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  • Evidence-based design

    Evidence-based design


    • Evidence-based design, or EBD, is a field of study emphasizing credible evidence to influence design. This approach has become popular in healthcare to improve patient and staff well-being, patient healing, stress reduction and safety. Evidence-based design is a relatively new field, borrowing terminology and ideas from disciplines such as environmental psychology, architecture, neuroscience and behavioral economics.

      Studies have examined how the physical environment can influence well-being, promote healing, relieve patient pain and stress and reduce medical errors, infections and falls. Many hospitals, community health centers and residential care centers are adopting evidence-based design for new construction, expansion and remodeling.

      EBD is a process used by architects, interior designers and facility managers in the planning, design, and construction of commercial buildings. An individual using evidence-based design makes decisions based on the best information available from research, project evaluations and evidence gathered from client operations. Critical thinking is required to develop appropriate solutions to design problems, since available information will rarely offer a precise fit to a client's situation. Therefore, research specific to a project's objectives is required. An evidence-based design should result in improvements to an organization's outcomes, economic performance, productivity and customer satisfaction.

      The process is particularly suited to healthcare, because of the unusually high stakes and the financial and clinical outcomes that can be impacted by the built environment; however, it may be used in other fields. Its positive effect is demonstrated by patients (who have higher-quality stays) and families; physicians, who practice based on medical evidence, and administrators, who reduce costs and improve organizational effectiveness.

      EBD is applicable to many types of commercial building projects. The building itself can help reduce stress experienced by patients, their families and caregivers. The healthcare environment is multifaceted; it is a work environment for staff, a healing environment for patients and families, a business environment and a cultural environment for the organization to fulfill its mission.



      • Environmental psychologists: Focus on stress reduction:
        1. Social support (patients, family, staff)
        2. Control (privacy, choices, escape)
        3. Positive distractions (artwork, music, entertainment)
        4. Nature (plants, flowers, water, wildlife, nature sounds)
      • Clinicians: Focus on medical and scientific literature:
        1. Treatment modalities (models of care and technology)
        2. Quality and safety (infections, errors, falls)
        3. Exercise (exertion, rehabilitation)
      • Administration: Refers to management literature:
        1. Financial performance (margin, cost per patient day, nursing hours)
        2. Operational efficiency (transfers, utilization, resource conservation)
        3. Satisfaction (patient, staff, physician turnover)
      • Evidence-based metrics: Includes research tools and methods for practitioners:
        1. Work measurement (time studies)
        2. Efficiency designs
        3. Patient and resource workflow
      • Reviewing existing research literature, selecting significant findings and recommendations
      • Matching referenced findings with data gathered from site visits, survey results and subject-matter experts
      • Predicting the outcome of design decisions
      • Tracking positive outcomes for design implementation
      • Level 1
        • Analysing field literature to follow related environmental research
        • Determining the evidence's meaning in relationship to the project
      • Level 2
        • Predicting expected outcomes of design decisions on general findings
        • Measuring results through analysis of implications and construction of a chain of logic from decision to outcome
      • Level 3
        • Reporting results publicly, moving information beyond design team
        • Subjecting methods and results to peer review
      • Level 4
        • Publishing findings in peer-reviewed journals
        • Collaborating with academic and social scientists
      • Analysing field literature to follow related environmental research
      • Determining the evidence's meaning in relationship to the project
      • Predicting expected outcomes of design decisions on general findings
      • Measuring results through analysis of implications and construction of a chain of logic from decision to outcome
      • Reporting results publicly, moving information beyond design team
      • Subjecting methods and results to peer review
      • Publishing findings in peer-reviewed journals
      • Collaborating with academic and social scientists
      • Designed infrastructure, including the built environment and technology
      • Re-engineered clinical and administrative practices to maximize infrastructure investment
      • Leadership to maximize human and infrastructure investments
      • The Patient Environmental Checklist assesses an existing facility's strong and weak points. Specific environmental features are evaluated by patients and their families on a 5-point scale, and the checklist quickly identifies areas needing improvement.
      • The Patient Survey gathers information on patients' experiences with the built environment. The questions range is wide, since patients' priorities may differ significantly from those of administrators or designers.
      • Focus Groups with consumers learn about specific needs and generate ideas for future solutions.
      • Cama, R., "Patient room advances and controversies: Are you in the evidence-based healthcare design game?", Healthcare Design, March 2009.
      • Hall, C.R., "CHD rolls out evidence-based design accreditation and certification", Health Facilities Management, July 2009.
      • Kirk, Hamilton D., "Research Informed Design & Outcomes for Healthcare" in Evidence Based Hospital Design Forum, Washington, January 2009.
      • Stankos, M. and Scharz, B., "Evidence-Based Design in Healthcare: A Theoretical Dilemma", IDRP Interdisciplinary Design and Research e-Journal, Volume I, Issue I (Design and Health), January 2007.
      • Ulrich, R.S., "Effects of Healthcare Environmental Design on Medical Outcomes" in Design & Health–The therapeutic benefits of design, proceedings of the 2nd Annual International Congress on Design and Health. Karolinska Institute, Stockholm, June 2000.
      • Webster, L. and Steinke, C., "Evidence-based design: A new direction for health care". Design Quarterly, Winter 2009
      • Sadler, B.L., Dubose, J.R., Malone, E.B. and Zimring, C.M., "The business case for building better hospitals through evidence based design". White Paper Series 1/5, Evidence-Based Design Resources for Healthcare Executives, Center for Health Design, September 2008.
      • Ulrich, R.S., Zimring, C.M., Zhu, X., Dubose, J., Seo, H.B., Choi, Y.S., Quan, X. and Joseph, A., "A review of the research literature on evidence based healthcare design", White Paper Series 5/5, Evidence-Based Design Resources for Healthcare Executives, Center for Health Design, September 2008.
      • A Visual Reference to Evidence-Based Design by Jain Malkin [1].
      • Study Guide 1: An Introduction to Evidence-Based Design: Exploring Healthcare and Design.
      • Study Guide 2: Building the Evidence-Base: Understanding Research in Helathcare Design.
      • Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process [2].
      • A Practitioner's Guide to Evidence-Based Design by Debra D. Harris, PhD, Anjali Joseph, PhD, Franklin Becker, PhD, Kirk Hamilton, FAIA, FACHA, Mardelle McCuskey Shepley, AIA, D.Arch [3].
      • Evidence-Based Design for Multiple Building Types by D. Kirk Hamilton and David H. Watkins [4].
      • Stout, Chris E. and Hayes, Randy A. The evidence-based practice: methods, models, and tools for mental health professionals. John Wiley and Sons, January 2005.
      • Ulrich, R., Quan, X., Zimring, C., Joseph, A. and, Choudhary, R., "The Role of the Physical Environment in the Hospital of the 21st Century". Report to the Center for Health Design, September 2004.
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