Evidence-based Design Approach Research Articles

Outcome of Applying Evidence-Based Design to Public Computing Centers: A Preliminary Study

Establishment of public computing centers (PCCs) has often been implemented within the digital divide framework and viewed as only stepping-stones towards preferred private access. However, a range of research indicates the ongoing importance of PCCs to meet both private and public computing needs. We used an evidence-based design approach to guide the implementation of a redesign of an active PCC located in an economically depressed metropolitan region of Illinois, USA. Results indicate that physical design is critical and inseparable from the overall success of the lab, leading towards positive changes in the use and perception of the lab.

Healing architecture

The value of a new evidence-based design approach to healthcare architecture is described and the range of evidence available introduced. The paper then focuses on the challenge of applying empirical research knowledge to a creative design process. Examples are given of the results of such an approach and of how we can develop design tools to transfer complex scientific knowledge into a “designerly way of knowing”.

The Research-Design Interaction: Lessons Learned from an Evidence-Based Design Studio

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD-the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.

Rigor and Replication

During the many years Wilbur Tusler, FAIA, FACHA, served as president of the Coalition for Health Environments Research (CHER), he preached that the emerging field needed more good studies that could be repeated by others. Good studies meant increasing rigor in a field whose practitioners were relatively new to serious research and where the pool of academic researchers was small. He wanted to see practitioners and researchers repeat each other's studies so that the findings would gain validity. Tib was one of the founders of CHER and with his colleagues on the board he funded a modest line of research every year. CHER has since merged with The Center for Health Design, a cosponsor of this journal, and together they appear to be prepared to provide funding for more research in the future. We commend them for their continuing commitment to research in the field. They put their wallets where their hearts directed them, while their brains and accountants told them that there would be little return on the investment and that the research funding amounts were too small to make a major difference. This was a courageous path for a notfor- profit organization.Some have said that the number of academic researchers will continue to be small as long as research funding is limited and there are few outlets for publication in peer-reviewed journals. Career advancement in academia requires funded research and published papers. Others contend that evidence-based models of practice will not flourish until clients realize their value and request them, and unfortunately it seems that many executive suites in healthcare organizations have a marginal understanding of research-informed design. On a positive note, more credible research is occurring, HERD is offering the healthcare design field another outlet for publication, and more practitioners and their clients seem to be adopting some version of an evidence-based process. Design practitioners and their clients are eager for quality research findings that can be appraised for their efficacy in specific design projects and lead to improved clinical outcomes in safer, more economical buildings.Many in healthcare and in the design field are looking to HERD for new material. We are pleased that HERD has surpassed its annual goal for paid subscribers before the publication of its fourth issue, so there seems to be genuine interest in the field of environments for healthcare, the evidencebased design (EBD) of these environments, and growth in the body of rigorous, replicable research in this emerging cross-disciplinary field. Perhaps a snowball effect is occurring. The need for an EBD approach is being recognized, and the need for a journal that disseminates new research and ways to translate existing research into practice is gaining acceptance while it rolls down a gentle hill and grows toward a tipping point.As the field gains energy and attracts interest, another good sign of scientific rigor is that there are credible calls for cautious skepticism. Because an evidence-based model is difficult to challenge, and because its adoption might afford a potential advantage in the marketplace, some may be making unsupportable claims. An example of a call for caution is the recent advisory that the board of directors and staff of the American Society for Healthcare Engineering (ASHE) of the American Hospital Association sent to its membership. They were concerned with potential misrepresentations of the EBD concept and the apparently widespread application of this new design methodology. The ASHE advisory lists three concerns:* The insufficient and untested nature of the demanded and offered by EBD advocates as compared to the evidence available for evidence-based medicine;* The questionable quality and small quantity of evidence available to support design decisions; and* The differences between how is being used in building design and in medical treatment and care. …

Welcome to a Special Issue

As the United States enters one of the largest healthcare construction programs in its history-with construction projected to exceed $70 billion a year by 2011 (Jones, 2007)-many healthcare organizations are using evidence-based design (EBD) to help guide their capital facility investment. EBD relies on a deep and broad knowledge of the relevant evidence from research and best practice. However, as Zimring, Augenbroe, Malone, & Sadler (2008) say in their paper in this issue:At the core of EBD is a fundamental shift in the way healthcare organizations think about, deliver, and manage buildings. Rather than simply being regarded as cost centers, in EBD buildings are seen as strategic tools where strategic investments can yield important benefits. Yet to achieve these benefits, buildings must be planned, designed, and operated in a new way?. [A]n EBD approach is a structured process that establishes broad agreement on the principles underlying a design, articulates goals that must be satisfied to achieve those principles, and sets measurable, expected outcomes. (pp. 7-8)This special issue focuses on four sets of key questions that illuminate the practice and science of EBD:* How does a chief executive officer actually implement EBD? All projects have ambitious goals; how can this practice actually be infused into the thousands of decisions made in a multiyear healthcare project?* What is the overall business case for EBD and how does one build a business case for individual projects?* How can physical design development be linked to development of the culture of an organization?* What is the evidence base for EBD? Where is rigorous evidence about the impact of the built environment on key healthcare outcomes to be found?These articles are based on research conducted by a diverse group of thought leaders with funding from the Robert Wood Johnson Foundation. The purpose of this grant is to provide materials and tools that will help high-level hospital decision makers effectively implement EBD in their projects. As this project, conducted jointly by Georgia Tech, The Center for Health Design, and the research partners writing in this issue, is completed, it will yield white papers, webinars, a Health- Care Design Community Portal, and other tools.This issue of HERD includes four papers:1. Implementing Healthcare Excellence: The Vital Role of the CEO in Evidence-Based Design. This paper uses lessons learned from hospital leaders and the experience of the authors to create practical guidance for CEOs who want to use EBD as a tool to transform their organizations. In addition to keys to success, the paper also discusses barriers to innovation and strategies for overcoming these barriers. This paper provides a model for EBD that CEOs can use to create a facility that increases quality, safety, patientand- family centeredness, and revenue and that reduces cost. …