Happy Stairs

Rounding is a critical part of any inpatient healthcare team's daily activities. Depending on the service, rounds can take us to many different patient care units, often traversing multiple floors and sometimes crossing more than one building. Depending on the day, rounds can easily help a team member like me accumulate well over my targeted 10k steps daily. Based on personal experience, however, in most hospitals reaching my target of 10 or more flights of stairs in a day has remained elusive.

This is regrettable given the many known cardiovascular and overall wellness benefits of stair climbing. In fact, these benefits are so profound that a great deal of effort has gone into testing how to improve stair usage in retail and workplace buildings. Interventions include several variations of motivational signs to inspire a seemingly simple change among those for whom using an elevator is not a necessity for mobility. The impact of these so-called point-of-choice prompts has been variable.

Sometimes stair climbing is the closest approximation to a workout I can squeeze in on a busy 24 hour call so I try to find the stairs and use them as much as I can. It is almost always a stair climb alone (everyone is so busy dividing and conquering), under uninspiring fluorescent lights, in an unwelcoming stairwell that requires me to make a significant detour from the seeming vice-grip of the open elevator doors. And, sometimes the elevator wins. When our minds are racing with the growing to-do list created during pre-rounds, sign-out, endless pages, and EMR alerts, the immediate extra cognitive burden to seek out the stairs often supplants the future health benefit we might reap.

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Until now.

After much anticipation, my hospital recently opened a stairwell just steps from the main elevators to the critical care wing. I squealed with delight when I saw that the "Do Not Enter" signs and construction barriers were removed to reveal an unmarked door. The new stairwell was open (exit signs, I presume, are on back order). We weren't in a rush at that moment and I took a minute to talk to my colleagues about how architects and designers contemplate things like daylighting, activation centers, and glass performance. We even talked about curtain walls. The designers of this stairwell, we concluded, nailed it!

Later that day and in subsequent days on call, when I asked my team if they wanted to take the "Happy Stairs" on rounds they all joined me with equal delight, and continue to do so a few weeks later. Even the colleague with a recent hip replacement who wasn't really even doing stairs at home yet has joined in regularly. No body-shaming signs on the stairwell doors (yes, someone tried that in a mall stair usage study once). No motivational quotes on the treads. Nope, none of that.

What was the difference then, you might be wondering? How did our team develop this healthier way of being at work which is seemingly still a conundrum for the behavioral health researchers?

Well, it was light. The stairwell was built as an addition with a full window spanning every floor. This marriage of the easy-to-find location next to the elevator core and the promise of daylight all that is needed to get natural-light-deprived health professionals to the stairs regularly on rounds. One of my colleagues even told me that she now will take a 5-10min break in the stairwell when things are qu*&? (we don't say that word among acute care call teams) to just look out the window and enjoy the view.

In much of what I read for this post I saw the phrase "movement is medicine" over and over. Daylight, too, is medicine. It has been shown to enhance the performance of visual tasks, benefits the body’s circadian system, improve mood and perception, and help maintain bodily functions through actions like vitamin D conversion. With this stairwell construction project, our employer has offered us a chance to choose movement without adding to our cognitive burden and get a dose of daylight. As a bonus, there is the added unstructured bonding time together which serves to make our team synergy even more robust when it really matters in the trauma bay or the ICU.