Evidence-based Design Process Research Articles

Color scheme: Implementation Evidence-Based Design for Palliative Care and Hospice Building

The number of patients suffering from cancer has increased 27.8% per 1000 population from 2013 to 2018 and most of cancer patients come from Jakarta. Based on interviews with health workers and cancer patients, it can be concluded that there are problems in terms of space requirements and space design in current palliative care and hospice care facilities. This study uses a qualitative method. The data used for this study came from interviews as part of the Evidence-based Design (EBD) process, which was then analyzed using coding techniques and precedent analysis to draw conclusions. It was found that color is an element that can influence human health, the preference for color by cancer patients in Indonesia is in line with the color preference for hospice buildings and cancer health facilities in western countries, and it was also found that cancer patients need a communal area, consultation area, therapy area, spiritual area, and in-patient area. Each of these areas requires a different color scheme.

How to Engineer eLearning: An evidence-based human-centered design process for modern times

This review highlights Learning Engineering Toolkit: Evidenced-based Practices from The Learning Sciences, Instructional Design, and Beyond edited by Jim Goodell and Janet Kolodner. Learning Engineering Toolkit serves as a detailed field guide to the collaborative and interdisciplinary aspects of learning engineering. Using an e-Learning and instructional design perspective, this review critically examines the core of the book's message; a foundational definition for learning engineering; and associated themes, strategies, and tools used to illuminate this promising field.

Viewpoint on what may be considered as evidence and how to obtain it when designing health-promoting and inclusive green spaces

PurposeThe point of departure for this viewpoint paper is the current development in which landscape architects are working towards achieving the United Nations sustainable development goals and the associated cross-cutting pledge “Leave No One Behind”. The sustainable development goals 3 and 11 can be achieved through landscape projects that are inclusive and health promoting, and the authors argue that an evidence-based design process is needed to ensure that project designs deliver what they promise. However, most landscape architects are not trained in evidence-based design and are therefore unsure of what can be used as evidence. A further challenge is the lack of relevant and applicable research evidence for design processes.Design/methodology/approachThe authors present a process model for evidence-based health design in landscape architecture as an overall framework on which the authors base their arguments. The model includes four topics of evidence: target group, human health, environment and use of nature. For each topic, the authors present their view on what may be considered as evidence and where it can be found or generated. The study view is supported by a detailed presentation of where and how evidence was found and generated in a design project for an accessible and health-promoting forest trail for people with mobility disabilities.FindingsThe authors suggest a broad definition of evidence, and that the design process should draw on evidence from relevant research and practice disciplines. Evidence can be found in multiple sources, for example, scientific articles, theoretical works and design guidelines. It can also be generated by landscape architects themselves, for example, through landscape analyses and stakeholder workshops. The evidence should guide and support the landscape architect and not dictate the design process.Practical implicationsThe authors hope that the knowledge provided on the evidence-based health design process and on where to collect or how to generate evidence may inspire landscape architects in their future health design projects.Originality/valuePeople with mobility disabilities face many health challenges and should potentially be able to benefit from visiting green spaces. The authors hope that the knowledge provided on the evidence-based health design process and on where to collect or how to generate evidence may inspire landscape architects in their future health design projects.

A process to foster pathology-related effects of design primes - how orthopedic patients might benefit from design features that influence health behaviour intention.

A growing body of literature mainly in the context of consumer research indicates that the formal-aesthetic and conceptual design of objects can influence users' thoughts, emotions and even behavioural patterns. While there is strong evidence regarding these effects on actual purchasing decisions, evidence on the effect of aesthetic design features (e.g., haptics, colour) on health-related mental concepts and intentions for health behaviour change is scarce. Based on insights from material and conceptual priming, this article illustrates the research-driven and evidence-based design process of two design primes and comprises pre-tests and an experiment in two settings on the effect of design on health behaviour focusing i.a. on intention for health behaviour change. In an evidence-based and research-driven process, two lecterns were designed to work as primes, i.e., to have a positive vs. negative influence on several mental constructs (sense of control, sense of coherence, resiliency, self-efficacy) and health-related intention. The lecterns differed mainly in terms of aesthetic appearance (e.g., material, colour, proportion, steadiness). They were tested in (a.) a university setting with students (n = 83) and (b.) a clinical setting with orthopaedic rehabilitation patients (n = 38). Participants were asked to perform an unrelated task (evaluation of an unrelated product) while standing at and using the lecterns. Overall, t-tests and Mann-Whitney-U tests show no significant differences but differing tendencies in a mentioning task. When asked to name health-promoting activities, in the clinical setting, participants using the "positive" prime (i.e., the steady lectern, n = 13) mentioned more sport-related aspects on average and a higher portion of sport-related aspects of their answers than participants using the "negative" prime (n = 11). In the university setting (positive: n = 36; negative n = 38), no such differences emerged. This finding gives reason to believe that the prime might be specifically effective in the clinical setting as it relates to physical activity being the most relevant topic of the patients' pathology.

Evidence-Based Design Process for Nutrition-Sensitive Agriculture Interventions: A Case Study of the Advancing Local Dairy Development Programme in Nigeria.

Nigeria is a significant contributor to the global burden of chronic undernutrition in children under 5 years of age. The undernutrition challenge constrains the productivity of rural households. This study was carried out among beneficiaries of the productivity-enhancing Nigerian Dairy Development Programme (NDDP) to guide incorporation of nutrition into the successor program-Advancing Local Dairy Development in Nigeria (ALDDN). Therefore, this study contributes to the literature about operationalizing nutrition-sensitive agricultural frameworks. The study sought to determine potential entry points for improving the nutrition of smallholder dairy farmers (≤ 5 milk cows) with a focus on food system entry points. Primary data were collected from 514 smallholder dairy households in Oyo and Kano states of Nigeria. Both quantitative and qualitative data were collected. Quantitative data collected included minimum dietary diversity for women, nutrition status, and socioeconomic characteristics of households. Qualitative data included information about sources of food, markets, and other food system characteristics. Quantitative data were analysed using descriptive statistical tools and correlation analysis, while common themes were identified from qualitative data. The study showcased men's important role in food purchase and consumption, particularly in Kano. Increasing opportunities and the ability of women to use nutrition education appeared necessary for translating knowledge into improved practices. The own consumption (i.e., the portion of the milk kept for households' consumption as well as diversification of foods produced for consumption); income; women's empowerment; and environmental sanitation pathways seemed to be the most feasible pathways for improving nutrition within the context of the study population.

The Nonvisual Legibility and the Coherence of Space: A New Theoretical Framework with Examples of Its Implementation in Empirical Research

The legibility and coherence of space are informative qualities as they facilitate the understanding and exploration of the environment. They also function as categories in architectural and urban design theory, as well as environmental psychology. The approaches of those disciplines, including their contemporary continuations, evolved from Lynch (1960) and are based solely on the visual qualities of the environment.In this article, I argue that relying only on the visual scope of human-environment relations is insufficient for inferring the user’s perception of the environment as legible and coherent and evaluating design solutions from the users’ perspectives. The proposed revised theoretical framework combines architecture and urbandesign perspectives with environmental psychology and broadens concepts of legibility and coherence. The revised framework combines the visual scope of the legibility and coherence with other aspects of human-environment relations by referring them to multisensory perspective, social and spatial functioning, levelsand characters of stimulation, and affective appraisal of the environment. To show how we can address this broadened approach to legibility and coherence in empirical research, I present two examples of experimental research using bimodal research materials. They present how nonvisual qualities contribute to legibility and coherence and how they can be measured (tested) during the data-driven evidence-based design process. The first experiment investigates the relationship between the qualities of soundscapes and the social functioning of users. The second covers the tactile and haptic dimensions and their connections with blind and visually impaired users’ spatial functioning.

From Evidence to Design Solution—On How to Handle Evidence in the Design Process of Sustainable, Accessible and Health-Promoting Landscapes

The work of landscape architects can contribute to the United Nation’s Sustainable Development Goals and the associated ‘Leave no one behind’ agenda by creating accessible and health-promoting green spaces (especially goals 3, 10 and 11). To ensure that the design of green space delivers accessibility and intended health outcomes, an evidence-based design process is recommended. This is a challenge, since many landscape architects are not trained in evidence-based design, and leading scholars have called for methods that can help landscape architects work in an evidence-based manner. This paper examines the implementation of a process model for evidence-based health design in landscape architecture. The model comprises four steps: ‘evidence collection’, ‘programming’, ‘designing’, and ‘evaluation’. The paper aims to demonstrate how the programming step can be implemented in the design of a health-promoting nature trail that is to offer people with mobility disabilities improved mental, physical and social health. We demonstrate how the programming step systematizes evidence into design criteria (evidence-based goals) and design solutions (how the design criteria are to be solved in the design). The results of the study are presented as a design ‘Program’, which we hope can serve as an example for landscape architects of how evidence can be translated into design.

Specialty Space: Breast Care Centers.

As background, breast care centers around the world vary in interior design based on geographical location and the trends of the healthcare design process at the time of construction. However, at the forefront of healthcare interior design is the evidence-based design (EBD) process and the Universal Design (UD) guidelines. The Center for Health Design states that the EBD process differs from the linear design process, in that EBD uses relevant evidence to educate and guide the design decisions. The objective of this study was to support future EBD and UD use in the development of patient areas in breast care center interior design. The methods for this study incorporated an extensive review of the literature, examples of eight breast care centers around the world, observations, an interview, and a staff survey concerning the interior design of a local breast care center. The results revealed that using the EBD process and UD, to develop guidelines for patient areas in breast care centers' interior design, directors could use guidelines to evaluate existing breast care centers or preconstruction for new breast care centers. This study concluded with design guidelines for patient areas in breast care center interior design. The recommended guidelines targeted the following features: robes (vs. hospital gowns), spa-like atmosphere, monochromatic color scheme, use of wood and stone, private check-in areas, wayfinding, room temperature comfort, seating comfort, seating style choices including bariatric, personal items storage, access to natural light, indirect artificial lighting, living plants, views of nature, flooring comfort, and wheelchair accessibility.

The role of evidence-based design in informing health-care architects

PurposeThis study aims to trace the relationship between the evidence-based design (EBD) process and decision-making during the architectural design process, the barriers to informing health-care architects and possible methods to overcome these barriers.Design/methodology/approachThis study aims to explore the barriers to the EBD process during the design process by reviewing the relevant literature and future steps to overcome these barriers and support design decisions.FindingsThe study shows that EBD is a relevant, useful tool for providing evidence that positively affects design decisions. This study divides EBD barriers into simple barriers and complex barriers, depending on the nature of the barrier. Additionally, methods to overcome these barriers are discussed to ensure the best use of EBD findings with a significant impact on health-care design decisions, as they are core elements in informing architects, especially when combined with the traditional design process. This study investigates how likely it is for the EBD to contribute optimally to design decisions depending on architects’ skills and cooperation with researchers.Originality/valueThis study can apprize health-care architects of the need to consider the role of EBD in improving the quality of design decisions, and the importance of combining EBD with the traditional design process to implement optimal design decisions.

Evaluación de la arquitectura hospitalaria: unidad de neonatología

La búsqueda de la eficiencia y la calidad es especialmente relevante en la arquitectura sanitaria ya que su diseño tiene una repercusión directa en los resultados clínicos obtenidos. Dentro del hospital, la unidad de neonatología es el lugar donde se atiende a los pacientes más vulnerables al entorno que les rodea. Este estudio evalúa el diseño de dos unidades españolas en relación con las guías de diseño nacionales y las recomendaciones del proceso de diseño basado en evidencias a partir del análisis de sus plantas, fotografías y la herramienta de evaluación post-ocupacional CURARQ-UNeo. Los resultados identifican las posibles actuaciones de mejora para cada unidad. Este tipo de evaluación puede impulsar el avance del proceso de diseño basado en evidencias en España con la finalidad de que las decisiones del proyecto contribuyan a mejorar la calidad de vida de los neonatos, sus familiares y el personal de una unidad de neonatología.

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development.

BackgroundAdolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use.ObjectiveThe current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content.MethodsWe developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development.ResultsConsistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow).ConclusionsReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process.

The use of lighting simulation in the evidence-based design process: A case study approach using visual comfort analysis in offices

The EBD-SIM (evidence-based design, simulation) framework is a conceptual framework developed to integrate the use of lighting simulation in the EBD process to provide a holistic performance evaluation method. A real-time case study, executed in a fully operational office building, is used to demonstrate the framework’s performance. The case study focused on visual comfort analysis. The objective is to demonstrate the applicability of the developed EBD-SIM framework using correlations between current visual comfort metrics and actual human perception as evaluation criteria. The data were collected via simulation for visual comfort analysis and via questionnaires for instantaneous and annual visual comfort perception. The study showed that for user perception, the most crucial factor for visual comfort is the amount of light on a task area, and simple metrics such as Eh-room and Eh-task had a higher correlation with perceived visual comfort than complex performance metrics such as Daylight Autonomy (DA). To improve the design process, the study suggests that, among other things, post-occupancy evaluations (POEs) should be conducted more frequently to obtain better insight into user perception of daylight and subsequently use new evidence to further improve the design of the EBD-SIM model.

A digital workflow to quantify regenerative urban design in the context of a changing climate

The regenerative approach to design goes beyond limiting the environmental impact of the built environment and towards the enrichment of the ecosystem, adaptation to climate change, and the improvement of human health. This concept is being applied to buildings through new standards such as the Living Building Challenge, yet examples of implementation of regenerative design at the urban scale are rare. While this is a promising direction for sustainable design, in theory new metrics, design tools and workflows need to be developed to translate regenerative design concepts into practice effectively. Among other factors, barriers to implementation remain rooted in the shortcomings of existing urban simulation tools to evaluate a wide range of performance metrics simultaneously. This paper thus proposes a prototype workflow to evaluate regenerative performance using existing evaluation tools in a single digital workflow. A series of existing and customised plugins, most of which are already in use and open source, were integrated into a multi-parametric workflow based on the Grasshopper visual programming tool. The workflow was tested on Malaga as a case study and incorporated key performance indicators related to outdoor human thermal comfort, biophilia, daylight performance, and energy use and production, based on data exchange and synergies across the different tools. These indicators were evaluated for present and future climate scenarios obtained from a weather generator. This paper demonstrates the potential of this workflow to receive visual feedback on various aspects of regenerative urban design, thus enabling designers to more effectively pursue an evidence-based urban design process.

“I look at my own forest and fields in a different way”: the lived experience of nature-based therapy in a therapy garden when suffering from stress-related illness

ABSTRACTEvidence confirms that nature-based therapy (NBT) has a positive effect on people with mental illnesses. However, there is a lack of evidence on the meaning of NBT for specific patient groups. The Nacadia® Therapy Garden was designed according to an evidence-based design process, and an NBT programme was developed. The aim of the study was to illuminate the phenomenon of participants’ lived experience of the NBT in Nacadia. Fourteen participants took part in semi-structured interviews (SSIs), and by way of reflective lifeworld research, the SSIs were analysed to identify and describe the meanings of the phenomenon. The essence of the phenomenon was found to be a process of adopting a searching approach to NBT and Nacadia to become familiar with the conditions. This familiarity stimulated the development of confidentiality and attachment to Nacadia. Feeling protected, safe, cared for, and not exposed was important, and motivated feelings of freedom, reduced demands, and increased the ability to access and try a spectrum of NBT activities. It encouraged participants to develop personal approaches and coping strategies to implement in their everyday lives for moving on.

New language outcome measures for Mandarin speaking children with hearing loss

ObjectiveThe paper discusses recent evidence on the assessment of language outcomes in children with hearing loss acquiring oral language. MethodsResearch emphasizes that language tests must be specific enough to capture subtle deficits in vocabulary and grammar learning at different developmental ages. The Diagnostic Receptive and Expressive Assessment of Mandarin (DREAM) was carefully designed to be a comprehensive standardized Mandarin assessment normed in Mainland China. ResultsThis paper summarizes the evidence-based item design process and validity and reliability results of DREAM. A pilot study reported here shows that DREAM provided detailed information about hearing impaired children's language abilities and can be used to aid intervention planning to maximize progress. ConclusionDREAM represents an example of translational science, transferring methods from empirical studies of language acquisition in research environments into applied domains such as assessment and intervention. Research on outcomes in China will advance significantly with the availability of evidence-based comprehensive language tests that measure a sufficient age range of skills, are normed on Mandarin speaking children in mainland China, and are designed to capture features central to Mandarin language acquisition.

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

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. …

Intuitive Hypothesis and the Excitement of Discovery

Lance Kubiak, MArch, is a former student of mine now working as an architectural intern in California. In a recent conference presentation about his design of facilities for the Veteran's Administration and wounded warriors suffering from traumatic brain injury and post-traumatic stress syndrome, Kubiak made reference to that is catching up to practice. His comment reflects the fact that we don't have evidence for all that we do, or all that is successful in our projects. Much that we design must inevitably be generated from a creative, intuitive decision, the result of which the architect simply believes will be worthwhile. I suggest the obligation for an evidence-based practitioner is to deliberately state the design hypothesis embedded within the intuitive decision, and to carefully measure the related outcomes. Study results can measure the wisdom of the intuitive decision, contribute important knowledge, and validate Kubiak's notion that there are instances where the evidence still needs catch up to explain what has already been done in the course of practice.Discovery that an intuitive decision was a success can be exciting. What is missing is the process of sharing this type of result in a way that others might learn from it. I wish more practitioners would document and confirm their intuitive design hypotheses with careful and thorough measurement. If studied using an appropriate methodology, the findings can be published to inform and advance the field.I was in Sweden the summer of 2013, conducting a workshop with my former faculty colleague, Roger Ulrich, PhD, now of Chalmers University of Technology. Ulrich used slides to describe an outstanding design for a recently constructed Swedish mental health facility. He suggested that there are 10 evidence-based concepts well suited to mental and behavioral health environments, and proceeded to use a specific project to demonstrate how 9 of those 10 concepts had been successfully incorporated into a design (Ulrich, 2013).The project was Ostra Hospital in Goteborg, by White Arkitekter and Stefan Lundin. Ulrich declared that designs to reduce human aggression in particular are important because violence seems to be increasing in behavioral health settings. He cited the project's designs to minimize noise and crowding, as well as enhance the patients' coping with a sense of control, calming distractions, and natural light. Movable seating in the day room, for example, could be described as contributing to a sense of personal control.This new, award-winning Swedish hospital was an attractive setting for statefunded psychiatric care, and appeared to be a good example of design based on understanding the results of research. Ulrich and his colleagues studied the outcomes at Ostra and compared them with two other psychiatric facilities, each with only one of the recommended stress-reducing features. One was the facility that Ostra replaced. Data on proxies for incidents of aggression showed the use of restraints fell by 44% and the need for sedation medication dropped by 21%. These were dramatic improvements.Stefan Lundin, the architect of Ostra, who has since become a good friend, was in the room with Ulrich and me and claimed that he had no prior knowledge of Roger's 10 concepts. His designer's intuition, knowledge of the client, and empathy for the patients had led him to a design solution that had, apparently entirely by coincidence, matched the research-informed guidelines produced by a recognized scholar. An intuitive decision need not be a poor decision. Understandably proud of the results, Lundin was still skeptical about the value of an evidence-based design process because he had not employed such a method. His ability to produce high quality design decisions that anticipated findings from credible research is not surprising. Many aspects of the very best in historical and vernacular architecture have eventually been supported by research studies. …

Using an EBD Approach for Healthcare Design

Those of us who work in the world of evidence-based design (EBD) are often under the illusion that everyone believes as strongly about using an evidence-based approach in healthcare design as we do. Apparently this is not the case-for some, EBD is still merely a marketing strategy rather than a solid approach to use in the design of healthcare facilities. This became clear to me at the 2013 Healthcare Design conference in Orlando. While riding the bus from the conference site back to my hotel one evening, I overheard three gentlemen with me on the bus discussing a session about EBD that they had attended. Without introducing myself as the co-editor of HERD, I joined their conversation and asked them if they an evidence-based approach in their They all answered with an enthusiastic yes. I asked how they found the evidence to guide their design projects. After a few moments of silence, one stated that he simply asked the client what they wanted in the and another answered that he used experience from past projects to guide his work. Next, I asked what journals they read to guide them in their project decisions. One answered that he occasionally read Healthcare Design. Since none of them mentioned HERD, I asked them, Do you ever read HERD? I was saddened to discover that one of my fellow passengers had never heard of HERD. The other two gentlemen explained that they had seen HERD but felt that it was too technical for them to use for their everyday practice.Of course this wasn't what I wanted to hear, being completely enthusiastic about HERD and EBD. Remember, all three gentlemen had said they EBD, but they didn't read any journals. This conversation validated my suspicion that some people will tell you that they use an evidence-based approach to healthcare design, when in fact they may do little to search for credible evidence to guide their project decisions. The conversation also caused me to reflect on factors that architects and designers at the grassroots level may consider to be barriers to using an evidence-based approach in their design. Therefore the aims of this editorial are to discuss frequently cited barriers to EBD and demystify the EBD process, making it easier for design practitioners (my buddies on the bus) to actually use evidence in their practice.Barriers to EBDThere are several aspects to an evidence-based approach in design that some may perceive as barriers. Some may believe that EBD is too costly, that they must add extra steps in the design process to accomplish EBD, yet there are few design firms who add extra charges for an EBD approach. Perhaps the notion that EBD adds costs to a project stems from the misconception that EBD implies a pure research methodology, when in fact EBD is the use of and application of existing evidence (research findings, observations, expert opinions, past experiences) to guide decision making in the design process. Working with the pure definition of EBD, no additional costs should be incurred in the process. On the other hand, if a formal research study is being conducted for a project, it is possible that additional costs may be incurred with the hiring of a research consultant (if necessary), the data collection process, the data analysis, and the dissemination of the research findings at national conferences or in professional journals.Another commonly cited barrier was mentioned by my fellow bus passengers, who indicated that research articles were too technical or too intimidating to read. Unfamiliarity with the research process, statistical analysis, and research terms can certainly be a barrier to those who have not had the opportunity, experience, or education in the research process. HERD has attempted to minimize this barrier by adding the Implications for Practice section to every article and will soon be adding a new feature, the Executive Summary section, which can be quickly perused by any reader for a quick synopsis of the purpose and findings of the article. …

Design Decision Making and ICU Life Support Systems

What kind of evidence would help a design team confirm an important decision, such as the choice of a life support system for an intensive care unit? How can a research-informed or evidence-based design process assist in making such a decision? (Hamilton & Shepley, 2010)The design of a hospital intensive care unit (ICU) patient room, where critical care is provided to seriously ill patients by specialist physicians and nurses, is significantly influenced by the type of life support system chosen for the design, such as a headwall, power column, or overhead boom configuration (Hamilton, 1999; Hamilton & Ulrich, 2008). Why do designers and their clients choose one system over another? The decision often seems to be made based on familiarity with one system or another, or purely on cost. What evidence could be used in making this decision as part of a design project?The headwall model, in which the utilities and physiological monitors are locat- ed on the wall behind the head of the bed (see Figure 1), is the most common choice. Familiarity with this model may influence its use; it has been the prin- cipal system in ICUs since their beginning, when the ICU was an adaptation of the surgical recovery room model. Clinicians who have experienced only this model may understandably favor it. Another factor is that a headwall configu- ration can be the most economical choice. In the case of a crisis, or code blue situation, the bed must be pulled off the headwall to allow someone to stand behind the head to ensure that the patient's airway remains open. Difficulties for staff associated with stepping over lines and cords, and potentially disconnect- ing something important, is an inconvenience at best and a problem with serious health consequences at worst.The power column system is the second most common choice (see Figure 2). The power column is a vertical system, standing floor to ceiling, typically located diagonally off the head of the bed. It has connections for medical gasses, out- lets for electricity, and uninterrupted power. A power column has a bracket on which to mount the physiologic monitor, and usually includes baskets or shelves for necessary items. It often has an attached sphygmomanometer.More recently, ceiling-mounted boom systems have been introduced, with over- head swiveling pendants to support the monitor, gasses, electrical connections, and other utilities (see Figure 3). The overhead boom life support model is similar to a power column, except that it is not attached to the floor, and can be moved to different positions. The ceiling-mounted boom system can include a pair of booms, and thus a pair of pendants with utilities and other features.Because these different systems to deliver life support technologies perform in different ways, they influence staff activity and behaviors (Gallant, 2001), although comparisons are possible (Pati et al., 2008). Flexibility and adaptabil- ity increases as one moves from headwall to power column to overhead booms. The power column obviates the need to move the bed and the risk of umbilical disruption. The overhead boom in turn allows greater movement of the bed and multiple possible positioning options, as well as the ability to swing it out of the way when desired.If I were still in practice as a hospital architect, or in a consulting role for an organization involved in the design of a new critical care unit, I would consider the choice of a life support system to be a key design decision requiring serious attention. Sometimes the program of space requirements will include a specific square footage that may restrict the choice, but design of the patient room can- not be completed without this decision.I have suggested that identifying the key design issue and turning it into a researchable question is an early step in an evidence-based process. To do this we would need definitions of life support systems, identification of the various choices available, and an understanding of the uses to which such systems may be put. …

Evolving Roles for Practice-Based Researchers

These times are witnessing interesting changes in the practice of architecture and the evolution of a design process that depends to varying degrees on the availability of reliable, relevant evidence. As this continues to evolve, there are paths for those who seek effective ways to use the best available research in making better design decisions, and paths for those who seek to perform useful and practical research to benefit design practice. At the same time, firms have begun to hire individuals with research credentials, either as traditional young professionals who have some training in research methods or as trained researchers who intend to use their doctorates in practice rather than academia.This is quite new, because few professional design programs have had extensive exposure to rigorous literature searches, research methods, the evaluation of findings, and scholarly writing. Further, in the past, typical well-trained doctoral students had no hope of entering practice because they were ex- pected to become faculty members at universities. Some PhD graduates felt the need to conceal their credentials to get jobs in practice. This is no longer the case as more options for trained researchers are now becoming available.Highest and Best Use of a Highly Specialized ResourceWhat, then, does the firm do to make the best use of this new kind of human resource? Can this expertise be acquired through an external consultant? How should the typical firm of design professionals integrate this new type of employee? How can such people be used on project teams? Can they be introduced to the client? How will they spend their time, and is there a chance it can be profitable? What work products can be expected from someone with a PhD who may not have had design training? Can they be useful in marketing? Predesign? Functional and space programming? Budgeting? What can be expected of a designer without a PhD who has a good understanding of research? How will their work be different in this new model?Is it possible for one person to provide all that the firm or client might want or need? It seems that there will be a period of adjustment as firms adapt to the new model of an evidence-based design process. There is more than one possible role to be considered.Designers Need To Understand ResearchThe effective designer in an evidence-based or research-informed practice model must have all the skills that a designer has traditionally needed. These designers must continue to be leaders in crafting effective and creative designs for projects. To be effective in the new model, however, they will also need to develop the skills associated with finding, evaluating, and understanding serious research, and then be able to grasp the implications of the research findings for each unique project. They need to learn to take key design issues important to the client or firm and be able to develop high-quality research questions that will lead to the discovery of relevant information. Architects and designers must respect the skills of the researcher who will be collaborating with them in new and unfamiliar ways.The designer must learn to use the capabilities of the researcher to help shed light on important questions and to find useful literature sources or other helpful information. Designers need to understand at least the basics of research types, methods, and measurements to collaborate more effectively. Designers will be among those who need to provide the researcher with important questions whose answers will make a significant difference to projects and clients. The researcher may need the designer's participation in developing a useful research project when the firm becomes involved in performing practical, applied research.The designer of the future must believe that working together with a researcher will improve the designs on which they collaborate. He or she must be eager for the chance to partner with a researcher. …