Research informed design, best practice, and fresh perspectives: can we all get along?

Abstract

Some healthcare design practitioners have adopted a design process that relies on information gleaned from credible and relevant research studies. Others continue to work in the realm of practices derived from long experience and deep understanding of their clients' issues. Some vocally advocate for the fresh perspectives of designers who are not burdened by ingrained habits and dogmatic assumptions about the best way to design for healthcare settings, contending that the only way to create great healthcare architecture is to avoid the so-called healthcare design experts. Are these mutually exclusive stances, or is there a possibility that there is a meaningful place for each approach? Can they all be applied in a single project situation?Research Informed DesignHERD has been a bully pulpit for advocacy of research informed design, or evidence-based design. The journal's editors and sponsoring organizations are on record as supporting the idea that better healthcare design decisions may be made by practitioners who refer to the scholarly literature and research findings in order to interpret their implications for a current design project.It is difficult, if not impossible, to argue that the opportunity for a better design decision addressing an issue deemed important by the client should be missed. If interpretation of credible scientific evidence and carefully measured outcomes from completed projects can help produce better results, possibly including better clinical outcomes, there would seem to be a significant, even moral, obligation to utilize a rigorous, research informed design process for the current project.When a highly regarded organization identifies reducing drug mixing errors as a key design issue for its proposed cancer center project, it might be helpful to turn to the literature to see what is known about the topic. An evidence-based practitioner might convert the design issue into researchable questions about drug mixing errors, environmental factors, and behavioral factors that could lead to relevant information that would influence development of design concepts intended to reduce errors. A better understanding of the role of interruptions, lighting, fresh air, and barcode technologies, as a few examples, could result in superior design decisions.Although such committed advocacy for a research informed design process sounds unwavering, it does not mean that every possible project, or every decision on a project, deserves the same rigorous process. A rigorous, evidence-based design process is advisable for addressing one or two key design issues on a project for which there is little available information, or for which there is no obvious solution consensus. That same extra effort and possible time commitment may be unreasonable if extended to a large number of less important design decisions. Which means that the vast majority of decisions on a healthcare project will likely be made on the basis of accepted best practices.Best PracticeHealthcare design has long been a specialty within the design field, based on the complexity of the clients' enterprise, and the extreme importance of life and safety for highly vulnerable populations. A number of design practitioners have developed a specialization in healthcare design, and practice at a high level of competence based on experience and continuous learning. These practitioners are using what the profession and the courts call best practice. They depend on detailed knowledge about the clients' requirements, and draw from a storehouse of relevant experience and local knowledge about the best way these issues have been addressed in the past.Organizations like the American College of Healthcare Architects (ACHA) and the American Academy of Healthcare Interior Designers (AAHID) set minimum standards for individual board certification in the specialty of healthcare design, and verify qualifications through examination and review of a practitioner's experience. …