Research or Evidence-Based Design: Which Process Should We Be Using?

Abstract

Many use the terms research and evidence-based design (EBD) interchangeably, but in fact, research and EBD have different but overlapping structures, processes, and outcomes. The purpose of research is to generate new knowledge, whereas the purpose of EBD is to translate existing research findings into practice, or to use research findings to guide decision making in the design of healthcare facilities. Both have an important role in advancing the field of healthcare design. The purpose of this column is to compare and contrast the terms research and EBD and to illustrate the importance of both processes in healthcare design.ResearchBy definition, research is the systematic investigation, testing or evaluation which is conducted to contribute to new generalizable or confirm/validate previous knowledge (U.S. Department of Health and Human Services, 2009). With that definition in mind, the purposes of research are to: (1) test assumptions and theories; (2) answer research questions and test hypotheses; (3) explore phenomena of interest; (4) determine differences between or among things; (5) explore relationships among things; (6) determine the causeand- effect relationships among variables (a phenomenon or concept of interest); and (7) predict that certain phenomena will result from the presence of specific variables (Polit & Beck, 2004).Research Questions and HypothesesWe often have ideas or notions about the impact of specific design features on outcomes; in fact, many of these notions have become accepted truths without the benefit of anyone testing their efficacy or reporting their effectiveness at achieving expected outcomes. These ideas can be trans lated into research questions that can be answered through scientific inquiry using research methods and procedures. For example: Is there a difference in the incidence of patient falls in the acute care setting with handrails on the headwall that connect to the bathroom compared to a room design without handrails? What is the effect of an open bathroom design on the incidence of patient falls compared to an enclosed shower design?Research questions lead to a hypothesis that can be tested using research methods. Hypotheses are statements of expectation: x is related to y; or x is different compared to y; or x predicts or causes y. Using the preceding research questions, the hypotheses could be: (1) The presence of a continuous handrail from the headwall to the bathroom will reduce the number of patient falls; and (2) An open bathroom design will reduce the number of patient falls in the bathroom. Both of these hypotheses can be tested by measuring the number of patient falls and comparing this number in two differently designed rooms. Research requires the measurement of the concepts of interest; but for the research to be valid and reliable, the measurements must actually measure what they intend to measure, and the measurements must be assessed in the same way each time a measurement is taken.Measurements can be conducted using questionnaires, observations, interviews, testing, biological measurements, surveys, and existing hospital data such as the number of falls, the number of nosocomial infections, length of stay, cost per discharge, or other such organizational or health information data. The type of analysis used to review the data is dependent on the design of the study (qualitative or quantitative); the type of data being gathered; the level of measurement (nominal, ordinal, interval, or ratio); and the types of questions being asked. The use of statistics helps minimize the possibility of reaching an erroneous conclusion about the findings or reporting an outcome that occurred simply by chance (Polit & Beck, 2004).Research Outcomes or OutputResearch findings result in a description of certain phenomena, a conclusion from the findings that can be generalized to other settings, and a recommendation for the use of the findings or additional research. …