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THEORY

HERD Vol. 6, No. 2, pp 98–118

Corporate Sustainability: The Environmental


Design and Human Resource Management
Interface in Healthcare Settings
Hessam Sadatsafavi, MA, and John Walewski, PhD

Abstract Theoretical Framework: The positive influence of human


resource practices on job attitudes and behaviors of employees is
Purpose of the Paper: The purpose of this study is to provide one mechanism to improve organizational performance outcomes.
healthcare organizations with a new perspective for developing Organizational psychologists suggest that human resource
strategies to enrich their human resource capabilities and improve practices are effective because they convey that the organization
their performance outcomes. The focus of this study is on leverag- values employee contributions and cares about their well-being.
ing the synergy between organizational management strategies Attention to employee socio-emotional needs can be reciprocated
and environmental design interventions. with higher levels of motivation and commitment toward the
Background: This paper proposes a framework for linking the organization. In line with these findings, healthcare environmental
built environment with the human resource management system studies imply that physical settings and features can have a posi-
of healthcare organizations. The framework focuses on the impact tive influence on job attitudes and the behavior of caregivers by
of the built environment regarding job attitudes and behaviors of providing for their physical and socio-emotional needs.
healthcare workers. Research from the disciplines of strategic Conclusions: Adding the physical environment as a complemen-
human resource management, resource-based view of firms, tary resource to the array of human resource practices creates
evidence-based design, and green building are utilized to develop synergy in improving caregivers’ job attitudes and behaviors and
the framework. enhances the human capital of healthcare firms.
Keywords: Staff, evidence-based design, interdisciplinary, model-
Author Affiliations: Mr. Sadatsafavi is a PhD Candidate in the Zachry ing, perceived organizational support
Department of Civil Engineering at Texas A&M University. Dr. Walewski is
an Assistant Professor in the Zachry Department of Civil Engineering
at Texas A&M University. Introduction
Corresponding Author: Hessam Sadatsafavi, MA, PhD Candidate, Zachry
Department of Civil Engineering, Texas A&M University, 3136 TAMU, CE/TTI Corporations can be seen as business entities that
Building, College Station, TX 77843-3136; hessam@neo.tamu.edu form the economic system of a society. Corpora-
Acknowledgments: The authors are grateful for thoughtful comments
and suggestions provided by Dr. Mardelle Shepley. The authors also grate- tions can also be viewed as social artifacts com-
fully acknowledge one of the reviewers for pointing out considerations for
defining and measuring high-quality work environment. posed of institutionalized activities. As such, when
Preferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sus- it comes to enterprises, the term sustainability
tainability: The environmental design and human resource management
interface in healthcare settings. Health Environments Research & Design represents two separate but interrelated concepts:
Journal 6(2), pp 98–118.
(1) creating an enduring competitive advantage
for companies to stay in business and (2) meeting

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their responsibilities toward the sustainable de-


velopment of the society in which they conduct Organizational resource
their activities. As suggested by Baumgartner and bundles contribute to
Ebner (2010), Dyllick and Hockerts (2002), and
Khan (1995), to succeed in these two aspects performance advantage
organizations need to obtain and use a wide ar- to the extent that they are
ray of resources, including economic, social, and
ecological capital. This article deals with the first rare, costly to imitate, and
aspect of corporate sustainability, which is the nonsubstitutable.
way organizational resources are used for creating
an enduring competitive advantage. value, nor be able to generate the same outcome
by using an alternative resource bundle. This
One approach for study of sustainability of paper proposes a model for linking the human
competitive advantages is the resource-based resource management system of organizations
view (RBV) of firms first proposed by Wernerfelt with their facilities for enhancing the three char-
(1984). He described how creating the bundle acteristics described above to increase the sustain-
of valuable resources can result in a competitive ability of competitive advantages. The proposed
advantage for organizations and argued that dif- framework focuses on the influence of physical
ferences in firm performance come from the dif- features of the work environment on job attitudes
ferences in the resources they own. As advocates of healthcare professionals and is developed by
of RBV, Wright, McMahan, and McWilliams adopting key findings from studies on strategic
(1994) suggest that in order for an organization human resource management, resource-based
to have an enduring competitive advantage, it has view of firms, evidence-based design, and green
to acquire different types of capital (economic, buildings.
social, and ecological) and combine them to cre-
ate value-generating resources often referred to as Healthcare organizations should give attention
an organizational resource bundle. to the synergy between organizational manage-
ment intervention and environmental design
Organizational resource bundles contribute to interventions. Limiting expenses and ensuring
performance advantage to the extent that they quality services are each imperative to a health-
are rare, costly to imitate, and nonsubstitutable care organization’s corporate sustainability.
(Armstrong & Shimizu, 2007; Barney, 1991; According to the American Hospital Association
Dyllick & Hockerts, 2002; Sirmon, Hitt, & (AHA), approximately 60 cents of every dollar of
Gove, 2008). According to Barney (1991), the expenditures goes to caregivers and other hospital
firm’s competitors should not possess the same workers. Human resource–related expenses are
resource bundle, not be able to easily recreate its higher than other essential expenses, including

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medications, devices, and other supplies, as well ground of the study is described after a review
as improvements to treatment facilities, installa- of job satisfaction theories. This section explains
tion or upgrades of health information technolo- how firms’ resources contribute to the sustain-
gies, utilities, and liability coverage (American ability of competitive advantages and identifies
Hospital Association, 2011). As a result, human the significance of human resources. Moreover,
resource–related expenses are primary targets the mechanism through which human resource
of cost-containment strategies when funding practices influence performance outcomes at
becomes limited. However, as Filipova (2011) individual and organizational level is described.
notes, strategies that require lowering staff levels How the built environment functions in a similar
may not ultimately be worth the tradeoff and manner is also discussed. To demonstrate this, a
organizations must find alternative ways to opti- framework for linking the human resource man-
mize expenditures without sacrificing the quality agement system of organizations to the built en-
of service. From an organizational management vironment is proposed. Next, different elements
viewpoint, this study provides healthcare or- of the model are explained and the hypothesized
ganizations with an alternative perspective for relationships between them are discussed. The
developing cost-avoidance strategies based on contribution of this study to the existing litera-
managerial and architectural design solutions ture on corporate sustainability is also presented.
to improve employees’ job attitudes and enrich
organizational capabilities. Literature Review
Job Satisfaction
Another important characteristic of healthcare A traditional theory for understanding job satis-
organizations is that healthcare service delivery faction is Maslow’s hierarchical model of human
is physically and emotionally demanding for needs. The model suggests a five-level hierarchy
caregivers, and because of that, these organiza- spanning from physiological needs, safety, and
tions experience severe challenges in terms of social needs to self-esteem and self-actualization.
employee burnout, strain, job satisfaction, absen- Maslow’s work was adopted by Herzberg (1959),
teeism, and turnover. Such challenges highlight who developed a two-factor job satisfaction
the importance of recognizing an employees’ theory. Herzberg suggests that satisfaction and
socio-emotional needs as a critical cost-avoidance dissatisfaction are two separate, or at times,
strategy and emphasize the role of the built envi- unrelated constructs which are influenced by dif-
ronment in achieving that objective. ferent factors. Whereas job satisfaction is mostly
influenced by factors intrinsic to the nature and
The organization of this paper begins with a experience of the work (e.g., the work itself,
review of the literature related to job satisfaction achievement, recognition, and responsibility), job
as well as the influence of the built environment dissatisfaction results from factors outside the job
on employees’ job attitudes. The theoretical back- (e.g., organizational policy, supervision, salary,

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interpersonal relations and working conditions).


Herzberg (1959) calls these hygiene factors. Although the built environment
theoretically fits as a factor of
According to Spector (1997), these two models
became less popular with an increase in the job satisfaction, it is absent
emphasis on underlying cognitive processes of in the research conducted for
job satisfaction rather than underlying needs. For
example, Hulin and Judge (2003) proposed that healthcare settings.
job satisfaction is a multidimensional psychologi-
cal response of individuals to their job and has that by placing new values on different facets of
cognitive (evaluative), affective (emotional), and the job, a person may maintain his or her satisfac-
behavioral components. Affective and cognitive tion when certain aspects of it change. Studies of
indicators of job satisfaction are also addressed in workers’ attitudes conducted by organizational
other definitions of job satisfaction (e.g., Brief & psychologists often support this concept. For ex-
Weiss, 2002; Davis, 2004; Harrison, Newman, ample, Greenberg (1989) found that employees
& Roth, 2006; Hulin & Judge, 2003). Affective attempted to compensate for financial underpay-
Event Theory, developed by Weiss and Cropan- ments by altering their perceptions of the physi-
zano (1996), includes affective and cognitive cal environment where they were working. More
components. The authors emphasize that job specifically, he concluded that when employees
satisfaction is a positive or negative evaluative were underpaid, they expressed higher levels of
judgment about one’s job, and is a combina- satisfaction with their work environment, show-
tion of the person’s beliefs about his or her job, ing that they were trying to cognitively alter their
and partly results from his or her emotional perceptions of the physical work environment
experiences at work. They suggest that long-term (Greenberg, 2011).
behaviors, such as turnover and retirement stem
from stability features and the structure of the job Although the built environment theoretically
environment, while short-term behaviors, such as fits as a factor of job satisfaction, it is absent in
lateness or helping others stem from spontaneous the research conducted for healthcare settings. In
job events. As the literature on environmental their review of the 21 studies related to hospital
psychology suggests, as a stable feature and struc- nurses’ job satisfaction, 14 of which were carried
ture of job environment, the built environment out in the United States, Utriainen and Kyngas
may influence long-term behaviors of employees. (2009) found interpersonal relationships (e.g.,
with other members of the nursing staff and
Multidimensional studies on job satisfaction, with medical staff) and patient care (e.g., seeing
such as those conducted by Locke (1969) and patients get better and patient satisfaction) as two
Skalli, Theodossiou, and Vasileiou (2008) show themes most significant to nurses’ job satisfac-

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tion. In addition to these two factors, Utriainen because of its indirect influence through other
and Kyngas (2009) also state that organizing factors such as job stress and improvements in
nursing work (e.g., work–family relationship, working conditions. The following section
working time, balanced workload, autonomy) is introduces and summarizes the literature on the
another significant predictor of nurses’ well being indirect influence.
at work. In an earlier but more comprehensive
study reviewing more than 50 studies of job Influence of Environmental Design on Job
satisfaction among nurses, Lu et al. (2005) listed Attitudes
factors such as working conditions, social interac- The link between the built environment and hu-
tion, and job security as complementary sources man behavior is a key concept of environmental
of job satisfaction. psychology for understanding how the behavior
and development of people are influenced by
To identify the relationships of specific variables their physical environments (Holahan, 1986).
with nurses’ job satisfaction two meta-analyses This body of research constitutes an important
were conducted by Blegen (1993) and Zangaro part of the literature related to architectural and
and Soeken (2007). Blegen’s (1993) analysis of urban design theories, and is often used to sup-
nurses working in patient care settings found that port informed decision-making by design profes-
job satisfaction had the strongest correlation with sionals. Gibson (2008) argues that ecological
job stress (r = -0.61), and was moderately cor- psychology is a pivotal, but underused body of
related with communication with supervisor (r = work when considering the organization-physical
0.44), autonomy (r = 0.42), and communication space relationships.
with peers (r = 0.44). Similarly, Zangaro and
Soeken (2007) indicated that job satisfaction had One of the most extensive bodies of work and
the strongest negative correlation with job stress knowledge base on the relationship between the
(r = -0.43), and the strongest positive correlation physical design of buildings and key organizational
with nurse–physician collaboration (r = 0.37). outcomes exists in the healthcare design domain,
They also found that autonomy had a moder- which is commonly known as evidence-based
ately positive correlation with job satisfaction (r design (EBD). In essence, the focus of EBD is
= 0.39). the influence of architectural and interior design
of healthcare facilities on key outcomes such as
As stated, the built environment is notably absent patient safety (e.g., hospital-acquired infections,
among the factors that influence job satisfaction medical errors, and falls), patient outcomes (e.g.,
in studies of healthcare professionals. A review of pain, stress, length of stay, and the perceived
the literature related to healthcare environmental quality of care), and staff outcomes (e.g., injury,
design suggests that the built environment is not stress, work effectiveness, and satisfaction). For
listed among the direct sources of job satisfaction instance, Ulrich et al. (2008) conducted a com-

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prehensive evaluation of the scientific research of the two-factor theory regarding job satisfaction
on evidence-based healthcare design, and one of because negative extrinsic factors, such as work-
their conclusions was that well-designed physi- ing condition (including workplace), can cause
cal settings play an important role in making job dissatisfaction.
hospitals a better workplace. Berry et al. (2004)
also note that healthcare facility design has a Altogether, this collective body of work provides
critical role in earning employee commitment, compelling evidence that improving attributes of
and that “facilities tell employees a great deal the built environment can enhance the general
about management’s concern for them” (p. 5). job satisfaction of nurses. However, as Djukic and
Other studies, such as Coile’s (2002) forecast of Kovner (2009) note, a review of job satisfaction
healthcare trends, also point to the effectiveness models does not provide significant evidence for
of healthcare facility design in employee recruit- supporting the idea that the built environment
ment and retention. has a strong direct effect on enhancing nurses’ job
satisfaction. These authors examined the effect
Berry and Parish (2008) studied differences in of multiple combined features of the physical
nurses’ perceptions of their job, hospital, and work environment on nurses’ job satisfaction and
building features six months before and six controlled for multiple covariates of satisfaction.
months after the opening of a new hospital wing The general conclusion they made was that the
and found significant differences in employees’ effect of the physical work environment on job
perceptions of quality of patient rooms, safety, satisfaction is not direct and is probably mediated
pleasantness, quality of workspace, job stress, job through other factors such as work attributes and
satisfaction, and service quality. Another before- job attitudes that directly impact satisfaction. This
after study of nurses in single-room maternity paper describes how these mediating variables can
care versus traditional birth settings by Janssen, be used to study the interaction between human
Harris, Soolsma, Klein, and Seymour (2001) resource practices and the built environment. To
found that nurses working in new units reported accomplish that, an examination of the theoreti-
better scores for room size, lighting, and noise cal background of the model is required.
levels and also reported higher job satisfaction.
Furthermore, studies that examined different fac- Theoretical Background
ets of job satisfaction, such as those conducted by Firm’s Resources and Sustainability of
Kotzer and Arellana (2008), Kotzer, Koepping, Competitive Advantage
and LeDuc (2006), Susan et al. (2003), suggest As previously identified, in order to be a com-
that nurses are generally not satisfied with their petitive advantage, an organizational resource
physical work environment and as a result, the needs to be rare, costly to imitate, and nonsub-
built environment can be a source of job dissatis- stitutable. Barney (1991) notes that in generating
faction. These findings follow the basic principles values from organizational resources, complex

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when combined with pre-existing resources.


In addition to the
characteristics of organizational Importance of Human Resources and Human
Resource Management System
resources, the process needed The literature related to resource-based view
for achieving a sustainable (RBV) of firms considers the stock of employees’
knowledge, skills, and abilities (Barney, 1991;
competitive advantage is well Wright, Dunford, & Snell, 2001) as well as their
documented. motivation and loyalty (Dyllick & Hockerts,
2002) to be a part of the human capital of orga-
phenomena are often involved. He maintains nizations. Additionally, formal and informal rela-
that to ensure the sustainability of competitive tions among employees and between employees
advantages, the link between a firm’s resources and the organization are considered to be part
and competitive advantage should not be fully of social capital of organizations. Wright et al.
understood by competitors. Barney, Wright, and (2001) note that RBV shifted emphasis away
Ketchen (2001) argue that building strategies on from external factors of competitive advantage
intangible assets that meet such criteria result toward internal firm resources mentioned above;
in higher performance than building strategies as such it brought legitimacy to the human
only on tangible assets that are easy to imitate resource’s assertion that people are strategically
by competitors, such as natural resources and important to firm success.
technology.
The importance of human resources in creating
In addition to the characteristics of organiza- a sustainable competitive advantage is part of the
tional resources, the process needed for achiev- strategic leadership and management literature.
ing a sustainable competitive advantage is well Hitt and Duane (2002) looked at human capital
documented. For example, Makadok (2000) through the lens of RBV and pointed out that
points out two distinct causal mechanisms human capital is significant in terms of creating
where an enduring competitive advantage can competitive advantages because it is often the
be created from resources. The first mechanism firm’s most unique resource and the mechanisms
is called resource-picking and refers to obtaining used for creating and managing it are likely to be
outstanding resources. An alternative mechanism complex. The importance of a human resource
is called capability-building, that focuses on management system as a mechanism for creating
enhancing the productivity of existing organi- competitive advantage from human capital is
zational resources. Makadok (2000) also points also documented. Regarding imitability of orga-
to the synergy that may occur when a newly nizational resources, Barney (1991), Wright et al.
obtained resource achieves higher productivity (2001), and Becker and Gerhart (1996) point to

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the importance of the human resource manage- Messersmith & Guthrie, 2010; Preuss, 2003;
ment system as an invisible asset embedded in the Takeuchi, Chen, & Lepak, 2009; Tyagi &
organization. Barney et al. (2001) further argue Sawhney, 2010). Gittel et al. (2010) note that
that human resource management systems and these mediating variables can be classified into
routines that develop over time can be unique two general pathways: (a) changes in employees’
to a particular firm and may contribute to the knowledge, skills, and abilities; and (b) changes
creation of a specific human capital pool. in employees’ attitudes (e.g., motivation and
commitment) and behaviors (e.g., discretionary
Human Resource Management and Firm’s efforts). They also note that these two pathways
Performance are not mutually exclusive and human resource
The relationship between human resource man- management can contribute to performance
agement and a firm’s performance is studied in through both pathways.
the Strategic Human Resource Management
(SHRM) field of organizational theory, which The Mechanism for Influence of Human
according to Wright et al. (2001) is devoted to Resource Management
exploring the role of human resources in sup- Researchers such as Huselid (1995); Becker and
porting business strategies. The impact of human Gerhart (1996); Evans and Davis (2005); and
resource practices on business growth, financial Takeuchi, Lepak, Heli, and Takeuchi (2007)
performance, and workers’ productivity is also studied the attitudinal and behavioral pathway
shown in the SHRM literature (Evans & Davis, and note that one explanation for why human re-
2005; Gittell, Seidner, & Wimbush, 2010). Fur- source practices, such as incentive compensation
thermore, an important question and the subject and employee involvement and empowerment,
of many studies in organizational theory has are effective is because they carry the message
been the mechanism through which the effect of that the organization values their contributions,
human resource practices is transferred to perfor- cares about their well-being, and in general sup-
mance outcomes. Different mediating variables ports them. What these authors suggest is very
have been studied, including functional flexibil- similar to the findings of studies in the broader
ity, behavioral flexibility, relational coordination, area of strategic human resource management
flexibility in personnel skills, shared goals, shared conducted by researchers such as Eisenberger,
knowledge, mutual respect, enhanced communi- Armeli, Rexwinkel, Lynch, and Rhoades (2001)
cation, improved social exchange, organizational and Eisenberger, Huntington, Hutchison, and
citizenship behavior, work satisfaction, lower Sowa (1986), who showed the positive influ-
job stress, and quality of information (Beltrán- ence of human resource practices on Perceived
Martín, Roca-Puig, Escrig-Tena, & Bou-Llusar, Organizational Support (POS). According to
2008; Evans & Davis, 2005; Gittell et al., 2010; Eisenberger et al. (1986) POS is “an experience-
Kalleberg, Marsden, Reynolds, & Knoke, 2006; based attribution concerning the benevolent or

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malevolent intent of the organization’s policies,


norms, procedures, and actions as they affect em- The proposed framework
ployees” (p. 42). An overview of social exchange
focuses on the influence of
theory is required to understand the mediating
role of POS. physical features of the work
environment on employees’ job
According to Cropanzano and Mitchell (2005),
social exchange theory is one of the most influ- attitudes.
ential conceptual paradigms for understanding
workplace behaviors. These authors explain help it achieve its goals (Eisenberger et al., 2001;
that social exchange in this theory refers to Eisenberger, Aselage, Sucharski, & Jones, 2004;
a series of interactions between two sides of a Hellman, Fuqua, & Worley, 2006; Wayne, Shore,
relationship with a potential to generate obliga- & Liden, 1997). In this study, the concept is ad-
tions. As Gouldner (1960) put it, obligation is opted to add architectural and physical features
created as a result of the norm of reciprocity of the workplace to the array of resources used
that obliges the return of favorable treatment. in the exchange relationship between employees
Cropanzo and Mitchell (2005) also explain that and their employer.
norms of exchange are the guidelines used in
exchange processes and one of the best-known Proposed Model
rules of exchange is reciprocity or repayment in The proposed framework focuses on the influence
kind. Eisenberger et al. (2001) suggest that the of physical features of the work environment on
reciprocity norm may apply to the relationship employees’ job attitudes. In reviewing the lit-
between employees and employer by obliging erature related to the influence of environmental
employees to return advantageous treatment design on job satisfaction of healthcare workers,
they receive by acting in ways valued by the it was the effect of physical work environment on
organization. job satisfaction is mediated through other factors
that directly impact satisfaction. This statement is
In summary, social exchange theory suggests that consistent with what Ulrich, Zimring, Quan, Jo-
employees consider the organization as an entity seph, and Choudhary (2004) posit in their study
with which they have exchange relationships to regarding the role of the physical environment,
explain why human resource practices have suggesting that design solutions such as improved
positive influence on employees’ attitudes. The ventilation, ergonomic design, better designed
reciprocity norm explains that as the organiza- nursing stations, improved lighting, and floor
tion gives special attention to employees’ needs, plans can reduce staff stress and improve their
a sense of obligation is developed in employees health and safety, the factors that are known to
to care about the welfare of the organization and be positively related to job satisfaction.

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This study considers POS as another important especially when they know that other facilities
mediating variable in the relationship between do not go beyond minimum requirements set by
architectural or physical features of the workplace occupational health and safety codes. Providing a
and job attitudes. As Eisenberger et al. (1986) note, healthy environment with a high indoor environ-
employees have a tendency to assign humanlike mental quality offers substantial inducements to
characteristics to their organization, and because of employees that can be reciprocated with higher
this personification, they view favorable or unfavor- levels of motivation and commitment towards the
able treatment as an indication that the organization organization. Accordingly, the first hypothesis is:
favors or disfavors them. Rhoades and Eisenberger
(2002) suggest that resources voluntarily provided Hypothesis 1: Perceived organizational support
by the organization are welcomed as indications the mediates the relationship between architectural or
organization values and respects its employees and physical features of the workplace and job attitudes.
cares about their well-being. For example, when
a hospital increases the ventilation rate or installs Perceived organizational support is influenced by
High-Efficiency Particulate Air (HEPA) filters to both human resource management system and
improve indoor air quality and potentially reduce environmental design, and because of that it can be
airborne infections, it may be perceived by employ- studied to understand the role of environmental de-
ees as a voluntary action showing the organization’s sign in management of human resources. According
mindset in putting higher emphasis on their needs, to Wicker (1992), physical objects along with people
are the main components of small-scale social
Table 1. Influence of the Built Environment and Human systems that impact activities within specifi-
Resource System on Employees’ Attitudes as Suggested by
the Social Exchange Theory
able time and place boundaries. He calls these
small-scale social systems “behavior settings.”
This study uses Wicker’s (1992) argument
HR System regarding the influence of physical settings on
occupants’ attitudes and behaviors and focuses
on the attitudinal and behavioral pathway
Weak Strong that influences organizational performance.
- +
Principles of Affective Event Theory also sug-
gest that as a stable feature and structure of
Quality of the BE

(1) (2) job environment, the built environment may


Low -
-- Neutral
influence long-term behavior of employees.
(3) (4)
High + As Table 1 shows, a negative message to em-
Neutral ++
ployees is sent when an organization has a
weak human resource management system,

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where employees are not involved in decision- literature does not suggest a strong direct effect
making, do not receive adequate training, and for the built environment, specifically when it is
are not compensated based on their perfor- compared with the bundle of human resource
mance. If the organization also fails to provide practices. As such, the second hypothesis is:
a high-quality work environment (“BE”), the
combined negative environmental factors will Hypothesis 2: Satisfaction with architectural or
have a detrimental effect on employees’ attitudes physical features of the workplace moderates the
(cell 1 in Table 1). In contrast, when the orga- relationship between human resource manage-
nization has a strong human resource manage- ment system and perceived organizational support.
ment system, and at the same time provides a
high-quality built environment, the combined Elements of the Model
positive factors will have a synergistic effect on Figure 1 shows a general framework linking
improving employees’ attitudes (cell 4 in Table human resource management practices and
1). Finally, in a situation when one factor is high architecture features to employee- and organi-
and the other one is low, they neutralize each zational-level performance outcomes, through
other, assuming that they have similar effect individual and collective measures of attitudinal
(cells 2 and 3 in Table 1). However, the existing and behavioral variables.

Figure 1. The proposed framework for linking architectural and physical features of physical environment with human
resource practices as they influence job attitudes and behaviors of healthcare workers.

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their wellbeing and health. For example, green


Attention to employees’ health building techniques such as improving indoor
and well-being is particularly environmental quality may decrease physiologi-
cal health issues (e.g., asthma and respiratory
important in healthcare settings allergies) and psychological health problems (e.g.,
where employees are exposed strain and anxiety) (Cirla, 2005; Corr, 2000; Fisk,
2000; Goe et al., 2004; Joseph, 2006a; Rashid &
to higher health and safety- Zimring, 2008; Ulrich et al., 2008).
related risks at work.
In a study of physiological health issues, Smed-
High-Performance Work System and bold et al. (2002) analyzed clinical data for 115
Architectural Features females who worked at 36 geriatric nursing de-
High-Performance Work System (HPWS) con- partments and concluded that poor indoor en-
sist of practices related to selection and staffing, vironmental quality, such as high temperature,
training, employee involvement and empower- low relative humidity, and low carbon dioxide
ment, reward and compensation, performance levels may affect the nasal mucosa of nursing
measurement and appraisal, and career planning personnel and cause nasal mucosal swelling.
and promotion. HPWS practices incorporated in Regarding psychological health problems, in
the model shown in Figure 1 are adapted from the a study of 141 nurses in a university hospital,
study by Garman, McAlearney, Harrison, Song, Alimoglu and Donmez (2005) found that at
and McHugh (2011), where they developed a least three hours a day exposure to natural light
conceptual model of HPWS practices for health- can lead to less stress and higher satisfaction at
care organizations on the basis of prior research. work. Furthermore, Pati, Harvey, and Barach’s
(2008) study of relationships between exterior
The architectural features shown in Figure 1 are views and stress among 32 nurses on 19 differ-
adopted from the evaluation of the scientific ent units at two hospitals found that visual relief
research on evidence-based healthcare design by improved short-term alertness and sharpened
Ulrich et al. (2008), as well as green building the focus of nurses, which in turn may enhance
features identified by the U.S. Green Building their job satisfaction and long-term retention.
Council’s (USGBC) Leadership in Engineering Fjeld and Bonnevie (2002) also examined the
and Design (LEED) for healthcare. Well-being impact of installing 23 groups of green plants
and health are important criteria associated with along with full spectrum fluorescent bulbs in
the green building movement (Kibert, 2008). For examination rooms of a radiology ward. The
office buildings and workplaces in general, using rooms had no windows or natural light and
green-building features can send the message to were used by 48 employees. The research found
employees that senior management cares about 10% reductions in sick leave, 32% in fatigue,

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and 45% in headaches after the intervention, all ment, including lighting, view, and unit layout,
statistically significant. are improved (e.g., Alimoglu & Donmez, 2005;
Janssen, Harris, Soolsma, Klein, & Seymour,
Attention to employees’ health and well-being 2001). To understand how this happens, this
is particularly important in healthcare settings study suggests that the impact of POS and job-
where employees are exposed to higher health related anxiety should be a topic of additional
and safety-related risks at work. Workers in research. The relationship between POS and
hospitals have to deal with patients and often attitudinal and behavioral outcomes has been
use many highly toxic chemicals (e.g., pesticides, considered in the SHRM literature. Rhoades
cleaners, and disinfectants). The literature review and Eisenberger’s (2002) meta-analysis found
by Ulrich et al. (2008) suggests that sick building that the relationship between POS and job
syndrome (SBS) is generally high in hospitals satisfaction is significant (r = 0.59). In another
buildings and health-related complaints are meta-analysis, Riggle, Edmondson, and Hansen
higher in hospitals with SBS. Moreover, accord- (2009) concluded that job satisfaction exhibits a
ing to the U.S. Bureau of Labor Statistics (2007), strong positive relationship with POS (r = 0.61).
the rate of occupational injuries and illnesses in Consistent with these findings, in her cross-
hospitals is 8.1 cases per 100 full-time workers, sectional survey of 656 nurses in 100 facilities in
which is about 80% higher than the rate for all of midwestern states of the United States, Filipova
the private industry (4.6 cases per 100 full-time (2011) found that POS positively predicted
workers). nurse job satisfaction.

Job Attitudes, Emotions, and Feelings Job-related anxiety is the second attitudinal
As Figure 1 shows, attitudinal variables are the outcome that mediates the relationship be-
first group of outcomes in the series of mediating tween the built environment and job satisfac-
variables between the built environment and or- tion. The negative effect of physical stressors
ganizational performance outcomes. Attitudinal in the workplace such as noise, light, heat,
outcomes are also the key to understanding the vibrations, and chemical and toxic substances
interaction between the built environment and are studied in the EBD and green building
human resource management system. The influ- literature, suggesting that environmental
ence of these two factors on behavioral variables intervention through architectural design can
and organizational performance is transferred play an important role in reducing employees’
through attitudinal variables. anxiety and increasing job satisfaction (e.g.,
Alimoglu & Donmez, 2005; Ampt, Harris, &
A review of the literature related to EBD sug- Maxwell, 2008; Bayo, Janssen et al., 2001; Jo-
gests that nurses report higher job satisfaction seph & Ulrich, 2007; Shumaker & Pequegnat
when physical features of the work environ- 1989; Tyson, Lambert, & Beattie, 2002).

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Hypothesis 3: There is a direct negative relation- (2009) also shows that overall organizational
ship between the perceived quality of the built commitment has a strong positive relationship
environment and nurses’ job-related anxiety and (r = 0.71) with POS. In summary, as social
depression exchange theory suggests, providing a high-
quality work environment has the potential to
In addition to this direct negative relationship be perceived by employees as an indicator of the
between the quality of the built environment and benevolent intent of the organization and may
job-related anxiety and depression, the literature create an affective bond between employees and
related to organizational support theory suggests the organization. In this regard, the following
that POS may reduce job-related anxiety because two hypotheses are suggested for future studies:
it conveys to employees that the organization will
provide resources such as physical assistance and Hypothesis 5: There is a positive relationship
emotional support (e.g., Hochwarter, et al., 2006; between the perceived quality of the built environ-
Wallace, et al., 2009; Witt & Carlson, 2006). To ment and nurses’ organizational commitment.
investigate the role of POS in the relationship
between the quality of the work environment Hypothesis 6: Perceived organizational support
and job-related anxiety the following hypothesis mediates the relationship between the perceived
is suggested for further consideration in future quality of the built environment and nurses’
studies: organizational commitment.

Hypothesis 4: Perceived organizational support Behavioral Outcomes


mediates part of the relationship between the The effect of the built environment and the
perceived quality of the built environment and human resource management system on
nurses’ job-related anxiety and depression. behavioral outcomes is transferred through
attitudinal variables. As such, the next group
Another important attitudinal variable in- of variables in the framework shown in Figure
corporated in the model is organizational 1 is individual-level behavioral outcomes. The
commitment. Social exchange theorists such influence of improvement in work attitudes on
as Eisenberger et al. (1986) suggest that employees’ performance has been investigated by
employees are prone to exchange their com- both organizational psychologists and healthcare
mitment for the supports they receive from environmental researchers.
their employers. This idea is supported in the
meta-analysis study by Rhoades and Eisenberger In the organizational psychology literature, several
(2002) as they found a significant and positive meta-analyses exist that link attitudinal variables
relationship between POS and desire to remain to behavioral variables such as in-role perfor-
(r = 0.59). The meta-analysis by Riggle et al. mance and extra-role performance (e.g., Blegen,

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1993; Combs, Liu, Hall, & Ketchen, 2006; Har- tion as it provides more opportunities to in-
rison et al., 2006; Meyer, Stanley, Herscovitch, teract with team members. In their theoretical
& Topolnytsky, 2002; Riggle, Edmondson, & framework capturing the current domain of
Hansen, 2009; Tett & Meyer, 1993; Zangaro & EBD in healthcare, Ulrich, Berry, Quan, and
Soeken, 2007). In-role performance, also known Parish (2010) point out the influence of the
as focal performance or role behavior, refers to built environment on participant outcomes,
work behaviors that are prescribed by formal including nonphysician staff and physicians.
job roles (e.g., administering medication and More specifically, they posit there are converg-
updating patient records, providing instructions ing findings from multiple rigorous studies
for care at home) and extra-role performance, indicating that safety enhancement solutions
also known as contextual performance, refers reduce absenteeism among nurses. Among
to discretionary work behaviors that are beyond nonphysician staff outcomes, Ulrich et al.
one’s formal job roles (e.g., staying late to help pa- (2010) suggest job-related injuries, workspace
tients, making suggestions to improve the overall social support, and teamwork within units as
quality of the care provided in the department). topics for future research.
For example, the meta-analysis by Harrison et al.
(2006) of studies published between 1983 and Performance Outcomes
2004 found that organizational commitment is Performance outcomes compose the final element
negatively correlated with turnover (r = -0.22), of the proposed framework. In a comparative
and job satisfaction is positively correlated with study of 77 nurses working in single-occupancy
focal performance (r = 0.30). Furthermore, the versus multi-occupancy rooms in acute care en-
Meyer et al. (2002) meta-analysis of 155 studies vironments, Chaudhury, Mahmood, and Valente
involving 50,146 employees found that affective (2006) found that nurses favor single occupancy
organizational commitment is positively cor- rooms with regard to ease of patient examination
related (r = 0.32) with organizational citizenship and interaction with or accommodation of family
behavior. members. Moreover, France et al. (2009) surveyed
clinicians working in a children’s hospital replaced
The impact of the built environment on with a family-centered care designed facility and
behavioral outcomes of nonphysician staff found that the percentage of nurses who gave
and physicians has been studied by healthcare higher ratings on efficiency of work flow increased
environmental researchers. For example, by 12%. They also found that the percentage of
Joseph (2006b) suggests that spatial transpar- nurses that gave better ratings on the effect of unit
ency (i.e., being able to see and hear what layout on patient monitoring increased by 22%.
others are doing from individual workspace As Ulrich et al. (2008) note, these examples dem-
or when moving around their workspace) may onstrate that the architecture and interior design
promote teamwork and enhance communica- of healthcare facilities have influence on staff out-

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comes such as medical errors, work effectiveness,


and communication with patients and families. This study demonstrates
The conceptual framework for an EBD domain that the built environment,
in healthcare provides a list of organizational
outcomes for future studies, where the impact of combined with the human
audio and visual environments, as well as safety resource management system,
enhancements on facility costs, revenue, and mar-
ket share are suggested areas for future research.
can be used for internal
development of resources
Considerations for Future Studies
and for extending current
In their study of environmental sources of
satisfaction among hospital patients, Harris, organizational capabilities.
McBride, Ross, and Curtis (2002) distinguished
between three relevant dimensions of the physi- To address this issue, judgmental measures,
cal environment, including relatively permanent where respondents use survey questionnaires to
characteristics such as the spatial layout of a rate various physical features, are commonly used
hospital and room size (architectural features); for measuring the perceived quality of the built
less permanent elements such as furnishings, environment. For an employee-level analysis, the
colors, and artwork (interior design features); perspective adopted in this study, this approach is
and ambient features such as lighting, noise advantageous because some direct physical mea-
levels, odors and temperature. The same three sures do not translate into employees’ perceptions
dimensions should be considered in the study of of the environment (Michael, Beard, Choi, Far-
caregivers. The key consideration for assessments quhar, & Carlson, 2006). For example, a physical
involving POS is defining the high-quality work measure of the size and number of indoor plants
environment, because in addition to indoor is not sufficient for evaluating the “connection
environmental quality features (e.g., thermal to the natural world” regarding indoor spaces,
comfort and indoor air quality), other attributes given that an individual’s perception may depend
of the built environment influence one’s percep- on factors such as the spatial arrangement of the
tion of the quality of workplace, such as a feeling plants. Judgmental measures may be more help-
of connection to the natural world, feeling of ful when it comes to such attributes as feelings
cleanliness, and the amount of privacy afforded of cleanliness that vary from person to person.
by the building. Measuring these criteria is chal- However, as Araya et al. (2006) note, it is im-
lenging as individuals’ perception and responses portant to control for individual characteristics,
to their impacts may be contradictory or change such as age and gender, to ensure the variance
over time. of outcome variables is explained by place-based
(i.e., different medical departments) rather than

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individual differences. It is also important to note and uniqueness of the mechanism from which
that the subjective nature of judgmental measures the human capital pool of the firm is created.
brings into question whether the findings actually Furthermore, the principles of RBV suggest that
represent the quality of the built environment. If the value generated by a rare, unique, and com-
measuring actual quality of the built environ- plex resource pool is difficult for competitors to
ment is needed, judgmental measures should be imitate or reproduce.
supplemented with objective data audit measures
collected by trained individuals. This study demonstrates that the built environ-
ment, combined with the human resource
In employee-level studies, individual-level char- management system, can be used for internal
acteristics such as age, tenure, education, and development of resources and for extending
personality traits should be considered as well. current organizational capabilities. By accepting
For example, according to Djukic and Kovner the role of the built environment as a human
(2009), age, educational level, and tenure might resource management tool, an extensive body
be positively related to autonomy and negatively of the knowledge in human resource manage-
related to job stress, both of which are impor- ment literature becomes available to healthcare
tant predictors of job satisfaction. Additionally, environmental researchers that can be used for
Rhoades and Eisenberger (2002) note that posi- strengthening the case for investing in facility
tive or negative affectivity alter the way employees design.
interpret organizational treatment as benevolent
or malevolent. More specifically, in line with the statement on
enriching organizational capabilities by Sirmon
Contribution to Literature et al. (2008), this study suggests that the physical
In describing the characteristics of resources in environment (i.e., facilities) can be added as a
creating competitive advantage, the importance complementary resource to the current resource
of a human resource management system as bundle (i.e., human resource management prac-
an invisible asset embedded in the operational tices) for enriching organizational capabilities
system of the organization has been presented. (i.e., improving employees’ job attitudes and
In addition, as a human resource management behaviors) and creating synergy. The proposed
system develops over time, it becomes unique framework adopts the concept of the synergy
to a particular firm and creates a specific human proposed by Makadok (2001), because it sug-
capital pool. The proposed framework suggests gests that organizations can achieve higher
that as a behavior setting that offers substantial productivity when they use their human resource
inducements to employees, the built environ- management system in combination with their
ment can be added to the array of human resource facilities. Furthermore, in line with the argument
management tools for enhancing the complexity made by Hamilton, Orr, and Raboin (2008), and

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Zimring, Augenbroe, Malone, and Sadler (2008), message to employees that the organization
the proposed framework offers a mechanism for values their contributions and cares about
leveraging the synergy between organizational their well-being. Employees can develop a
management interventions and environmental sense of obligation, care about the welfare
design interventions. of the organization, and help it achieve its
goals when the organization gives attention to
Implications for Practice employee needs.
• Differences in firm performance originate • Because caregivers are exposed to higher
from differences in the resources they own. health and safety-related risks, attention to
To have an enduring competitive advantage, their health and well-being is particularly
firms need to obtain a wide array of resources, important. Providing a healthy environment
including economic, social, and ecological with a high indoor environmental quality
capital, and combine them to create a value- offers substantial inducements to employees
adding resource bundle. The value generated that can be reciprocated with higher levels
by a rare, unique, and complex resource pool of motivation and commitment towards the
is difficult for competitors to imitate or repro- organization.
duce. • As a behavior setting that offers substantial
• Human capital and the human resource man- inducements to employees, healthcare firms
agement system can be significant sources for should add the built environment to the ar-
a competitive advantage. Human capital (the ray of human resource management tools for
stock of employees’ knowledge, skills, and enhancing their human capital.
abilities, as well as their motivation and loy-
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