Dealing with Complexity through More Robust Approaches to the Evidence-Based Design of Healthcare Facilities

Abstract

IntroductionHealthcare systems and facilities provide settings for a wide range of activities and accommodate patients with everincreasing expectations regarding the quality of service provided. The planning and design of healthcare systems and facilities are often complex processes that have to provide flexible, adaptable, and multifunctional solutions to meet rapidly changing demands, and use effective stakeholder engagement processes to ensure that a wide range of current and future patients' needs are taken into account. Thus, new approaches to the planning and design of healthcare facilities have emerged, such as scenario planning, user-centered design, building information modeling, physical and virtual mock-ups, and simulation and visualization. These new approaches rely heavily on research evidence, thus increasing the need for robust evidencebased planning and design, especially in relation to the health-promoting aspects of built healthcare environments. To improve, innovation and new solutions are needed, though some may fail.Evidence-based design (EBD) provides an excellent process for the diffusion of innovation and learning from previous experience to lessen the impact of innovation failure. However, in some situations, EBD can encourage the status quo or it may not be suitable because of the context-specific nature of the evidence. Given the complex and parametric nature of many planning and design processes, new (enhanced) approaches to EBD must emerge. Such approaches should take into account current and anticipated trends, such as the increased need for flexibility; include robust methods of data (evidence) collection and analysis; provide mechanisms for effective stakeholder engagement; and be based on theory relevant to the complex nature of the problem.This issue of HERD includes seven articles:* Two articles capture current trends, especially in relation to the need for flexibility and adaptability to accommodate changing needs over time.* Two articles highlight the importance of robust data collection and different users' needs (focusing on patients' and parents' satisfaction regarding children's healthcare facilities).* Three articles provide some excellent ideas regarding the development of more robust and advanced approaches to EBD through the application of new concepts, undergirding theories, and principles.Current and Future Trends: Flexibility and AdaptabilityHealthcare provision in many countries is experiencing profound change, the main drivers being aging populations, increased public expectations about the quality of care, rapid advances in medical technologies and clinical practices, poor lifestyle choices resulting in increased obesity, and increased economic pressures. Healthcare systems and facilities must be sufficiently flexible and adaptable to accommodate different operational models over the lifetime of a facility. The articles by Carthey et al. and Kendall report on different and interesting aspects related to current trends. They consider* terminology and design-related strategies for flexible healthcare facilities; and* current trends in practice and the potential implications for architectural education.Carthey and colleagues report on different terms and strategies associated with healthcare facilities. The main goal was to identify practical, cost-effective, design-related strategies for making healthcare assets flexible. Initially, the authors systematically reviewed the literature from a wide range of sources to assemble and compile various definitions and terms used to describe flexibility and adaptability. Interestingly, they also identified varied applications of related terms such as convertibility and expandability. They suggest that there is a need to define flexibility and adaptability and associated terms more rigorously if future-proofing strategies that have been implemented are to be assessed appropriately. …