Is Evidence-Based Design a Field?

Abstract

What does it take for area of practice and area of research to become a recognized field? Merriam-Webster's second definition for field after the land used by a farmer is an area or division of activity, subject, or profession (www.Merriam-Webster. com). Perhaps that simple definition already applies to the evidence-based division of design activity or to identifiable area within the design professions.If the design of healthcare facilities based on the best available information and credible research findings is a recognizable field, when and how did it begin? I like to think that architects designing hospitals have been trying to work with the best information since Florence Nightingale's observations on hospital design were published in the 1850s. Nineteenth-century hospital architects toured the renowned hospitals of Scotland and Germany, doing what we might today call benchmarking. The original design for Johns Hopkins by Dr. John Billings dating to the 1880s featured innovative chimneys to create a fresh-air draft across beds widely separated to reduce infection and minimize contagion. These and other design decisions that paralleled the Scientific Revolution were based on the best available information of their time, as were many of the design decisions for hospitals during the turn-of-the-century period and the years between World Wars I and II. As hospital design developed in the 1950s and 1960s postwar era, numerous changes occurred when architects and designers incorporated ideas inspired by the march of science and medicine.By the 1960s and 1970s, hospital design was the subject of several books, and hospital designs were based on careful predictions of utilization derived from demographic data and population projections. The identification of age cohorts, prevalent disease patterns, and historic utilization of services were needed to determine the number of beds, whether to expect a large volume of obstetric patients, and how many operating rooms to provide. Many of these designs were very much data driven. The evolving complexity of the facilities needed to support the delivery of advanced medicine produced the conditions in which healthcare design became a specialty field. This subset of architecture was marked by the growth of the American Institute of Architects (AIA) Academy of Architecture for Health (www.aaia.org/practicing/ groups/kc), which began shortly after World War II as a committee with a handful of members and today serves more than 6,000 members of the AIA. The evolution of the Academy subsequently led to the first examination-based, board-certified specialty among North American architects, the American College of Healthcare Architects.I was once encouraged by Professor Craig Zimring to think that a field wouldn't exist until university students felt that they could follow a productive course of study, publish their scholarly papers, and consider it as a legitimate and distinct career choice. I interpret this as a higher standard than the Merriam-Webster definition. For many years graduate students at Texas A&M University, Clemson University, the Georgia Institute of Technology, and the Medical Architecture Research Unit (known as MARU) at London's South Bank University (www.lsbu.ac.uk/ maru) have pursued specialized healthcare design education and found it to be a consistently productive path to steady employment. Today new and emerging programs at many institutions such as Arizona State University, the University of Kansas, the University of Nebraska, the University of Illinois-Chicago, Ball State University, the University of Texas-Arlington, the University of Texas-San Antonio, and the University of Washington indicate the increasing spread of specialty education. The Global University Programs in Healthcare Architecture organization apparently represents more than 30 specialized programs and their faculty from around the world (www. gupha.org). These universities have a number of academic researchers on their faculties who have chosen to work in areas that contribute to the growing body of relevant environmental science. …