Evidence, Decisions, Guidelines, and Standards

Abstract

HERD promotes the concept of research-informed design for health environments. I have written that design professionals should consider a rigorous process for the examination of relevant evidence and the development of appropriate design interventions for important projects (Hamilton & Watkins, 2009). This suggests that I am a proponent of rational decision making, and indeed I am. On the other hand, I also recognize the need for balance. Most decisions on architectural, engineering, or design projects are made on the basis of practice. The majority of design decisions are made expeditiously and based on prior experience with similar situations, familiar materials, and known technologies. This is as it should be. Some decisions are made on the basis of experiment or artistic choice. This is also as it should be, because architecture is still an art.Are Decisions Ever Truly Rational?Rational decision making would appear to be the logical outcome of an evidence-based process. Decisions based on careful interpretation of credible evidence would seem to help us avoid subjective, intuitive, emotional, or purely aesthetic decision making. For some who observe that architecture lacks rigor, rationality is a positive goal. Yet architecture has always been a blend of science and art. I believe it always will be.Making decisions is a fascinating capability of the human brain, and our brains use a wonderful mix of rational (neocortex) and emotional (limbic) processes to make decisions. The rational factors are more readily accessible to being put into language, and so we tend to be more aware of them. But the emotional factors drive the bus. (A. Kruse, JD, MSOD, personal communication, February 24, 2009)So while we yearn for answers to important questions and for guidance at critical moments in the design process, not all decisions can be expected to be rational. Furthermore, some decisions we believe to be rational certainly have been influenced by our subconscious emotional responses. Neuroscience tells us that there is no such thing as a totally rational decision (Lehrer, 2009). Many in the design professions would argue that irrational or emotionally intuitive decisions are frequently those that produce the highest quality architecture and design. Such people would argue against any limitation on the freedom to perform design in their own individual and idiosyncratic way.What Is the Role of Standards......in a field that demands both rigorous and artful decisions? Many who practice or employ design are eager for strong, credible evidence that can lead to reliable guidelines and standards. Strong guidelines can simplify decisions and codify best practice in a way that satisfies our rational brains. When I was in architectural practice, I had health system clients who initially expected that design professionals who relied on evidence would be able to produce readily available answers to their problems. These clients did not realize that evidence- based design is a process, not a product. While it is tempting to believe that an exhaustive search of the relevant literature, careful interpretation of the implications of the research, the development of related and derivative design concepts, the construction of a physical structure, measurement of the associated outcomes, and a subsequent published report lead to certainty about a topic, such confidence may be premature.The evidence in every field-especially in medicine- is constantly evolving and growing, so rigid standards based on findings that can easily be superseded are likely to be inappropriate. The evidence from environment-behavior studies and many types of social science research in complex, multivariable settings is often less conclusive than the quantitative studies one associates with medicine and the hard sciences. Evidence applied to one situation may produce a completely different recommendation in another situation. …