Evidence-based Design Research Research Articles

Are We Speaking the Same Language? Terminology Consistency in EBD.

The aim of this study is to analyze the consistency, variability, and potential standardization of terminology used to describe architectural variables (AVs) and health outcomes in evidence-based design (EBD) studies. In EBD research, consistent terminology is crucial for studying the effects of AVs on health outcomes. However, there is a possibility that diverse terms have been used by researchers, which could lead to potential confusion and inconsistencies. Three recent large systematic reviews were used as a source of publications, and 105 were extracted. The analysis aimed to extract a list of the terms used to refer to the unique concepts of AVs and health outcomes, with a specific focus on people with dementia. Each term's frequency was calculated, and statistical tests, including the χ2 and the post hoc test, were employed to compare their distributions. The study identified representative terms for AVs and health outcomes, revealing the variability in terminology usage within EBD field for dementia-friendly design. The comparative analysis of the identified terms highlighted patterns of frequency and distribution, shedding light on potential areas for standardization. The findings emphasize the need for standardized terminologies in EBD to improve communication, collaboration, and knowledge synthesis. Standardization of terminology can facilitate research comparability, enhance the generalizability of findings by creating a common language across studies and practitioners, and support the development of EBD guidelines. The study contributes to the ongoing discourse on standardizing terminologies in the field and provides insights into strategies for achieving consensus among researchers, practitioners, and stakeholders in health environmental research.

COMPUTATIONAL DESIGN APPROACH FOR APPLYING NEURO-ARCHITECTURE PRINCIPLES IN HEALTHCARE FACILITIES

Neuroscience tools’ advancements have paved the way for neuroscience and architecture collaboration, spawning "Neuro-architecture." Neuro-architecture studies in various settings have been tentatively translated into design principles to improve the mood, perception, and satisfaction of healthcare facility users, as well as patient wellbeing and recovery rates. Integrating such principles into computational design methodologies should benefit users’ mental health and reduce the gap between computational design and human mental needs. The research was conducted in two phases: in the first phase, typologies used in evidence-based design research (EBD) were applied in order to determine neuro-architecture design principles for the interior environment of healthcare facilities. In the second phase, the research employed space syntax analysis to evaluate the incorporation of neuro-architecture principles into healthcare facility interiors. The method visualises and evaluates spatial qualities that reflect the application of planning and navigation neuro-interior principles for the inpatient ward of a healthcare facility

Research Methods Used in Evidence-Based Design: An Analysis of Five Years of Research Articles From the HERD Journal.

This study aims to analyze research methodologies from 157 research articles published in this journal in the last five years (2016-2020). Health environments research is comprised of research covering many topics and from various disciplines worldwide. No systematic study exists to uncover themes in evidence-based design (EBD) research concerning the types of research published, people engaged in research, and the research methods employed. Understanding the nature of health environment research performed can help researchers, practitioners, and students situate their work within an EBD research structure. Case study research was used to analyze 157 articles published in the Health Environments Research & Design Journal devoted to EBD and research. Secondary data were extracted to capture research methods from health environments studies and then analyzed to identify themes. The design and outcome categories were structured around and the Center for Health Design's (CHD) Knowledge Repository with origins to Ulrich et al.'s Evidence-Based Design Framework. Findings are reported on categories commonly found in empirical research articles: (i) key words, (ii) disciplines from authors, (iii) settings studied, (iv) populations studied or sampled, (v) research approach and study design, (vi) research strategies, (vii) data collection methods, (viii) data analysis procedures, (ix) design categories and variables, and (x) outcome categories and variables. The analyses highlighted the research methods most frequently used in health environments research. Findings revealed several inconsistencies across articles on key words and the framing of research methodologies. Results suggest that there should be a consistent and overarching research taxonomy with a set of acceptable terms for effective literature searches.

The therapeutic value of waiting areas in access and accessibility to care

Abstract Background Patients have increased biological metrics when entering healthcare environments as a response to stress. Priming them with nice settings before consultation or procedure might benefit their health. Yet hospital waiting areas might be neglected by regulators. Our aim was to understand how these are perceived by those who commission them and by those who deliver them in terms of their intangible value. Methods After a comprehensive scoping literature review of evidence based-design research eight features –daylight, furniture, materials, nature, views, colours, artwork and positive distraction– were identified as the most significant in waiting areas for patient wellbeing. Using those features as criteria we explored the regulators' views comparing and contrasting the UK, USA and Australia's design guidance on waiting areas. Also, 16 awarded hospital buildings provided case studies under the scope of those features. We examined the way these buildings were presented post-award and how those therapeutic features were portrayed in that process. Results Results indicate a hiatus between architects and regulators towards the therapeutic value of waiting areas design. Architects highlight qualities such as comfort and aesthetics. Yet, guidelines focus on functionality and transition and do not consider waiting areas design as important. Conclusions The welcoming factor of health spaces pre-consultation has been ignored by regulations yet at the same time has been used by architects to communicate their projects to the public. Actions to improve national regulations could impact on waiting areas design and consequently on people's health benefits. They could even have longer-term benefits supporting early detection of disease by reducing the fear and stigma that people feel when engaging with healthcare services. This paper supports a positivist and systemic approach and highlights a neglected area in terms of health services thinking and research. Key messages A welcoming pre-consultation experience might affect the patient/clinician relationship and make the patient feel valued by the institution. This should be supported by waiting area design regulations. The research on hospital waiting areas features demonstrates that the therapeutic qualities of healthcare space have been ignored by regulators.

Sources and flow of healthcare built environment design evidence

PurposeA substantial amount of research argues that built environmental interventions can improve the outcomes of patients and other users of healthcare facilities, supporting the concept of evidence-based design (EBD). However, the sources of such evidence and its flow into healthcare design are less well understood. This paper aims to provide insights to both the sources and flow of EBD used in three healthcare projects, to reveal practicalities of use and the relationships between them in practice.Design/methodology/approachThree healthcare case study projects provided empirical data on the design of a number of different elements. Inductive thematic analysis was used to identify the source and flow of evidence used in this design, which was subsequently quantised to reveal the dominant patterns therein.FindingsHealthcare design teams use evidence from various sources, the knowledge and experience of the members of the design team being the most common due to both ease of access and thus flow. Practice-based research and peer-reviewed published research flow both directly and indirectly into the design process, whilst collaborations with researchers and research institutions nurture the credibility of the latter.Practical implicationsThe findings can be used to enhance activities that aim to design, conduct and disseminate future EBD research to improve their flow to healthcare designers.Originality/valueThis research contributes to understandings of EBD by exploring the flow of research from various sources in conflation and within real-life environments.

Assessing the post-occupancy performance of educational design/build: the thinking while doing initiative

PurposeEducational design/build (e-d/b) curricula in university-level professional schools of architecture have flourished in recent years, internationally, as new programs are launched and the volume of built work increases dramatically. This growing body of built work, however, has typically not been subjected to rigorous behavioral assessment from the standpoint of what is actually built, as experienced through the eyes of user-recipients in the everyday milieu. The lack of rigor in this aspect of assessing the efficacy of what gets built continues to hinder evidence-based academic scholarship on this subject.Design/methodology/approachAn interdisciplinary research initiative titled Thinking While Doing, spanning the years 2013–2019, centered on exploring the inner profundities of e-d/b. As part of a multifaceted project involving seven universities in Canada and the United States, behaviorally focused post-occupancy assessments were conducted of three open-air pavilion structures from the viewpoint of 161 respondents' impressions, degree of satisfaction and everyday uses.FindingsFunctionality, community context, materiality and aesthetic factors were among the set of variables analyzed. Among the results, the three open air pavilions were viewed as tectonically sound and aesthetically iconic and were considered to be valued additions to their immediate physical contexts and local community.Research limitations/implicationsStudy limitations and directions for future research are discussed.Practical implicationsStudent learning objectives in relation to the design intent of the built structures are highlighted.Social implicationsThis evidence-based design research empowers stakeholders seeking campus-community partnership opportunities.Originality/valueThis is the first comparative, behaviorally focused appraisal of its type from the perspective of everyday user-recipients in the realm of e-d/b.

Evidence-Based Design in Hospital Renovation Projects: A Study of Design Implementation for User Controls.

The purpose of this article was to investigate and report the implementation of evidence-based design (EBD) principles relating to user controls into hospital renovation projects. Progress requires the application of the most recent knowledge and technology. When it comes to the design and construction of healthcare facilities, the latest knowledge comes in the form of EBD research. EBD is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. The desired outcomes of EBD recommendations include improvements to enhance user control. User control factors include the individual control over bed position, air temperature, lights, sound, and natural light. A list of recommendations from existing EBD literature related to user controls was compiled. Construction documents from 30 recent healthcare facility renovation projects across the United States were obtained and analyzed. Implementation levels for the EBD categories of user controls were reported. The findings indicate relatively extensive industry use of EBD principles relating to user control of temperature, lights, and natural lighting. The findings indicate that EBD recommendations related to user controls are being adopted in practice at consistently high levels. These findings also reveal that there are still areas of potential improvement which could inform those who influence or determine building design, codes, standards, and guidelines. The results are helpful to owners, designers, and contractors by providing a glimpse into how well the industry is recognizing and implementing known best practices. The findings likewise introduce new opportunities for further research which could lead to additional improvement in the healthcare facilities of the future.

Evidence and affect: employing virtual reality to probe what’s missing from evidence-based design research

Within healthcare environments, evidence-based design (EBD) studies often seek to identify architectural design strategies capable of affecting a reduction in patient anxiety. Yet, the theory of affect is seldom discussed. The definition of affect employed herein refers to a spatial capacity to elicit certain subjective, sensory experiences, and to communicate what dispositions and agencies are enactable in a place. Within this article, we examine the relevance of affect to the field of EBD and present findings from a pilot study where 68 participants were asked to experience and document their responses to three virtual architectural environments with varying aesthetic characteristics. Finally, we provide a discussion of the implications of these findings to the field of EBD and reflect on the affordances of virtual reality (VR) as a method for investigating affect. The discussion is supported by selected data from a corresponding study conducted by the authors within a cancer centre.

Evidence-Based Design in Nederlandse ziekenhuizen

Evidence-Based Design in Nederlandse ziekenhuizen

Evidence-Based Design and Transformative Service Research application for achieving sustainable healthcare services: A developing country perspective

Patients look carefully for detailed information pertaining to their expectations before selecting a healthcare service provider. In order to meet these expectations and achieve patient wellbeing, healthcare service providers should understand more the importance of sustainable hospital servicescape designs for their patients jointly with the common focus on functionality in the medical procedures. The importance of the servicescape in creating a healing environment for patients has been shown through Evidence-Based Design research. The rising importance of consumer wellbeing and sustainability is shown in Transformative Service Research. The aim of this study is to bridge the gap between the two research fields to develop guidelines for future hospital servicescapes in developing countries. The application of this study is on Egypt because of the deterioration of its healthcare service provision. Results indicate that patients find plants and greenery, safety, and single rooms as the most important aspects to improve their wellbeing state. These results indicate that patients want to receive their basic treatment in a healing environment without mistakes. The achieved results act as guidelines for improving servicescapes of hospitals in Egypt and other developing countries. This contributes to hospital managers by offering a more sustainable competitive advantage. Contributions for future research are related to testing the effect of the servicescape on patient wellbeing by combining all servicescape aspects in one model.

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based Design in Nederlandse ziekenhuizen

Evidence-Based Design in Nederlandse ziekenhuizen

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.

Evidence Based Design and healthcare: an unconventional approach to hospital design.

Evidence Based Design (EBD) is a scientific analysis methodology that emphasises the use of data acquired in order to influence the design process in hospitals. It measures the physical and psychological effects of the built environment on its users. EBD uses formularization of hypothesis, testing/analyzing and outcome gathering as a framework. The design practice, in general, has always been based on a combination of legal, technical/ functional/ and aesthetical knowledge. This generalization has been shifted to another level after the implementation of EBD. In the last 30 years many case studies were collected which demonstrate the built environment's impact on users. EBD methodology can be applied to any type of building, but it is particularly used to analyze the efficiency of healthcare facilities. The Goal of this paper is to demonstrate various applications of EBD principles in healthcare buildings through case studies concerning: - reduction of infections - reduction of stress on medical staff - improved patient healing In addition to the analysis of case studies, we will also focus on official EBD researches developed by healthcare designers and professionals as "alternative solutions". These alternative "ad hoc" solutions are developed in order to answer EBD research results. The solutions that are developed from the results can answer the real needs of each hospital and improve best technological practice to reduce infection, stress and improve patient comfort. Abroad the EBD research results are studied and used by many contemporary hospital architects to develop new solutions to meet the specific requirements of any hospital project they are currently designing. This procedure demonstrates that for each outcome and key finding, there is always at least one alternative solution and, therefore, the achievement of a new hypothesis, case studies to test/measure and outcome to gather occurs. This repetitive attitude leads to a "virtuous circle" where the development of new samples produces a double- positive effect in both EBD research (in terms of new case studies to analyze) and in EBD lessons for implementation in various hospitals. Through this paper the authors state that the combined effort is needed by EBD practitioners, healthcare architects and hospital managers for the improvement and diffusion of EBD in healthcare, especially in Italy where this methodology is not widely used.

Chronobioengineering indoor lighting to enhance facilities for ageing and Alzheimer's disorder

Evolutionary processes generate a variety of paradoxes which must be faced in order to design the most effective structures to fulfil various human requirements and preferences. One of these paradoxes comes from the evolution of circadian rhythm systems, which are normally synchronized to the geophysical cycle of night and day and coordinate internal temporal order, but are now in conflict with modern technology and the 24/7 paradigm for urban living. Modern lighting systems have traditionally focused on providing sufficient illumination for people to navigate and manipulate their environments without regard to the side effects that lighting might have on temporal aspects of behaviour and physiology. However, studies involving shift work and other applications of artificial lighting have indicated that these side effects can be quite significant. Furthermore, when an ageing circadian system is coupled with a deteriorating physiology, the side effects of a 24/7 artificially illuminated indoor environment can be especially debilitating, especially for older adults with dementia. Chronobiology is the field of biology that examines periodic (cyclic) phenomena in living organisms, whereas photobiology is the scientific study of the interaction of light on living organisms. Chronobioengineering is an emerging field of scientific study that translates research results and concepts from these fields into practical applications. The following discussion focuses on the use of light cycles to synchronize circadian rhythms and ways human health and wellbeing can be enhanced through light-emitting diode (LED) lighting in the ageing population, specifically those with dementia of Alzheimer's type. The hypothesis is that the implementation of a lighting system specifically designed to synchronize circadian rhythms in this population will alleviate symptoms of dementia and thus enhance the quality of life for both residents and caregivers. The research team is working with a lighting industry partner to manufacture a 2′ × 2′ retrofit LED luminaire for installation at St. Francis Country House, a skilled-nursing facility near Philadelphia. Research includes working with the nursing home caregivers and administrators to establish criteria and protocols for evidence-based design research that will evaluate the efficacy of the daylight-matching luminaire.

Evidence-Based Design and the Fields of Human Factors and Ergonomics: Complementary Systems-Oriented Approaches to Healthcare Design

The evidence-based design (EBD) movement in architecture has been formed around notion that design of physical envi- ronment in healthcare facilities should be guided by empirical evidence that links design elements to healthcare outcomes (Hamilton, 2003; Ulrich et al., 2008). The outcomes targeted by EBD com- monly involve patient safety and related patient outcomes, but can also include staff such as productivity, satis- faction, and worker safety. Decades of EBD research and practice have shown that environmental design does indeed play a significant role in measures of care quality; however, it is important to remember that these qualities are not attributable solely to environmental design. The design of physical space is one component of a complex system that includes humans and technologies-which are also system components with their own set of design to consider-interacting within built environment. The qualities of interest to EBD (patient safety, outcomes, worker satisfaction, etc.) therefore should be considered as emergent proper- ties of entire system, viewed holistically, which depend not only on individual contributions of components but also on their complex interac- tions (e.g., Carayon et al., 2006).This systems-oriented perspective when evaluat- ing healthcare quality is one that is adopted by many emerging fields, including systems engineering and related fields of and (HFE). Indeed, in same way EBD might be consid- ered a form of systems engineering that emphasizes environmental component of healthcare sys- tem, HFE emphasizes studying and designing to support components of system. As for- mally defined by Internation- al Ergonomics Association (2000), HFE is the scientific discipline concerned with understanding of interactions among humans and other elements of a system, and profession that applies theoreti- cal principles, data and methods to design in order to optimize well-being and overall system performance. Central to HFE analysis is gaining an understanding of needs, abilities, and limita- tions of people and considering these in design of system components so that humans can perform work effectively, safely, and with adequate personal satisfaction.Traditionally, HFE has been divided into three domains of specialization: related to physical interaction, cognitive factors, and organizational (e.g., Wickens, Lee, Liu, & Gordon-Beck- er, 2004). The science of physical is often colloquially referred to as ergonomics (although formal definition of term does not exclu- sively apply to physical factors) and concerns topics such as anthropometry, biomechanics, metabol- ic processes of humans performing work, and design of workspaces to accommodate sizes, shapes, and physical work-producing abilities of workers. The specialization related to cog- nitive (often labeled as human factors to distinguish from physical ergonomics-although again, labels are not exclusive) is concerned with cognitive activities and functions such as percep- tion, attention, memory, decision making, problem solving, and learning. The study of organization- al factors-sometimes labeled as macroergonom- ics-considers social interactions among groups of people, including topics of communication and team dynamics; role of technology in support- ing these dynamics; and cultural influences on pat- terns in communication and team activities.Each of these three domains of specialization with- in HFE can complement EBD approaches to physical design of healthcare environments and thus further improve healthcare system. Most clearly, decisions about unit and/or room layout, and locations of equipment and supplies, can benefit from physical ergonomic assessment. For example, spaces between beds in intensive care units often are too small (Carayon & Alvarado, 2007); minimum inter-bed distance should allow comfortable access for larger care workers and also support workers' ability to interact with common equipment in space without disturb- ing neighboring patients. …

Using Clinical Simulation Centers to Test Design Interventions: A Pilot Study of Lighting and Color Modifications

The aim of this pilot study was to test design interventions such as lighting, color, and spatial color patterning on nurses' stress, alertness, and satisfaction, and to provide an example of how clinical simulation centers can be used to conduct research. The application of evidence-based design research in healthcare settings requires a transdisciplinary approach. Integrating approaches from multiple fields in real-life settings often proves time consuming and experimentally difficult. However, forums for collaboration such as clinical simulation centers may offer a solution. In these settings, identical operating and patient rooms are used to deliver simulated patient care scenarios using automated mannequins. Two identical rooms were modified in the clinical simulation center. Nurses spent 30 minutes in each room performing simulated cardiac resuscitation. Subjective measures of nurses' stress, alertness, and satisfaction were collected and compared between settings and across time using matched-pair t-test analysis. Nurses reported feeling less stressed after exposure to the experimental room than nurses who were exposed to the control room (2.22, p = .03). Scores post-session indicated a significant reduction in stress and an increase in alertness after exposure to the experimental room as compared to the control room, with significance levels below .10. (Change in stress scores: 3.44, p = .069); (change in alertness scores: 3.6, p = .071). This study reinforces the use of validated survey tools to measure stress, alertness, and satisfaction. Results support human-centered design approaches by evaluating the effect on nurses in an experimental setting.

Reconsidering the Semiprivate Inpatient Room in U.S. Hospitals

In the past 5 years, U. S. hospitals have virtually abandoned the semiprivate inpatient room. The inconclusiveness of recent research, however, indicates that this room type remains a potentially viable care delivery setting in both developed and developing countries for specific patient cohorts and care scenarios during hospitalization. Although the U.S. healthcare industry has embraced the all-private room hospital, does the semiprivate room have a place at all in the 21st-century American hospital? Literature on the subject, both for and against, is summarized. This is followed by a proposal for a case study prototype and its functional integration within a conventional medical/surgical unit in a U.S. hospital. The results suggest that a tempered reintroduction of semiprivatism affords opportunities for socialization, patient-family transactions and amenities, and staff effectiveness without compromising patient safety. Implications for environmental stewardship with respect to the carbon-neutral hospital of the 21st century are cited, as are priorities for further evidence-based design research on this issue.