY O

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Buildings work at behavioral + symbolic levels

Buildings work at behavioral and symbolic levels*; both have implications for health• How do I feel in this space? • Do I feel safe, valued, energetic, positive, healthy? • Does this space enable me to do my best work?

*Cranz, G. (2010). Levels of analysis in environmental design. In Cranz, G. & Pavlides, E. (Eds.). (2010). Environmental Design Research:

The Body, The City, and the Buildings In-Between. San Diego: Cognella. PROPERTY OF

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How Does This Relate to Design?

Engagement: employees want to come to work and

are able to do their best work(ICHW, 2015)

Drivers of need satisfaction: • Comfort• Connection• Equity• Flexibility• Predictability• Privacy• Safety

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Study Overview

• Focus Group Methodology• Individual and Group Process

1. “Think about what connectionmeans to you. What would make a space feel more connected? Using words and images, take 5-7 minutes to record your ideas.”

2. Prompt 2: The Box (spatial elements and qualities)

• Data AnalysisPROPERTY O

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Comfort - what

• “Feeling good,” “physical, mental, social”• Physical comfort

• Right lighting; good temperature• Being able to dress like you want• A good fitting chair that reclines; couch, bean bags; stretching room• Moveable furniture• A “clean, tidy, neat” space

• Mental (“feel at ease; not come home stressed”)• Able to receive good energy from the people around me• Relationships with coworkers fostered (social events)• Being able to talk about personal issues; being trusted and

encouraged; no discrimination; boss is accessible • A “fun” environment

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Comfort - how

• Plenty of breaks to stretch and walk; places to have a break and meet co-workers

• Space for collaboration, and office individual office spaces with completely enclosed walls; places for “real private work”

• Both “quiet and focused” and “engaging and interactive” environments

• Outdoor space for breaks; ability to work inside or outside; safe neighborhood; outdoor activities

• Amenities: feeling that you can have what you need whenever you need to; personal needs met

• Be able to design the room, customize workspace [user-generated]*

• Other: circular building; big entry; no interruptions/no bothering; clean; nap time; “floor is not hard”; a “homey” feel

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Key Ideas• Breaks: break room in

center; gymnasium• Private spaces• Amenities: in center;

childcare; gym• User-generated:

adaptable temperature; sliding doors

• Circular building

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Key Ideas• Outside/beyond office:

safe neighborhood; no buildings next door; rooftop garden

• Other: Circular building

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• Communal and private workspaces (separated by floor)

• Outside: Roof deck; transparent glass

• Breaks: couches, TV

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Connection - what

• Community, communication, collaboration; recognition• Connection to inside/outside; connection to management; connection

between employees; connection of ideas• Connected to work visually, physically, mentally, and socially • Environment where voice is heard, recognized for efforts, company is invested

in you, outside of work accomplishments (work and non-work)• feeling welcomed; being able to voice concerns; knowing that you can approach anyone in the workplace;• “your work is recognized and valued by other members of the organization” PROPERTY O

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Connection - how

• Connection to management, employees: sense of importance to group; proximity of people; sliding glass doors; can see and communicate with peers (“without fear of being called out for talking to them”)

• Connection of ideas, comfort to collaborate, communication (at and beyond work), teamwork; co-working spaces

• Yet, also “some privacy…space where I can be myself and do what I want”

• Connection to outside: connection to “nature/health”; connection to the outer world; lots of windows/natural light

• Other: hexagonal workspaces, open plan, shared resources, beds (!), kitchens

• “members can sleep and eat together to make a space feel more connected”

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Main ideas:Management/employees: cubicles face common area; sociopetal seating (x2)Outside: treesCollaboration: collaborative seating (yet private offices)

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Management/employees: ping pong table, cafeteria, break roomsOutside: windows, outdoor area, “open air spaces”Other: “connection to health”

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Management/employees: break room, couches; short walls; memo wallOutside: trees; glassCollaboration: innovation area; café; collaboration desks

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• Private and social areas (separated by lofted floor)

• Couches and long tables• Mini offices with glass,

sliding doors ”to encourage leaving them open”

• Shared resources

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Note beds and kitchen –eat and sleep together!

Beds and kitchen – eat and sleep together!

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Equity - what

• Equity is about equal opportunity• Fairness, equal allocation of

resources; respect all occupations• Options and choice

• Private, but not too private• Creative freedom

• Sharing spaces, feelings, interests• Management is responsive• Giving people a say• Feeling listened to

• No boundaries, transparent

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Equity - how

• Equal allocation of resources/space: have the same (type, size) facilities, chairs, desks, offices*; equal access to communal resources (e.g., lighting, windows, views); “equal freedom from distraction”

• Visually display incentives • *and hierarchy? yet, “management should be on same level”

• Options and choice: seating, noise levels, food; open floor space (designated space = unequal)

• Sharing spaces, feelings, interests: conference spaces as places “to freely share creativity”

• No boundaries, transparent: windows, skylights, glass, personal space

• Other: white walls, round or “diamond layout” tables

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Equal allocation: divide in half by noise levels (freedom from distraction); gender neutral bathroomsOptions: standing/sittingSharing: art wallOther: circles

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Equal allocation: auditory barrierOptions: food options Sharing: benches, cubicles arranged for collaborationEqual opportunity:*

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• Note the 4-sided elevator!

• Everyone on the same floor, “not sectioned off by hierarchy”

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Flexibility - what

• Cultural, spatial, bodily• Inviting, calm, peaceful, warm*• A lot of choice

• No set spaces (function, role)• Flexible space = flexible body (movement,

postural variation)• Movability; makeshift privacy• Open access; free

• Abstract processes encouraged• Multiple resources, tools, modes of

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Flexibility - how

• Inviting: bright and inviting lighting (skylights, glass doors, windows, changing lights); music; garden; high ceiling

• Options• No set spaces; unprescribed space – can work anywhere), “not tied to a desk”• Flexible bodies, postural variation, “possible movement in space”• Movable furniture, adjustable lights

• Multiple resources and modes of expression: blackboards and computers; multiple entrances and exits

• Open: no clock; outdoor space; storage on walls; open spacePROPERTY O

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Main ideas:Inviting: natural lighting, windowsOptions: movable (sliding) walls; work and break spaces outside; individual and collaborative spaces; sit/standOpen: “space created based on preference”

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Options: different postures (carpeted space to encourage); furniture (and tree!) on wheels*Multiple resources: shared supplies

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Predictability - what

• Workplace meets expectations• Knowing that your workplace will have the things you need to do the work

assigned• Being able to predict certain outcomes at your workspace so you can make

decisions

• Safety: to know you will be safe or not (“no panic: know next action”)*• Autonomy, privacy (visual, aural)• Enough resources, enough workspaces, predictable infrastructure• Familiarity with space (function, navigation) and people• Not disturbed by irrelevant things (low distraction)

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Predictability - how

• No workplace hazards: structurally sound floors and ceilings; sanitation; no pooping dogs, bugs, leaky ceilings

• Autonomy, privacy: personal items; personal spaces; aural privacy (carpeting to control sound)

• Sufficient and reliable resources: central location for supplies/supplies continually restocked; food, furniture, maps, wifi, parking, nap pods, showers, bathrooms

• “Employees can fix the equipment”

• Familiarity with space, people, and schedule: display schedules/calendars and staff information; signage, labels

• Other: plants (“can predict they will grow nature’s predictability”)*

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• No hazards: clean!• Privacy: carpet controls

sound; ample private spaces

• Sufficient resources: consistent personal spaces; central supplies; ample flex space

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• Familiarity: staff information via display; coffee tables

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• Parking spots –more spaces than people!,

• Kitchenette• Emergency

resources

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Privacy - what

• Digital, personal, spatial privacy • Having spaces for both collaboration and privacy* (question of the default;

“being able to progress on work without collaboration”)• Digital: log in codes, passwords, privacy screens• Personal space: your space is respected; you can deal with your private life;

personalize space; making the space my own (like private property); no looking over shoulders or sneaking up

• You have a choice in when to show/reveal your work; turn on/off communication depending on needs

• Comfort: a safe space, relaxation, customization PROPERTY O

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Privacy - how

• Spaces for both collaboration and privacy: private rooms (which can’t be seen through) and collaborative spaces (which can be seen through)

• Personal space• Controlling access: doors, closets; high walls and seat backs; tables that hide your legs; key card

access; opaque windows/shutters; can see who is coming; private offices; soundproof (”ensuring confidentiality”); reception desk

• “each office has all materials required for position: staplers, pencils…”*

• Personalization: personalization; cubicle or office has amenities in it (personal fridge, water cooler, white board)

• Comfort: sofa, comfy chair, “personal comfortable chair”• Other: pastel colors, nature, garden area, music (without disturbing others),

hexagonal workstations• “round tables not great for private work”

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• Collaboration and privacy: pathways to collaboration; private spaces (can’t see in); private tables in collaborative room

• Comfort: chairs

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Private offices

Reception area

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Private officesPersonal space: high backed chair; desk hides legs; personal resources (water cooler)

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• Drawers• Dividers• Tinted

windows and shutters

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Safety - what

• Physical safety• Structural safety (“facilities protect”)• Taking account for natural disasters

• Psychological safety • Privacy• Personal space• Pleasant colors (calming)• A safe and inclusive space• Food, job, financial security

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Safety - how

• Physical safety: structural safety (sturdy walls, retrofitting); natural disaster and emergency preparedness (exits, alarms); no toxic substances; easy access to exits; good lighting (controllable)

• Limiting access: card key, scanners, access codes

• Psychological safety: privacy, personal space, safe and inclusive space*, white walls; backs against wall

• Other: [environmental cues and affordances]: warning signs; wayfinding signs; ramps for people with disabilities;

• “small city; 10-20 people”** [defensible space – Oscar Newman]PROPERTY OF

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• Main ideas:• Physical safety:

natural light; reception

• Psychological safety: GN bathroom; HR

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• Physical safety: receptionist; nature; protect sharp edges; emergency button

• Psychological safety: colors; lockers (personal space)

• Cues: wayfinding signs

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• Accessible HR boss• Cameras and lights• Windows (as exits)• Visible emergency

protocols/ resources

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Discussion

• Interrelation of 7 drivers (privacy, comfort*)• Common themes

• Nature (comfort, connection, flexibility, privacy)• Posture (comfort, flexibility)• User-generated design (comfort, equity, flexibility, predictability) • Shapes (comfort, connection, equity), colors (connection, predictability, safety)• Break room (comfort, connection, flexibility)

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Discussion

• Conflict and overlap• Break rooms as social space vs. refuge (connection vs. comfort or privacy) • Walkway to limit vs. connect (privacy vs. connection)• Predictability vs. unpredictability (lead to new ideas)• Tension between open and closed spaces (defaults*)

• Implications• Methodology: Unique way to identify design correlates (and ultimately make

workplaces meet needs and promote worker health)• Findings: Perceptual and behavioral implications of office space impact

need satisfactionPROPERTY OF

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Graduate Student Experience Impact on Health and Academic Success

Isabelle Thibau, [email protected]

Iris AnanthsetFran Kipnis

Cristina Banks, PhD

Interdisciplinary Center for Healthy Workplaces, UC BerkeleyJune 10, 2017

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Study OverviewResearch questions:

• What do graduate students need in their work environments to be successful?

• How do their work environments affect their health, well-being, and work outcomes?

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What we found

Certain features in the study environment contribute more to need satisfaction than others

We identified features that the University should add to the student environment to promote greater need satisfaction.

Some work performance attitudes are related to better or to worse health

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Study Overview

Subjects: Graduate students from UCB campus (N=462)

Measure: Graduate Student Experience Survey

Method: Developed, administered on-line survey to all registered graduate students (7,083) via email solicitation by each department head, one-month response period; attrition rate = 26%

Analysis: Descriptive statistics, chi square analyses, and multiple regressions

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Tool Description

Survey: 5 sections• (Context) Demographics, academic program • (Environment) Rate importance of features, tell

us what you have or use• (Individual behavior) Study habits• (Needs) Identify basic needs that are satisfied

by each feature• (Personal outcomes) Work satisfaction,

productivity, physical and mental health, stress

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Results

29%

50%

21%

Berkeley School Students Reported Attending (N=462)

Science-related schools Non-science related schools Haas School of Business

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47%

51%

45%

0%

10%

20%

30%

40%

50%

60%

Finding Time to Eat My financial situation Getting academic/social support

PERCENTAGE OF STUD ENTS REPORTING D ISTRACTION BY CONCERN (N=393)

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Health10%

26%

44%

20%

Overall Health (N=397)

Very Poor/Poor Fair Good Very Good

5%14%

57%

25%

Stress (N=397)

None/Very mild Mild Moderate Severe

76%

24%

Depression (N=397)

Unhappy/dispirited Not unhappy/dispirited

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Workspace Features

•Sufficient space to do work

•Uncluttered workspace

•Windows•Bathrooms nearby•Individual study table•Ergonomic chair•Physical layout that

promotes focus•Private group study

room•Space for rest and

recharge

Ambiance Features

•Generally quiet•Natural light•Collaborative

environment•Odorless environment•Fresh air

Cultural and Policy Features

•Clear understanding of course instruction, of assignments

•Fairness and equity•Safety and freedom

from harassment•Manageable workload•Effective methods of

communication•Supportive culture•Ability to apply skills

on assignments•Peer support•Assignments have real

world application•Accommodation for

personal circumstances

•Opportunities to provide input on assignments

•Events promoting social interaction

•Recognition for accomplishments

Resources

•Reliable Internet•Technological

compatibility•Access to healthy food•Training in research

skills•Access to kitchen/food

storage area•Leadership training•Availability of tech

equipment and devices

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Most Need Satisfaction

Manageable workload

Supportive culture

Equity

Sufficient space to do work

No harassment

Top 1-5

Peer support

Quiet study space

Windows

Uncluttered space

Natural light

Top 6-10 Effective

communication

Collaborative environment

Ability to apply learned skills to assignments

Reliable internet

Clear understanding of assignments

Top 11-15

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Least Need Satisfaction

Bright colors

Wall art

Accommodation on assignments

Music

Fixed desk

Bottom 1-5

Natural colors

Outside table

Couch

Armchair

Views of internal space

Bottom 6-10

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Do students actually have these features?

And do these important features satisfy their needs?

Have + Satisfy Have + Don’t Satisfy

Don’t Have + Satisfy Don’t Have + Don’t Satisfy

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Physical Comfort PlantsManageable Workload Individual Table

Energy Manageable WorkloadKitchen Access

Quiet, Temperature ControlInput on Assignments, Leadership Training

Growth Apply Skills on AssignmentsLeadership Training

Sufficient Space, Effective CommunicationManageable Workload

Safety Lockable StorageNo Harassment

Temperature ControlManageable Workload

Purpose Input on AssignmentsApply Skills on Assignments

Temperature ControlManageable Workload, Equity

Positive Emotions

CouchTemperature Control

Peer SupportManageable Workload

Lockable StorageInput on Assignments

Apply Skills on AssignmentsResearch Training

Belonging Bathrooms, Reliable InternetInput on Assignments, Manageable Workload

Control Input on Assignments Ergonomic Chair, Supportive CultureApply Skills on Assignments

Mastery

Flexible SpaceCompatible Tech

Input on AssignmentsApply Skills on Assignments

Study TrainingResearch Training

EngagementInput on Assignments

Apply Skills on AssignmentsCollaborative Environment

Rest and Relax AreaSupportive Culture

Manageable Workload

Have Feature

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Physical Comfort

Energy Manageable WorkloadQuiet

Growth Manageable Workload

Safety Lockable StorageNo Harassment

Purpose

Positive Emotions Manageable Workload

Belonging Reliable Internet

Control

Mastery Research Training

Engagement Manageable Workload

Don‘t Have

Feature

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Satisfaction with Work Performance

• Dissatisfaction with workload and number of available study locations is associated with increased stress.

• Satisfaction with study habits and knowledge gained associated with increased stress.

• Dissatisfaction with professional network associated with poorer health.

• Satisfaction with workload associated with better health.

• Satisfaction with workload associated with not feeling dispirited.

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ConclusionWe should design spaces that have elements that support basic need satisfaction. Certain features contribute more to need satisfaction: quality space, freedom from distraction, support, safe,

enough resources to take care of basic needs. The University should add to the environment features

that have greater student need satisfaction.manageable workload, quiet workplace, no harassment,

and reliable internet. Some work performance attitudes are related to better

and others to worse healthWorkload, availability of space in which to study, study

habits, knowledge gained, and professional network

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Where do we go from here?

• More data, more research• Research tool and methodology being

adopted in Norway• Work with UC on designing space• Develop an assessment tool and inventory

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Bray, J., Kelly, E., Hammer, L., Almeida, D., Dearing, J., King, R., & Buxton, O. (2013). An Integrative, Multilevel, and Transdisciplinary Research Approach to Challenges of Work, Family, and Health. Research Triangle Park, NC: RTI Press. Retrieved from http://www.rti.org/publication/integrative-multilevel-and-transdisciplinary-research-approach-challenges-work-family

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