Using Everyday Metrics as Evidence to Evaluate Healthcare Projects.

Abstract

Recently, when reviewing an article submitted to Health Environments Research & Design Journal for publication, the article's author indicated that leaders in healthcare design believed that evidence-based design (EBD) increased the total costs of a project. Needless to say, this comment sparked my interest, but there were no citations of personal communications or published quotes from the noted leaders. Personally, I have overheard other informal discussions asserting that research and EBD increase the costs of a project, but there certainly have not been any published evidence supporting such claims.It is possible that using evidence to guide design decisions can increase project costs while decreasing long-term recurrent operational costs with improvements in mechanical systems, water conservation, and productivity improvements. The Fable Hospital 2.0 article cites the cost-benefit analysis of specific design features, where evidence justifies initial incremental cost increases because of improvements in patient and staff safety, operational performance, access to capital, and sustainability ([Sadler et al., 2011]). While patient safety outcomes were previously intangible financially, value-based purchasing has made patient safety outcomes a tangible financial benefit with value-based purchasing and pay for performance. Therefore, evidence demonstrating the cost-benefit of a specific design innovation can potentially provide revenue enhancement for a hospital.[Image omitted: See PDF.]Perhaps a bigger question that must be addressed is related to the need to evaluate the efficacy and efficiency of healthcare projects. What business would ever invest hundreds of millions of dollars or even billions of dollars without any measurement of their return on investment? Likely, no businessesWhat business would ever invest hundreds of millions of dollars or even billions of dollars without any measurement of their return on investment? other than healthcare organizations and their respective boards of trustees would ever allow such an investment without significant measurement to indicate whether such an investment improved the organization's market share, reputation in the community, and employee work environments. Wouldn't they want improvements in satisfaction and retention, customer satisfaction or other customer metrics, or other business metrics including the bottom line? So, when I hear comments that design research to measure the effectiveness of specific design solutions drives up the cost of the project, I am simply amazed. Actually, I am surprised that we in the healthcare and design industries have not yet been forced by some mandate or regulation to report on the outcomes of our design decisions to the communities we serve, lending sources, and trustees. If we don't measure the outcomes of critical design decisions, how can we determine whether those design decisions were effective or should be repeated in future projects?If we don't measure the outcomes of critical design decisions, how can we determine whether those design decisions were effective or should be repeated in future projects? I am amazed that without a specific explanation, someone would say that EBD drives up the cost of a project. Essentially such a statement indicates that using credible evidence to guide design decisions always increases total project costs. Really? I am more concerned that not using credible evidence to guide design decisions will increase recurrent operational costs for the next 30-50 years and likely result in negative outcomes for healthcare providers, patients and families, and even the organization.Of course there may be reasonable cost increases to the project during the design process because of flaws or oversights in the original space program or even errors in the original project budget projections. It is also possible that new innovations or interventions to improve infection control (hand hygiene) or energy savings from newer releases in mechanical systems can be fully justified as increases to project costs. …