In a typical year you will take two million breaths in your office. This, however, is not a typical year. The pandemic spawned by the novel coronavirus has forced a global reckoning with the awesome power of infectious diseases to grind economies to a halt. The forced lockdowns and retreat into home isolation has also given us a heightened awareness of the role our surroundings play in our health and wellbeing. COPYRIGHT © 2020 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. 2 While no one could have predicted the exact nature of the outbreak that is now upending our lives, many of us working in public health have been urgently advocating for organizations to invest in healthier buildings for some time. History tells us that buildings play a central role in the spread of disease. From measles to SARS to influenza and the common cold, the scientific literature is full of examples. But, as much as buildings can spread disease, if operated smartly, they can also help us fight against it. Amidst the chaos, one thing is clear: We will all go back to work with new expectations about the buildings where we live, learn, work, and play. Buildings that Fight Disease and Promote Health For our book, Healthy Buildings: How Indoor Spaces Drive Performance and Productivity, the two of us have spent the last three years speaking to executives across the business spectrum who oversee real-estate portfolios that cover several billion square feet and contain millions of employees. We aimed to better understand how to drive healthy building science into practice. Locked in a global battle for talent, the business leaders we spoke with were eager to find new ways to attract, retain, and enhance the performance of their employees. Few of them realized that their buildings could play a vital role in the health of their business. In response to Covid-19, that’s rapidly changing. CEOs from companies large and small have come out of the woodwork to engage with us on how to design, operate, and manage better buildings. Calls are also coming in from groups that run medical offices and dental clinics, hotels, schools, airports, and theaters, as well as mid-size law firms and small businesses in both small towns and major metropolitan areas. The question on the mind of every business and organizational leader is this: When the time comes, how do I re-populate my buildings and restart my business? Re-Populating Your Buildings As you prepare for the return of your employees, remember that the scientific models on the spread and containment of SARS-CoV-2 indicate this is a problem we will be dealing with for at least 12 months. Likely approaches to controlling the spread and damage from the virus include a combination of widescale testing, and periodic isolation and quarantine. Some cities and regions will begin re-populating their buildings over the next few weeks, and some will likely be hit with repeated cycles of social distancing. In either case, as employees return to offices, there is a framework companies can deploy to keep people safe without crippling their businesses and our economy. First, we all have to understand — and communicate to employees — that there is no such thing as zero risk. The goal is to minimize risk, and we can get there using a layered defense approach by applying what is known in public health as the hierarchy of controls. COPYRIGHT © 2020 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. 3 The hierarchy of controls is how the field of occupational health thinks about protecting workers from any hazard — biological, chemical, or otherwise. There are five types of controls, moving from the most eective at the bottom to least eective at the top
Elimination of exposure. The first, and most eective control, is to minimize social interaction. Of course, you could keep everyone 100% safe by keeping them at home for the near future. But this will COPYRIGHT © 2020 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. 4 come at a great cost to your company and the economy. In time, you will need to begin re-populating your building. This means you will be accepting some degree of risk. Substitution activities. This brings us to level two of the pyramid: “substitution.” Evaluate critical, core workers who need to be onsite and create work teams that can be physically isolated from one another. That way, if one employee gets sick and their close contacts need to self-quarantine, you can shut down that one group for two weeks without shutting down your entire company. Engineering controls and healthy building strategies. The next step is to boost your building’s defenses against disease. This means immediately enacting some key healthy building strategies. At the room level, consider using portable air purifiers and looking into new technologies like touchless entryways, elevators, sinks, and toilet flushes. In addition, having an enhanced disinfection protocol in place that clearly spells out the locations, timing, and frequency of cleaning is critical, as well as training cleaning sta on these new procedures. Most importantly, at the building level, focus on improving these 9 Foundations of a Healthy Building: • Ventilation • Air quality • Thermal health • Moisture • Dusts & pests • Safety & Security • Water quality • Noise • Lighting and views These were distilled from 40 years of scientific evidence at Harvard’s Healthy Buildings lab, and improving them will serve as a long term preventative measure. While some of these you might have expected, like better acoustics and lighting, we suspect you haven’t been thinking about how humidity, temperature, furniture, carpeting, and even dust can impact employee health — and even beyond health, performance. But consider just a small smattering of the evidence: One study of young adults found that every 1°F deviation from an optimal indoor temperature came with a 2% decrease in output. In another study, researchers found that every time you double the rate of outdoor air delivered into an office, worker performance improves by 1.7% across four simulated office tasks: text typing, addition, proofreading, and creative thinking. It’s no surprise, then, that an analysis of sick leave data for more than 3,000 workers across 40 buildings found that 57% of all sick leave was attributable to poor ventilation. COPYRIGHT © 2020 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. 5 Of course, it’s not just air quality that drives health and performance. A study of workers found that they reported more headaches and worked 6.5% more slowly on a typing test when they were in an office with a pollution source. The “pollution source” in question? A dirty carpet. The amount of indoor nature and views matter, too. Young adults in an office designed following biophilic design principles had lower blood pressure, lower heart rates, and better performance on short-term memory tests. Making sure each foundation is up to par with our current healthy building standards is key to both stopping the spread of infectious disease, and setting up a successful workforce. Administrative controls. Here, the big picture focus should be on de-densifying your buildings and maintaining social distancing (e.g., staying six feet apart). You can do this through both time and space. By limiting who comes to your office (substitution), you’ve already taken one step. You can do more by getting clever with your scheduling. Consider extending operating hours and asking employees to come in shifts. Running a two-shift operation — say, six a.m. to 12 p.m., and one p.m. to seven p.m. with an hour of deep cleaning in between, instantly cuts the occupant density by half. Not everyone needs to arrive right at the start of their shift. Staggering arrival and departure times, even by 10 minutes, can prevent traffic jams at the elevators and common areas. Another option is to alternate work-from-home and office days, using A/B days, so that only half your company is in the building on any one day. This tactic also mitigates exposure to rush hour crunches in public transportation. In addition, because one unfortunate fallout of the virus is an economic slowdown, layos may lead to higher vacancies in office space, retail stores, restaurants, hotels, and more. This means there is a lot of “unused” space in most commercial buildings, and now is a good time to repurpose it. Move desks into conference rooms and common areas to spread out your workforce. In terms of meetings, any gathering with more than 10 people should be virtual for the near term. For essential in-person meetings, you can slide your chairs back and keep to the edges of the room. If you’re at a conference table, leave a chair open between each person. Skip the handshakes, and wash your hands immediately before and after each meeting. Personal protective equipment (PPE). The last, and least eective control measure, is personal protective equipment. Employees should be wearing a mask on their way to and from work, and also as they enter the building and walk through common areas and take the elevators. Wearing a mask protects others and the wearer. Finally, remember that no one control strategy is sufficient. You have to think about this in terms of a layered defense, doing everything you can to minimize the risk. COPYRIGHT © 2020 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. 6 How Can You Measure Success? If you wait for people metrics to show you success — like the number of sick or absent employees in a given time frame — you are acting too late. Like a doctor at the start of an exam, if you want to protect your workforce, you should be regularly checking the health of your building, not just your people. It’s common for organizations to measure the life of their workspaces in terms of years, when visible decay and wear and tear become noticeable. But buildings change on a much shorter timescale and the eects are not always visible. Every business tracks key performance indicators so they can keep tabs on their progress. But very few track what we’re calling Health Performance Indicators, or HPIs. At a fundamental level, health drives human performance. This means that building performance is a critical metric that every business should be tracking. HPIs can be used to measure indoor environmental quality, or what we call “the pulse” of your building. We have divided them into four quadrants: leading and lagging indicators, and direct and indirect indicators. Direct indicators measure people, while indirect indicators measure the building. Leading factors are those that can be measured — and caught — before an issues arises, whereas lagging ones can only be measured after the fact. For example, “commissioning” your building, which is akin to giving your car a tune-up, can help you identify problems with your ventilation system before anyone is actually in the space. As such, “commissioning” is leading factor and an indirect indicator.