Table 3.

Identified Barriers, Facilitators, Strategies and HCW Wishes to Optimizing Physical Distancing

Work System Element	Barrier	Facilitators	Strategies and Wishes Described by Participants
People	• Need to eat and drink outside of break time • Fatigue at the end of a shift • Desire to quickly complete shift • Desire to have close connections with other HCWs or maintain friendships at work • Familiarity and comfort with coworkers may make HCWs believe physical distancing is not as important at work • Feeling of invincibility • Feelings about the importance of physical distancing compared with other precautions (eg, personal protective equipment)	• Desire to do the right thing • Belief in the importance of physical distancing • Trust in physical distancing guidelines	• Communication with others about need to physically distance • Increased recognition of staff and their efforts • A focus on rewards rather than punishments
Physical Environment	• Insufficient space for all HCWs • Insufficient spacing of computer workstations for all HCWs • Poor layout of room causes crowding • Storage of supplies needed at times of the day requires HCWs to gather to find supplies • Tables are small, making it difficult to spread out during meetings	• More spacious areas	• Convert rarely used rooms to workspaces • Relocate or space out computers • Strict occupancy limits for rooms • Relocate meetings to larger spaces • Remove tables and chairs to prevent gathering
Tasks	• Need to provide confidential information • Communication and teaching requires close proximity to hear • Reporting, huddlings, and signing out require gathering • Patient care requires multiple HCWs at a time • Need to view data on a shared computer screen • Meals and celebrations may take multiple people • Space for eating was not a priority • The immediacy or urgency of a task takes priority • Brief tasks are perceived as not requiring physical distancing	• Willingness to adjust workflows to promote physical distancing	• Spread out during reporting or signing out • Move talks or meetings online • Maintain disctance during meals • Have fewer people on rounds
Tools and Technologies	• Insufficient numbers or quality of computers or other tools necessary to perform work • Needing to share computers • Placement of computers prohibits efficient use • Masks muffle speech, making it difficult to hear • Video conferencing technology intended to allow others to join remotely requires members of a team to gather around 1 computer monitor	• Video conferencing technology • Communication via electronic messaging applications or telephone	• Phone-based reporting or signing off • More computers that are portable • Dedicated video conferencing room for team to remotely join • Remote patient monitoring • Additional plexiglass barriers • Video conferencing for bedside rounds • Cognitive aids such as floor stickers, room occupancy limitations, and signage • Frequent e-mailed reminders • Accessible internal web resources • Disabling computers, and more or higher quality computers
Organization	• Scheduled communications such as huddles require HCWs to gather • Many HCWs change shift at the same time, temporarily doubling the number of HCWs • Hospital workflow means that certain times of the day or days of the week have more HCWs • The workflow of the day requires tasks to occur in a certain order for many HCWs (eg, report or rounds, medication dispensing, meals, etc) • Unclear who has priority to be in a room • Unclear how many people are in a room before entering • Hierarchy determines where HCWs sit and whether they ask others to physically distance • Culture of bedside rounds	• Time of day or week may be less busy • Role of leadership in encouraging physical distancing	• Increased hospital-level recognition of staff and their efforts • Focus on rewards rather than punishments • Centralized meal program for staff • Importance of communication from administration • Staff member responsible for monitoring physical distancing • Changes to structure of huddles or report, such as one-on-one huddles • Changes to rounds including having fewer people participate • Hospital training on physical distancing
External Environment	• Requirements from regulatory agencies prohibit optimal placement of workstations or tools • Requirements from regulatory agencies prohibit signage or other cognitive aids	• External societal pressures for physical distancing

Note. HCW, healthcare worker.