Evidence-based design

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Evidence-based design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. It is a process used by architects, interior designers, facility managers, and others in the planning, design, and construction of commercial buildings. An evidence-based designer, together with an informed client, makes decisions based on the best information available from research, from project evaluations, and from evidence gathered from the operations of the client. Critical thinking is required to develop an appropriate solution to the design problem; the pool of information will rarely offer a precise fit with a client's unique situation and therefore research that is specific to the project's objectives is almost always required. In the last analysis, though, an evidence-based design should result in demonstrated improvements in the organization's outcomes, economic performance, productivity, customer satisfaction, and cultural measures.

This is a method applicable to many types of commercial building projects, but is uniquely suited to healthcare because of the unusually high stakes and the financial and clinical outcomes that can be impacted by the built environment. The building itself can help to reduce the stress experienced by patients, their families, and the teams caring for them. The healthcare environment is a work environment for the staff, a healing environment for patients and families, a business environment for the provision of healthcare, and a cultural environment for the organization to fulfill its mission and vision.

A natural parallel and analog to evidence-based medicine, it is currently being used in the healthcare industry to help convince decision-makers to invest the time and money to build better buildings - and realize strategic business advantages as a result.

Research relevant to healthcare design can come from many areas:

• Environmental psychologists focus on stress reduction, which includes:
  1. social support (patients, family, staff);
  2. control (privacy, choices, escape);
  3. positive distractions (artwork, music, entertainment);
  4. influence of nature (plants, flowers, water, wildlife, nature sounds).
• Clinicians focus on medical and scientific literature, which includes:
  1. treatment modalities (models of care, technology);
  2. quality & 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 PDA (Time Study RN/MD);
  2. Design for Efficiency (Layout-iQ);
  3. Patient and Resource Workflow (Rapid Modeling).

Approximately 1200 credible studies with specific environmental relevance have been identified by The Center for Health Design in these areas, and many more applicable research citations are in other branches of the literature.

[edit] External links

• The Center for Health Design
• Role of the Physical Environment in the Hospital of the 21st Century report published by The Center for Health Design in 2004 that summarizes current evidence-based design research for healthcare.
• InformeDesign free online research database of studies linking the environment to outcomes.

[edit] Further reading

• 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]