A Systematic Approach to the Inclusion of Evidence in Healthcare Design

Abstract

IntroductionThe Institute of Medicine (IOM, 2000, 2001) and The Joint Commission (2009) have identified threats to quality healthcare within health delivery systems stemming from both processes and the environment. Medical error and hospitalacquired infection threaten patients' health outcomes, creating burdens beyond what originally brought them into the health system. Lighting, noise, aesthetics, ergonomics, design layout, and services within the built environment can affect patients', families', visitors', and healthcare professionals' health and experiences (Codinhoto, Tzortzopoulos, Kagioglou, & Aouad, 2009; Ulrich et al., 2008).The Joint Commission (2009) sets forth five goals for effective facility design and management.These goals include:1. Reduce and control environmental hazards and risks.2. Prevent accidents and injuries.3. Maintain safe conditions.4. Maintain a patient-centered environment.5. Reduce environmental stress.The IOM (2000; 2001) identified variability in healthcare practices as a key contributor to poor outcomes. The basis of decision making also varies from past educational training and opinion to the best research available (Estabrooks, 1998; Estabrooks et al., 2005; IOM, 2000, 2001, 2004; Joint Commission, 2009; Pravikoff, Tanner, & Pierce, 2005; Sackett, Straus, Richardson, Rosenberg, & Haynes, 1996; 2000). Evidence- based decision making is widely accepted as an essential foundation for reducing variability and promoting safe and satisfying healthcare (Sackett et al., 1996; 2000; IOM, 2000, 2001). Many disciplines within the healthcare profession have embraced the notion of evidence-based practice (EBP) (Satterfield et al., 2009). The purpose of this paper is to propose a systematic approach to incorporating evidence into the healthcare design decision-making processes.Evidence-Based Decision MakingEBP has been defined in medicine and nursing as the incorporation of the best available research evidence with patient preferences, clinical context, and healthcare resources (Ciliska, 2005; Cullum, Ciliska, Haynes, & Marks, 2008; Sackett et al., 2000; Shaneyfelt et al., 2006). Evidence-based decision making becomes the process for achieving EBP and it involves asking a focused answerable question, acquiring evidence, critically appraising the evidence, applying the evidence to practice, and evaluating the process (Greenhalgh & Macfarlane, 1997; Sackett et al., 2000; Shaneyfelt et al., 2006).EBP models provide a vehicle for implementing EBP. Many models for systematically moving evidence into practice have been described. Proponents define a transdisciplinary approach to evidence-based decision making (Baumbush et al., 2008). The structures and processes espoused by the various models vary based on theoretical perspectives of originators but all have the main steps of evidence-based decision making incorporated within them (Greenhalgh & Macfarlane, 1997; Baumbush et al., 2008).Evidence-Based DesignThe specialty of built environment design is embracing evidence-based decision making (Cesario, 2009; Hickey, 2010; Hignett & Lu, 2010; Joseph, 2006; van de Glind, de Roode, & Goossensen, 2007). Evidence-based design is informed by multiple perspectives, including those of architects, engineers, interior designers, healthcare professionals, patients, regulatory guidelines, and research evidence. The health, safety, and satisfaction of both patients and caregivers comprise the broad focal areas of space design (Cesario, 2009; Hignett & Lu, 2010; Joseph, 2006; van de Glind et al., 2007).The research literature demonstrates the connections between the physical and social environment and the promotion of health, safety, and effectiveness outcomes for patients and caregivers. Aspects of environmental design include lighting, noise, aesthestics, ergonomics, and room and unit layout (Codinhoto et al. …