Evidence-Based Design: What is It?

Abstract

While some debate the efficacy of evidence-based design, others believe firmly that evidence-based design for healthcare projects is a requirement for the design of safe and effective healthcare environments. The ways designers and healthcare leaders acquire, assess, and use evidence and how they search out remains elusive. Not only is there variability in the evidence-based design process from firm to firm and project to project, but there is also significant variation in how designers and healthcare clients define the term evidencebased anything-design, practice, nursing, and medicine. There is literature that features evidence-based management, manufacturing, marketing, policing, and agriculture. These definitional variations can create unrealistic expectations about the process and skepticism about its efficacy in making a real difference in patient, provider, or organizational performance outcomes. The purpose of evidence-based design is to make use of data from multiple credible sources to guide design-related decisions with the ultimate goal of improving the patient care experience, the staff work environment, and organizational performance.The term evidence-based design evolved from other disciplines that have used an evidence-based model to guide decisions and practices in their respective fields. The impetus for the evidence-based movement began in the United Kingdom in 1972. Dr. Archie Cochrane, an epidemiologist, was critical of physicians who did not apply findings in their practice and made clinical decisions based on tradition (We've always done it this way ), what they learned in school (even though it may have been outdated), or incidental, anecdotal findings shared by colleagues (e.g., hallway conversations). Cochrane espoused the need to develop a synthesis of findings that could be critically appraised by physicians and other clinicians for their use in guiding decisions in practice (Cochrane, 1972). Although Cochrane died in 1988, his work led to the development of the Cochrane Center at Oxford University in 1992 and later the Cochrane Collaboration (Cochrane Collaboration, 2001), which is the source of thousands of systematic reviews for randomized controlled trials to support clinical decision-making and practice protocols for medicine, nursing, and other health sciences.One of the first formal and widely accepted definitions of evidence- based medicine was put forth by Sackett et al. (1996), who stated that Evidence-based medicine is the conscientious, explicit, and judicious use of current evidence in making decisions about the care of individual patients. The practice of Medicine means integrating individual clinical expertise with the available evidence from systematic research (p. 71). Similarly, Muir Gray (1997) proposed a definition for clinical practice with an additional dimension: EB clinical practice is an approach to decision making in which the clinician uses the evidence available, in consultation with the patient, to decide on the option which suits the patient best (p. 102).The second Institute of Medicine report (2001), Crossing the Quality Chasm, indicated that the actual care received by individuals sorely lagged behind the pace of emerging themes identified in medical science and technology, contributing to significant breeches in quality. The report proposed 10 new rules deemed essential to improve the quality of healthcare, and rule number 5 challenged providers to use evidence-based decision making and to apply evidence in healthcare delivery. …