Stress, resilience, and recovery: assessing a physical restorative space within a multimodal support program for hospital workers

The healthcare workforce faces increasing levels of stress and burnout, negatively impacting employee wellbeing and patient outcomes. Restorative spaces have emerged as a potential intervention to support resilience and mental health in high-stress clinical environments. In January 2024, Johns Hopkins Hospital launched the RISE Restorative Space, a cluster of rooms designed to provide employees with opportunities for relaxation, stress reduction, and peer support. To quantify usage of the RISE Restorative Space, assess employees' experiences, and assess the value of maintaining and expanding such spaces for employees and healthcare organizations. An exploratory multi-method design was used to examine patterns of program utilization and employee-reported experiences from January to April 2024. Employee identification badge swipe data was used to measure overall utilization and unique user engagement. A web-based survey was sent to employees who had accessed the space, collecting information on usage patterns, perceived benefits and challenges of using the space, and workplace wellbeing using the Mini Z General assessment. A cost analysis was conducted to estimate cost per user. In the first 4 months between January 1 and April 30, 2024, the space was accessed 4,271 times by 823 unique users, with 71.0% returning at least once. Survey data (N = 296) revealed that employees using the space primarily sought relaxation (47.7%) and positive distraction (42.9%). A total of 34.1% reported experiencing burnout, and 93% of respondents indicated they would recommend the space to colleagues. The cost per unique user was $204, with decreasing costs per use as utilization increased. The RISE Restorative Space demonstrated high engagement and positive reception among healthcare employees, suggesting that dedicated spaces for relaxation and peer support may be a valuable investment in workforce wellbeing. Future assessments will explore the longitudinal impact of restorative spaces on employee stress, burnout, and job satisfaction.

Health care workers are routinely exposed to substantial cognitive and emotional demands in hospital settings. These demands have been linked to burnout, turnover intentions, reduced engagement, and impaired performance, with downstream consequences for patient safety, quality of care, and organizational functioning (Bell et al., 2023; Chen and Meier, 2021; Dall'Ora et al., 2020; Usset et al., 2024). During the COVID-19 pandemic demand intensified, increasing attention to the need for health organizations to invest in support for worker wellbeing and to promote both individual and organizational resilience (Baskin and Bartlett, 2021; Kisely et al., 2020). Since that time, adverse impacts on health care workers have persisted, with recent evidence suggesting that burnout, emotional exhaustion, and workforce strain—already well-documented prior to the pandemic—remain elevated relative to pre-pandemic levels (Lucy et al., 2023; Steinbaugh et al., 2026).

A growing body of literature highlights the importance of moving beyond individual-level interventions to more comprehensive, organization-embedded approaches to workforce wellbeing (Brand et al., 2017; National Academy of Medicine, 2024). Organizational strategies that acknowledge environmental, structural, and cultural contributors to stress are increasingly recognized as crucial complements to mental health services. Within this shift, growing attention has focused on how the physical environment of healthcare organizations can be designed to support healthcare workers' wellbeing, including opportunities for stress recovery, regulation, and connection. However, much of the existing literature examines the broader effects of hospital design and environmental features, with less attention to dedicated spaces specifically designed to facilitate restoration and respite for healthcare workers (Du et al., 2026; Phillips and Becker, 2019; Shetty et al., 2024).

Insights from environmental psychology and occupational health suggest that restorative physical spaces may play a meaningful role in mitigating stress (Cerwén et al., 2016; Djebbara et al., 2019; Herzog et al., 1997). Exposure to environments designed to reduce sensory overload, promote calm, and support personal control is associated with improvements in perceived stress, emotional regulation, cognitive functioning, and physiologic stress markers. Within healthcare settings, this kind of physical space may offer healthcare workers the opportunity to briefly disengage from high-intensity clinical demands, regulate emotional and physiologic arousal, and return to work more restored (Putrino et al., 2020).

Although restorative environments have been proposed as beneficial for healthcare workers, they remain relatively novel within healthcare settings, and empirical evidence on their effectiveness is limited. During the COVID-19 pandemic, some institutions rapidly developed dedicated spaces that integrated sensory rooms, quiet rooms, and areas for peer connection, that elicited high utilization and strong perceived value from healthcare workers (Blake et al., 2021; Putrino et al., 2020). To date, the published literature is largely situated within the extraordinary context of the pandemic, a period marked by sustained stress and high levels of burnout that have persisted beyond its acute phase. It remains unclear to what extent observed patterns of use and perceived benefit generalize to more stable operational periods, and how restorative spaces function when integrated into long-term workforce wellbeing strategies.

The Resilience in Stressful Events (RISE) program was developed to provide organizational peer support and resilience resources to healthcare workers. As an extension of this model, the RISE Restorative Space at Johns Hopkins Hospital (JHH) was launched in January 2024, building in part on the broad acceptance and high utilization of RISE services during the COVID-19 pandemic. While initially conceived to include a private consultation area for peer support sessions, the design team envisioned a more comprehensive space from the outset, incorporating areas for quiet reflection, sensory regulation, creative engagement, and social connection. The intent of these private and group spaces was to facilitate relaxation, stress reduction, and temporary disconnection from work demands, aligning with the RISE program's broader mission to support employee wellbeing.

The objective of this evaluation was to quantify use of the RISE Restorative Space during its first 4 months, from its launch on January 1, 2024, through April 30, 2024; assess employees' experiences with the space; and examine its perceived value for maintaining and potentially expanding restorative spaces within hospital settings. By characterizing how healthcare workers engage with restorative environments, this study aims to contribute descriptive evidence to an emerging area of workforce wellbeing research and to inform organizational decision-making regarding the role of restorative physical spaces to support healthcare workers.

This multi-method assessment included several components: employee badge swipe data, an anonymous survey comprising both validated and newly developed measures, and a cost-per-user analysis. This project was conducted as a program assessment for quality improvement purposes and did not meet the definition of human subjects research requiring review by the Johns Hopkins Bloomberg School of Public Health (BSPH) Institutional Review Board (IRB).

The intervention: RISE Restorative Space

The RISE Restorative Space at JHH includes five distinct areas: two shared spaces and three private rooms. The shared spaces are the Art Activity Room and the Gathering Room. The Art Activity Room offers a range of creative materials, including painting and drawing supplies and guided vision-board tools and supplies. The Gathering Room is a communal, drop-in space designed to support relaxation and social connection that features comfortable seating, natural light, biophilic elements, and activities such as books, puzzles, and musical instruments. Both shared spaces are unscheduled and accessible at any time, allowing employees to visit alone or with colleagues and supporting informal restoration and spontaneous social interaction.

The private spaces include a Private Consultation Room, Sensory Room, and Tune Room. The Private Consultation Room is a reservable space designed for confidential, in-person support encounters. It is used for Employee Assistance Program (EAP) consultations with licensed counselors as well as RISE peer support sessions. In the past, EAP required employees to schedule off-campus appointments; the Private Consultation Room enables access to in-person counseling within the hospital, in a comfortable, dedicated setting closer to employees' work environments. The room also serves as a designated space for RISE peer support, which may be provided one-to-one or in small groups.

The Sensory Room features a massage chair, bubble lights that change color, aromatherapy, and Bluetooth-connect speakers. The room is a low-stimulation environment designed for individual decompression and sensory grounding. The Tune Room houses a vibro-acoustic, medical-grade bed designed to support relaxation and mental clarity by engaging the parasympathetic nervous system (Fooks and Niebuhr, 2024). All private and shared spaces were developed using neuroaesthetic design principles, with consultation from experts in developing restorative spaces including International Arts + Mind Lab,1 Studio Elsewhere,2 and Reddymade.3

Design features for all the rooms include the use of natural, room-specific color palettes (with more vibrant hues in the Art Activity Room), and a coordinated lighting plan emphasizing softer temperatures, adjustable illumination, and windows to allow for natural light. Desirable architectural modifications such as curved structural elements were not feasible within the existing budget, but design strategies incorporated visual softness and sensory modulation within the existing space constraints.

Participants

Using administrative badge swipe records that track entry into the RISE Restorative Space, we identified unique individual workers who accessed the space at least once between January 1 and April 30, 2024. In early May 2024, we invited these employees to complete a ~5-minute web-based survey sent to their institution-affiliated email addresses. Three reminder emails were sent over 1 month. The survey was administered via Qualtrics and anonymous; the web link was public and not tied to respondents' email addresses or any identifiable information.

Measures

Measures were derived from administrative badge swipe data and participant survey responses, the latter of which included demographic characteristics, experiences with the RISE Restorative Space, and burnout.

Employee badge swipes

The RISE Restorative Space operates without regular supervision, so access is tracked via employee badge swipes at each room's entrance. Swipe data, extracted from the facilities team's database, were used to analyze user-level metrics, including how many unique employees have accessed the RISE Restorative Space and with what frequency unique employees have revisited the space. These data also provided broader utilization metrics, including the frequency of visits to each room, the times of day different rooms were in use, and how usage patterns have changed since the space opened in January 2024. Notably, the Art, Gathering, and Consultation rooms share a single keycard entry point, meaning swipe data for these rooms cannot be distinguished from one another.

Demographics

We assessed sociodemographic characteristics, including employee role, sex, gender, race, ethnicity, and year of birth.

Experience

Participants were asked about various aspects of their experience with the RISE Restorative Space. Specifically, the survey inquired about which rooms they visited, frequency of use, how they learned about it, motivations for usage, any challenges they encountered, likelihood of recommending the space, and the types of wellness resources they would like to see more of at their institution.

Burnout

We used the Mini Z General assessment to examine workplace stress, satisfaction, burnout, and drivers of burnout among respondents. The 11-item measure consists of 9 Likert-type items assessing job satisfaction, stress, professional values and teamwork; a multiple-choice question regarding current burnout level; and an open-ended prompt inviting respondents to share sources of stress and suggestions for support. For subscale 1, which assesses the extent to which respondents perceive their work environment as supportive, scores range from 7 to 35, with higher scores indicating a more supportive work environment and a score of 28 or higher indicating a highly supportive workplace. Subscale 2, which evaluates electronic medical record-related stress, was adapted to focus on workplace stress, has a range of 3–15, where higher scores indicate more manageable workplace stress and a score of 12 or more suggests manageable stress. Overall, the total score ranges from 10 to 50, with higher scores indicating a more positive work experience and scores of 40 or above reflecting a joyful workplace. Although psychometric properties specific to the General assessment are not available, the core Mini Z instruments from which it is adapted demonstrate good internal consistency among healthcare worker populations, with reported Cronbach's alpha coefficients ranging from 0.75 to 0.83 (Linzer et al., 2022).

Cost analysis

Cost identification was conducted over the first 4 months of program implementation. Total program costs were estimated as the sum of facility-related expenses ($153,000) and a $15,000 contribution from the Johns Hopkins Office of WellBeing, for a total of $168,000.

We calculated three cost metrics to identify program cost relative to reach (cost per employee), uptake (cost per user), and intensity of use (cost per visit) during the initial implementation period. Cost per employee was estimated by dividing total program costs by the approximately 15,000 employees eligible to access the space during the study period. This figure represents an estimated eligible employee population rather than a fixed headcount, as ongoing staff turnover and changes in employment status made the number of eligible employees variable over the study period. Cost per unique user was calculated by dividing total costs by the number of unique employees who accessed the space at least once during the study period (N = 823), as identified through employee badge swipe data. Cost per use was estimated by dividing total costs by the total number of recorded visits (i.e., all badge swipes) during the study period, thereby accounting for repeat utilization.

Employee badge swipes

Between January 1 and April 30, 2024, the RISE Restorative Space was accessed via keycard a total of 4,271 times, excluding visits by custodial and RISE team staff. The space had 823 unique users (Figure 1). Individual usage ranged from 1 to 98 visits. Of the 823 employees, 584 (71.0%) returned to the RISE Restorative Space two or more times. Usage increased each month across all rooms, with the most pronounced increase for the Sensory Room (Figure 2). The Restorative Space was accessed most frequently between 9:00 a.m. and 5:00 p.m., with a second peak between 1:00 a.m. and 4:00 a.m. (Figure 3).

Survey

We received 331 completed surveys from the 836 invited employees (response rate: 39.6%). Of these, 296 (89.4%) confirmed they had used the RISE Restorative Space. We performed all subsequent analyses using the sample of 296 users.

The mean age of survey respondents was 42.8 years (SD = 10.2 years). The majority identified as female (68.2%), White (48.23%), and non-Hispanic (72.3%; Table 1). Nearly one fourth of the survey respondents were nurses.

On average, respondents used the RISE Restorative Space 4.2 times over the preceding 4 months (SD = 3.6), though the number of uses ranged from 1 to 22. The Sensory Room and Tune Room were the rooms used by the greatest percentage of respondents (57.4 and 45.6%, respectively), followed by the Art Activity Room (16.6%), Gathering Room (14.5%) and Private Consultation Room (2.7%).

Approximately one third of respondents heard about the space from a general E-Newsletter sent by the hospital's communications office (32.6%), email (37.2%) or word of mouth (32.6%). When asked what prompted them to use the RISE Restorative Space for the first time, nearly half of respondents endorsed the response option “Seeking relaxation” (47.7%). Other frequently endorsed response options were “Curiosity” (38.4%), “Seeking rejuvenation” (28.4%), and “Fatigue” (27.8%). The most frequently endorsed responses to the question “By using the RISE Restorative Space, I achieved a sense of...” were “comfort” (58.0%) and “positive distraction” (42.9%).

Over a quarter of respondents reported no challenges when using the RISE Restorative Space (26.6%). The most frequently cited challenges included equipment malfunction (16.6%), someone entering while they were using a private room (16.6%), and the room they reserved being occupied (13.6%). Despite these challenges, approximately 93% of respondents said it was extremely likely (74.4%) or somewhat likely (18.4%) that they would recommend the RISE Restorative Space to a friend or colleague. Additionally, 48.0% of respondents wanted to see (or see more) spaces such as the RISE Restorative Space at their institution. Approximately 43.2% of respondents desired more fitness facilities, and 30.2% sought more access to group fitness classes.

When asked about other employee support resources they had used at the hospital, 20.9% of respondents reported using the EAP, 11.1% had accessed fitness facilities, and 8.1% had participated in at least one program out of the office of wellbeing, such as meditation classes, step challenges and smoking cessation. Additionally, 10.8% reported utilizing the RISE peer support program.

The Mini Z general assessment within the survey assessed burnout in respondents. The mean score for the supportive work environment subscale was 16.7 (SD = 7.5), with 4.1% of respondents scoring high enough (28 or above) to qualify as being in a highly supportive workplace. The mean score for the manageable pace subscale was 8.9 (SD = 4.2). No respondents reached the score of 12 or above, the threshold for perceiving workload as manageable, suggesting that participants generally perceived their workload as not manageable. The mean score for the joyful workplace subscale was 25.6 (SD = 11.2), with 3.4% of respondents scoring 40 or higher, indicating a joyful workplace. For the single-item burnout measure, 34.1% of respondents reported experiencing burnout.

Cost analysis

Total program expenditures for the RISE Restorative Space during the initial 4-month implementation period were $168,000, including $153,000 in facility-related costs and a $15,000 contribution from the Johns Hopkins Office of WellBeing. During this period, 823 unique employees accessed the space, representing approximately 5.5% of the total hospital workforce (N = 15,000). The estimated cost was $11.20 per employee and $204 per unique user. Across 4,271 total visits, the cost per use was $39.33.

In this observational study of a multi-room restorative space in a large academic medical center, we found high utilization rates and largely positive experiences among employees. Within the first 4 months of opening, the RISE Restorative Space was accessed over 4,000 times by 823 unique users with over 70% returning at least once, suggesting positive, consistent engagement. Most respondents reported achieving comfort or positive distraction through use of the space, and nearly all were likely to recommend it to a colleague. Use was highest in the Sensory and Tune Rooms, indicating demand for private, immersive restorative experiences.

Use increased across all rooms over the 4-month implementation period, with the most pronounced increase observed in the Sensory Room. The Sensory and Tune Rooms were also the most frequently accessed spaces among survey respondents, suggesting sustained interest in these types of restorative environments. The high use of the Sensory and Tune Rooms may reflect interest in spaces that facilitate relaxation, comfort, and positive distraction, which were among the most reported reasons for and experiences of using the Restorative Space. Use was highest during typical daytime working hours (9:00 a.m.−5:00 p.m.), but a second peak occurred between 1:00 a.m. and 4:00 a.m., indicating that the space was also used during overnight hours. Together, these patterns suggest that a continuously accessible restorative space may serve employees working across a range of schedules and may meet different needs throughout the workday and night.

Our findings align with results from prior studies demonstrating the value of designated restorative environments in healthcare settings. Research during the COVID-19 pandemic showed high uptake of similar spaces, though data outside crisis conditions have been more limited (Blake et al., 2021; Putrino et al., 2020). Connors et al. previously described high demand for protected spaces supporting peer connection and individual respite (Wu et al., 2020). Our findings suggest continued demand for accessible, protected restorative environments beyond acute crisis periods, and that thoughtfully designed spaces can support recovery and stress reduction across a wide range of staff roles and departments. Our respondents reported a high rate of burnout and relatively low perceptions of workplace support, underscoring the need for such resources in the hospital environment. Furthermore, our results indicate that respondents have a desire to see more spaces such as the RISE Restorative Space in their institutions.

Notably, a second hospital within the same health system launched its own RISE Restorative Space in May 2024 (Malik, personal communication). In the first 4 months (May 16–September 16), the space was used by 945 unique employees and received overwhelmingly positive feedback. One of the most appreciated features was a “blessing jar,” where visitors could leave and read encouraging messages. While this element was not used in the current study, its popularity highlights how individual institutions can tailor restorative spaces to reflect the needs and culture of their own staff. These findings support the transferability of the RISE Restorative Space model across settings and underscore the value of local adaptation to maximize impact.

These findings should be interpreted with caution given several limitations. First, our reliance on employee badge swipe data introduces ambiguity around individual usage. In shared spaces like the Art and Gathering Rooms, group visits may appear as multiple individual swipes. Some employees may have swiped in for others, while traffic jams at peak times may have led to multiple or missed swipes, potentially inflating or undercounting usage. Second, the survey sample may be affected by selection bias: individuals more positively disposed toward the space may have been more likely to complete the survey, skewing satisfaction data upward. Questions about experience with the RISE Restorative Space were developed specifically for this assessment and have not been formally validated, so findings based on these items should be interpreted with caution. Lastly, while our burnout measure provides insight into workplace stress, it may not fully capture the complexity of employee wellbeing or reflect changes resulting directly from space use.

These early findings suggest that restorative spaces like the RISE Restorative Space offer a positively perceived and potentially cost-efficient way to support employee wellbeing. Such spaces may be valuable as traditional shift structures continue to evolve, and healthcare organizations seek innovative strategies to address burnout and staff retention. Our cost analysis suggests that such investments can achieve broad reach at relatively low cost per user—especially as staff awareness and utilization increase over time. The approximately 15,000 employees referenced in the cost analysis represents the estimated number of employees eligible to access the RISE Restorative Space during the study period, rather than the number of employees who used the space. Because utilization and awareness are expected to change over time, the cost-per-employee and cost-per-user estimates presented here reflect the first 4 months of implementation and should not be interpreted as fixed estimates of long-term cost efficiency. As use increases, the cost per user may decrease; however, ongoing costs associated with staffing, maintenance, programming, and space operations may also accrue over time and should be considered in future assessments of the sustainability and cost-effectiveness of restorative spaces. Future efforts should aim to optimize awareness, ensure accessibility, and integrate restorative spaces within a broader continuum of employee wellness offerings. In this regard, the RISE Restorative Space model offers a replicable framework for other institutions seeking to improve the healthcare work environment through environmental and human-centered design.

Several implementation lessons emerged from this assessment. Although the RISE Restorative Space can function as a largely self-directed resource, survey responses about participants' experience highlighted the importance of having a dedicated individual responsible for oversight, coordination, and ongoing engagement. Dedicated ownership supported programming, maintenance, staff outreach, and alignment with institutional priorities. Future efforts should prioritize not only physical infrastructure, but also operational stewardship to optimize awareness, accessibility, and sustained use. Finally, the development of the RISE Restorative Space was intentionally aligned with the hospital's strategic priorities related to workforce wellbeing and organizational culture, extending and integrating existing supports offered by the RISE Peer Support Program and the Johns Hopkins EAP. In this regard, RISE offers an institutionally embedded restorative space model for other health organizations seeking to improve the healthcare work environment through environmental and human-centered design.

An important limitation is that survey respondents may not be representative of the broader Johns Hopkins Hospital employee population. Employees who used the RISE Restorative Space may differ systematically from those who did not, including in their awareness of the space, availability, workload, or access to resources that enable them to take time away from work to access the resource. The direction of this potential selection bias is uncertain: employees experiencing greater stress or burnout may have been more motivated to seek out the space, while those experiencing the greatest workload or time constraints may have been least able to use it. Future research should examine experiences among both users and non-users of restorative spaces to better understand their reach, accessibility, and potential impact across the workforce.

Future research will build on these findings through a planned evaluation, which will assess longitudinal changes in employee wellbeing and examine whether (and through what mechanisms) use of the RISE Restorative Space is associated with reductions in burnout, stress, and other indicators of occupational strain. This work will also explore usage trajectories (e.g., infrequent vs. regular use) and whether different room types (private vs. communal) address distinct wellness needs. Complementary qualitative interviews will be conducted to contextualize quantitative findings and inform design and programming decisions. Further planned analyses will include detailed costing and formal assessments of cost-effectiveness.

The RISE Restorative Space demonstrates that thoughtfully designed, accessible, and institutionally supported restorative environments can meaningfully engage healthcare employees, promote wellbeing, and complement broader organizational efforts to reduce burnout. By combining physical infrastructure with dedicated operational stewardship, these spaces offer a scalable and adaptable model for other institutions seeking to enhance workforce resilience and create a supportive work environment.