State of the Science in Healthcare Design.

Abstract

[Image omitted: See PDF.]In reflecting over the past 10 years of publications in Health Environments Research & Design (HERD ), I wondered if we made any progress in advancing the science of healthcare design. I know intuitively HERD has made a significant difference by disseminating new knowledge gained from healthcare design research and by supporting the application of an evidence-based design (EBD) process. HERD has facilitated the understanding of terms and concepts such as EBD, design research, research-informed design (RID), project evaluation including postoccupancy evaluations (POEs), and design process evaluations. Challenged by the question, have we really advanced the science of healthcare design? I decided to take inventory of the types of articles published from our very first issue in 2007 to the current Issue 9:4 (October/November 2016). I was surprised at the variety and depth of some topics which certainly indicates a depth of knowledge in some specific areas.Articles on EBDEBD clearly has been the buzzword for the last decade. Most firms claim to use an EBD process, even when they don't understand what EBD is or how or when it is integrated into the traditional design process steps. In the past decade, we published numerous articles focused on defining EBD and discussing various methods of EBD including statistical measures of findings compared before and after the completion of a project. Articles also discussed evaluating the quality and level of evidence that can be used to guide design decisions ([Marquardt & Motzek, 2013]; [Pati, 2011]; [Stichler, 2010], [2015]; [Taylor & Hignett, 2014]). The integration of EBD into the traditional design process has been discussed in other articles ([Carr, Sangiorgi, Buscher, Junginger, & Cooper, 2011]; [Martin, 2009]). It would seem we are approaching a fairly sophisticated understanding about the steps of EBD, and its importance in guiding design decisions; however, what seems to be missing is clarity around the integration of the EBD process into the traditional design process. Confusion continues about the similarities and differences between healthcare design research and EBD.Healthcare Design ResearchResearch articles testing a theory or hypothesis or evaluating the effect of specific design features on patients or staff outcomes been published. Methodology columns focused on teaching HERD readers about different research designs such as quantitative or qualitative research, statistical methods to use for data analysis, data collection methods, and evaluating levels and quality of research articles.The initial goal of HERD was to disseminate new knowledge developed from research that could be used in practice to shape design decisions. Numerous research articles been published focusing on the architectural design of specific clinical specialty areas such as emergency departments, birthing centers, children's specialty facilities, neonatal intensive care units, intensive care units, operating rooms, waiting areas, outpatient clinics, rehabilitation centers, psychiatric facilities, and long-term care facilities including special needs for the aging population, patients with dementia/Alzheimer's, or assisted living. Clearly, our body of knowledge about the effect of specific design in clinical areas on outcomes is growing. Several articles appeared more recently in the past 5 years on RID which is an offspring of EBD that limits the type of evidence used to inform design decisions to research evidence only ([Hamilton, 2013], [2014]). We are now approaching a depth of knowledge in some areas where RID is most appropriate.Research Focused on Patient and Staff ExperiencesI was pleasantly surprised to count approximately 37 articles focusing on patient and employee safety on a range of topics including design features to enhance (1) patient visibility from hallway workstations, (2) handwashing by locating sinks and hand gel dispensers in work areas, and (3) work efficiency with the placement of mobile and stationary computers for documentation of caregiving activities. …