Establishing a Substantial Link between Human and Environmental Welfare

Abstract

Research is viewed as an essential activity in the creation of design solutions to address the safety crisis in healthcare environments (Institute of Medicine, 1999). This issue of HERD contains research findings from qualitative and quantitative methods of inquiry and from exploratory studies to experiments, a discussion of theory building, and the presentation of tools for inquiry. Authors of these papers represent diverse experiences and viewpoints: they are current and former nurses/ nursing administrators, interior design and architecture practitioners and/or design firm researchers, and academicians. All discuss an evidencebased design (EBD) approach, while lamenting its limited influence on design practice. The issue is evidence; identifying and validating it is a paramount challenge, especially considered against the balance of design solutions and trends based on anecdotal information. These authors also note as a limitation the generalization of findings attributable to unique research settings, small data sets, and confounding variables. However, the insights and resources contained within these papers are impressive. A brief discussion of each paper is followed by questions to be considered.Ulrich and colleagues discuss origins, the development of EBD, and the benefits stakeholders could experience from its application to the design of the healthcare environment. They describe a conceptual framework for healthcare's EBD domain across nine design variable categories, identify knowledge gaps, and encourage the use of both. By providing categories (e.g., safety enhancement, sustainability) within their framework, their organizational structure helps the healthcare designer consider the current-perhaps overabundant-knowledge and information sources available.Zborowsky and Bunker-Hellmich ask and why now in reference to design practitioners' focus on EBD and the emergence of practicebased research (PBR) in architecture and design firms. They predict findings from PBR, adding to the knowledge gleaned historically from the disciplines of environmental psychology and cultural geography. Acknowledging the struggle of reconciling confounding research findings, Zborowsky and Bunker-Hellmich advocate for hypothesis creation and grounding design solutions in findings from testing theoretical frameworks. Moreover, stakeholders must be incorporated in the decision-making process in concert with the knowledge generated from PBR both inside and outside the design firm. They propose that sharing knowledge beyond the firm will require a paradigm shift in approach, attitude, and the design firm's economic model, but that doing so is an ethical obligation.Shoemaker's mixed-methods research study, described in Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case Study of Organizational Decision Making, addresses a critical issue: the impact of healthcare leaders' and providers' decision-making actions. Features that contribute to patient and staff safety, functionality, and well-being are addressed in this context in relation to establishing policy and identifying criteria that will form the basis of facility design and operations. Shoemaker's inquiry highlights the impact of leadership style and groupthink on design decisions that have human, environmental, and fiscal implications into the future. Most importantly, Shoemaker provides a framework and protocols for evaluating the influence of healthcare leaders' and providers' decisions relative to EBD concepts.Trzpuc and Martin's exploratory study focuses on the caregivers in the healthcare environment. …