Evidence-based Healthcare Design Research Articles

Assessing child satisfaction and expectations for developing a child-friendly environment at the pediatric department in a general hospital in Qatar.

"Patient-centered" care positions the patient at the core and emphasizes fulfilling their unique needs, preferences, and values. This approach is particularly significant in the context of children. Although widely recognized as necessary, this approach is not universally implemented. The children find themselves in hospital wards where they are required to follow protocols and systems designed primarily for adults. In the appropriate atmosphere, children often express themselves more effectively through words, body language, and play, leading to a richer understanding of their needs. There is growing recognition of the importance of addressing children's concerns regarding hospital environments. This study investigates children's satisfaction with the physical aspect of the hospital environment. Insights from this exploration could provide valuable input for creating hospital environments centered around children's needs and preferences. This mixed-methods study involves children aged 6-14 years with parental consent from a premiere healthcare provider in the state of Qatar. The survey used nine items to gauge satisfaction with the existing hospital environment as a "child-friendly hospital" and another nine items to explore their expectations for such environments. The Mann-Whitney U and Kruskal-Wallis tests as well as thematic analyses were employed to assess the statistical significance of differences in satisfaction levels and children's expectations of the hospital's physical environment. A total of 398 children participated in the study. Of them, 40.3% were aged 6-8 years; 60.3% had experienced two to five hospital visits; 55.8% of children participated during their outpatient service visit; and 31.7% were Asian. Children's satisfaction levels with various aspects of the hospital environment-including its physical appearance, signage, lounge, consultant rooms, corridors, bedrooms, TV content, toys, and staff uniforms-were in the range of 42.9%-59%. The children expressed a desire for a hospital environment that is spacious, colorful, attractive, and filled with cartoon characters and toys in the children's hospital from the front lounge to the inpatient units. The findings underline the importance of considering the perspectives of children in evidence-based healthcare design. The study reveals that children's satisfaction with the hospital environment is generally average or below average. Ultimately, a "child-friendly hospital environment" integrates children's rights into healthcare to significantly improve outcomes.

Research capacity strengthening in health and care delivery through housing for chronic diseases

BackgroundFrom all buildings, houses are where we spent most of our lives. The impact of housing conditions on health was evident during the COVID-19 pandemic. Despite the 2018 Astana Declaration placing integrated delivery of primary health care and public health services across all sectors, a framework that explores health and care in relation to housing remains unexplored. The aim was to determine relevant evidence gaps to building capacity in supportive housing-health care research about chronic diseases and multimorbidity, identify ongoing strains and offer potential solutions.MethodsAn integrative review was conducted through multiple systematic searches in electronic databases. We employed an interdisciplinary approach integrating several research fields -built environment, clinical and human physiology, environmental health, and public health and health care services- around chronic illness and multimorbidity to understand the depth and scope of linkages. Inductive content analysis was used to describe emerging domains from evidence meeting inclusion criteria.ResultsWe defined a multifaceted framework with priority eight building blocks for action: 1) expanding capacity for chronic care model into the primary care setting; 2) scaling up environmental determinants to cover residential spaces; 3) implementing acute methodologies for indoor environment risk assessment; 4) increasing clinical research applicability into built environment studies; 5) recognizing chronic conditions-promoting inflammation physiology; 6) qualifying reliable surrogate disease biomarkers in human monitoring; 7) enforcing technologies for new forms of outpatient care; and 8) renewing evidence-based healthcare design.ConclusionsFuture research needs to prioritise articulating these emerging insights through systematic, translational and multisectoral approaches to strengthen health and care delivery through housing design solutions for people living with chronic morbidity.Key messages Integrating the evidence-based design in future interventions may promote transformative changes in housing and public health programmes engaging primary healthcare services for chronic patients.This eco-biopsychosocial supportive framework informs practice to advance research capacity development in enabling health-conducive environments across various levels of care and health promotion.

From Fable to Reality at Parkland Hospital: The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment.

This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.

Advancing evidence-based healthcare facility design: a systematic literature review.

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

Study protocol for a randomised trial evaluating the effect of a "birth environment room" versus a standard labour room on birth outcomes and the birth experience.

IntroductionIn the last decade, there has been an increased interest in exploring the impact of the physical birth environment on birth outcomes. The birth environment might have an important role in facilitating the production of the hormone oxytocin that causes contractions during labour. Oxytocin is released in a safe, secure and confidence-inducing environment, and environments focused on technology and medical interventions to achieve birth may disrupt the production of oxytocin and slow down the progress of labour. An experimental “birth environment room” was designed, inspired by knowledge from evidence-based healthcare design, which advocates bringing nature into the room to reduce stress. The purpose is to examine whether the ‘birth environment room’, with its design and decor to minimise stress, has an impact on birth outcomes and the birth experience of the woman and her partner.Materials and methodsA randomised controlled trial will recruit 680 nulliparous women at term who will be randomly allocated to either the “birth environment room” or a standard room. The study will take place at the Department of Obstetrics and Gynecology at Herning Hospital, with recruitment from May 2015. Randomisation to either the “birth environment room” or standard room takes place just before admission to a birth room during labour. The primary outcome is augmentation of labour, and the study has 80% power to detect a 10% difference between the two groups (two-sided α = 0.05). Secondary outcomes are duration of labour, use of pharmacological pain relief, mode of birth, and rating of the birth experience by women and their partners.Trial registrationNCT02478385(10/08/2016).

Evidence-Based Design Has a Sustainable Positive Effect on Patients' Perceptions of Quality of Care in Forensic Psychiatry: A 3-Year Follow-Up Study.

This prospective longitudinal study aimed to assess the sustainable effect on patients' assessment of ward atmosphere and quality of care at three forensic psychiatric clinics relocated to new facilities built with the latest evidence-based healthcare environment design to support recovery. Baseline data were collected in the old facilities and during three follow-ups after relocation, between 2010 and 2016. Of 74 patients who gave informed consent to participate, 58 patients (100%) answered the questionnaires at baseline, with 25 patients (43%) completing them at Follow-up 1, 11 patients (19%) at Follow-up 2, and seven patients (12%) at Follow-up 3. This study provides evidence that the mean values of patients' perceptions of care quality in these forensic psychiatric facilities increased when moving to new buildings and were stable up to 3 years after relocation, which was statistically significant in the domain of secluded environment (p < 0.05). The sample size at Follow-up 3 was small, and thus the results are limited, which indicates that further research is needed to confirm the findings.

Building aspirations… building ambitions?

Much has been written of late on the requirements of a patient-centred hospital environment suitable for healing. So much so that, within healthcare, the theoretical concept is referred to as ‘evidence-based design’, in which – through form and function – the positive interaction and outcomes that buildings and their environments can have on the health, recovery, safety and wellbeing of patients and carers – and on the health and morale of its staff – is considered. In view of Birmingham’s new £50 million Dental Hospital and School of Dentistry opening its doors to the public earlier this year, this article provides a précis of the establishment, and illustrates how evidence-based healthcare design concepts have been woven into its design.

Effects of environmental design on patient outcome: a systematic review.

The aim of this systematic review was to assess how inpatients were affected by the built environment design during their hospitalization. Over the last decade, the healthcare system has become increasingly aware of how focus on healthcare environment might affect patient satisfaction. The focus on environmental design has become a field with great potential because of its possible impact on cost control while improving quality of care. A systematic literature search was conducted to identify current and past studies about evidence-based healthcare design. The following databases were searched: Medline/PubMed, Cinahl, and Embase. Inclusion criteria were randomized clinical trials (RCTs) investigating the effect of built environment design interventions such as music, natural murals, and plants in relation to patients' health outcome. Built environment design aspects such as audio environment and visual environment had a positive influence on patients' health outcomes. Specifically the studies indicated a decrease in patients' anxiety, pain, and stress levels when exposed to certain built environment design interventions. The built environment, especially specific audio and visual aspects, seems to play an important role in patients' outcomes, making hospitals a better healing environment for patients. Built environment, evidence-based design, healing environments, hospitals, literature review.

Qualitative research in health design.

Just as all facility designs are not the same, research designs also differ depending on the purpose of the study, availability of previous evidence on a topic, and the desired outcome of the data. Unfortunately, qualitative research is frequently misunderstood, because those not familiar with the research method believe it to be of a lesser quality than quantitative study design, considering that sample size, data analysis methods, and even goals for generalizability are different than quantitative research. Qualitative research is a very robust and important research method to be used when little information exists about a subject, there are few instruments to measure the phenomena of interest, or when the research really aims to understand the participants' perspective.Qualitative research can be defined as a form of social inquiry that aims to understand how people interpret the environment in which they live, work, or receive care (Atkinson, Coffey, & Delamont, 2001). A variety of approaches exist in qualitative research and many share the same purpose-to comprehend, describe, and interpret different phenomena as perceived by individuals, groups, and cultures. Researchers in different fields, including ethnography, sociology, education, nursing, and marketing, regularly use qualitative approaches to explore how people understand and interact with the social world. Qualitative approaches are useful in the exploration of change or conflict and because of its versatility, individuals from various professions can collaborate on conducting qualitative research (Creswell, 2009). Although different types of qualitative research share common characteristics, the process by which it is approached can depend on a variety of contextual factors. In health design, qualitative research can serve as a valuable method to explore how healthcare environments can be enhanced to improve outcomes in those receiving and providing care and to generate new knowledge about evidence-based healthcare design. This article will focus on the main features of qualitative research, usefulness in health design, research considerations, data collection, research approaches/methods in health design, qualitative data analysis, and methods to establish trustworthiness in qualitative research.Main Features of Qualitative ResearchThere are several unifying features of qualitative research studies focusing on data collection and data analysis. Most qualitative research has the following characteristics:* The theoretical framework for qualitative research is not predetermined, but is deduced from the qualitative data.* Researchers must be sensitive to the context of the research, because the data and findings are context-specific and may or may not have any generalizability to other settings or context.* Qualitative researchers often immerse themselves in the environment and with individuals whose perspectives and ideas they wish to explore.* Researchers narrow in on the emic perspective the viewpoint of the participants involved their meaning, and interpretations.* Qualitative researchers describe, analyze, and interpret using thick description to further explore the participants' perspectives.* The researcher is the main instrument in the research where reflexivity provides the researcher's explicit stance of the research.These unifying features will be described in more detail in the following sections in order to enhance the reader's understanding of qualitative research design, methods, and outcomes.The Primacy of DataQualitative researchers' and participants' interactions lead to an understanding of experiences and generation of data. The data itself has primacy and can uncover new theoretical ideas, help alter existing theories, or reveal the importance of a certain phenomenon. Consequently the research methods cannot be predetermined before beginning qualitative research, as with other types or research where ideas or assumptions can lead to hypothesis testing. …

Building a knowledge base for evidence-based healthcare facility design through a post-occupancy evaluation toolkit

Background: Post-occupancy evaluation (POE) can play a critical role in evidence-based healthcare design (EBD) by evaluating design effectiveness and adding to the knowledge base. However, its potential has not been fully realized due to the lack of standardized tools, inaccessibility of findings, a focus on technical performance instead of patient-centred outcomes, and irrelevance to healthcare processes. Objective: To strengthen the EBD knowledge base by developing standardized POE tools. Methodology: A conceptual framework was created from a review of over 100 research publications. A standardized POE toolkit was developed, including questionnaires on design strategies, healthcare outcomes, and staff perception. Pilot testing was conducted at five healthcare construction projects. This toolkit is being further augmented by additional on-site audit POE tools. Findings: From the pilot testing of the first POE tool, significant variations were found among the five pilot facilities in terms of the design strategies adopted. Satisfaction with the indoor environment was higher among occupants at facilities with more sustainable design strategies implemented. Patients reported high satisfaction (65–83% top ratings) and high willingness to recommend facilities (71–85% ‘definitely recommend’). The general satisfaction of staff with building ranged from 0.88 to 2.2 on a scale from −3 to 3. Conclusion: A robust framework and a set of standard tools for obtaining broad building-level data related to healthcare design have been established to comprehensively evaluate building performance and to enable quick dissemination and easy access to new knowledge created.

Impact of healthcare design on patients’ perception of a rheumatology outpatient infusion room: an interventional pilot study

Evidence-based healthcare design is a concept aimed at reducing stress factors in the physical environment for the benefit of patients and the medical staff. The objective of this study was to examine the impact of room modifications on patients' perception of an outpatient infusion room used for treating rheumatologic diseases. Patient and nurse interviews, a staff workshop and field observations were performed to identify environmental room factors important for the patients, and the room was modified accordingly. The changes included the colours, atmosphere and functionality of the room. Artificial plants and a water bubble wall were added to the room. Forty-four patients receiving intravenous biologic therapy for inflammatory arthritis completed a questionnaire before and after the intervention. The agreement with 25 statements regarding the environmental room factors was scored (range 0-4). A total score was calculated as the sum of all 25 scores (range 0-100). The median (range) age was 55 (28-78) years. Seventeen out of 25 scores improved significantly (p < 0.000-0.050), none deteriorated. The amount of decorating and room colours, for example, was scored significantly higher after the intervention (p < 0.000), and the atmosphere was considered significantly more comfortable and "safe" (p < 0.005). The total score increased from 63.0 (34-88) to 81.0 (48-100) (p < 0.000). The study suggests that room modifications according to the principles of evidence-based healthcare design may have the potential to improve patients' perception of outpatient infusion rooms used for treating rheumatologic diseases.

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.

Design for the Post-Antibiotic Era: Experiences from a New Building for Infectious Diseases in Malmö, Sweden

To describe the experience of planning and designing a new facility for infectious diseases in Sweden and to discuss underlying theories relating to infection prevention and evidence-based design. Departments of Infectious Diseases are common in healthcare facililties in Sweden. In 2005, a decision was made to build a new facility. The program required spacious single rooms, with a high ventilation standard, and anterooms. In this article we present an analysis of the future of infectious diseases. Underlying theories are discussed. We also describe how a program was outlined using literature studies, including evidence-based healthcare design, focus groups of staff, and study visits. Active involvement of users and infection control specialists was important in the building process. A full-scale patient room mock-up was built with ventilation, electrical, and other systems. The mock-up was cost effective because it avoided costly mistakes during the building process. The mock-up also was a place where staff could assess and begin adapting to their future work environment. Separate ventilation and separate entrances to patient rooms from the building exterior allowed placement of isolation units in the main hospital area. Antimicrobial resistance, emerging diseases, healthcare associated infections, and outbreaks highlight the need for infection control measures in all hospital design. Infection control should be integrated in all hospital planning and be part of contracts. In this study we describe a specialized unit where a high degree of standardization and flexibility has made it possible to have a unique standard of preparedness for the post-antibiotic era. Design process, evidence-based design, infection control, planning, safety.

Implementation of evidence-based design approaches in transportation decision making

Evidence-based design (EBD) originated in the healthcare industry as a combination of evidence-based medicine and evidence-based practice. EBD is a process for creating or improving healthcare buildings by using rigorous evidence to create benchmarks of current practices, achieve specific goals, and then monitor the success of the design to inform future decision making. EBD studies for the healthcare industry are compiled into an international database to provide design information to all users. This paper reviews applications of EBD in healthcare and other fields, assesses the potential value of applying EBD in the transportation field, and makes recommendations that can help with the adoption of EBD for transportation design and engineering. Emerging areas such as transportation asset management, health impact assessments and green design are particularly appropriate and promising for the development and application of EBD databases. This paper is a useful resource for transportation executives or researchers who are interested in developing evidence-based databases to guide their future decision making to be more strategic to take advantage of proven successful applications. When appropriately applied, EBD has the potential to reduce costs and risks while increasing innovation and encouraging new ideas for transportation and other projects.

Healing environment: A review of the impact of physical environmental factors on users

In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.

Chronic Disease: Are We Missing Something?

Chronic Disease: Are We Missing Something?

A Conceptual Framework for the Domain of Evidence-Based Design

The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.

Establishing a Substantial Link between Human and Environmental Welfare

Research is viewed as an essential activity in the creation of design solutions to address the safety crisis in healthcare environments (Institute of Medicine, 1999). This issue of HERD contains research findings from qualitative and quantitative methods of inquiry and from exploratory studies to experiments, a discussion of theory building, and the presentation of tools for inquiry. Authors of these papers represent diverse experiences and viewpoints: they are current and former nurses/ nursing administrators, interior design and architecture practitioners and/or design firm researchers, and academicians. All discuss an evidencebased design (EBD) approach, while lamenting its limited influence on design practice. The issue is evidence; identifying and validating it is a paramount challenge, especially considered against the balance of design solutions and trends based on anecdotal information. These authors also note as a limitation the generalization of findings attributable to unique research settings, small data sets, and confounding variables. However, the insights and resources contained within these papers are impressive. A brief discussion of each paper is followed by questions to be considered.Ulrich and colleagues discuss origins, the development of EBD, and the benefits stakeholders could experience from its application to the design of the healthcare environment. They describe a conceptual framework for healthcare's EBD domain across nine design variable categories, identify knowledge gaps, and encourage the use of both. By providing categories (e.g., safety enhancement, sustainability) within their framework, their organizational structure helps the healthcare designer consider the current-perhaps overabundant-knowledge and information sources available.Zborowsky and Bunker-Hellmich ask and why now in reference to design practitioners' focus on EBD and the emergence of practicebased research (PBR) in architecture and design firms. They predict findings from PBR, adding to the knowledge gleaned historically from the disciplines of environmental psychology and cultural geography. Acknowledging the struggle of reconciling confounding research findings, Zborowsky and Bunker-Hellmich advocate for hypothesis creation and grounding design solutions in findings from testing theoretical frameworks. Moreover, stakeholders must be incorporated in the decision-making process in concert with the knowledge generated from PBR both inside and outside the design firm. They propose that sharing knowledge beyond the firm will require a paradigm shift in approach, attitude, and the design firm's economic model, but that doing so is an ethical obligation.Shoemaker's mixed-methods research study, described in Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case Study of Organizational Decision Making, addresses a critical issue: the impact of healthcare leaders' and providers' decision-making actions. Features that contribute to patient and staff safety, functionality, and well-being are addressed in this context in relation to establishing policy and identifying criteria that will form the basis of facility design and operations. Shoemaker's inquiry highlights the impact of leadership style and groupthink on design decisions that have human, environmental, and fiscal implications into the future. Most importantly, Shoemaker provides a framework and protocols for evaluating the influence of healthcare leaders' and providers' decisions relative to EBD concepts.Trzpuc and Martin's exploratory study focuses on the caregivers in the healthcare environment. …

Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case Study of Organizational Decision Making

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process? Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects. A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire. A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about EBD. Financial considerations were a factor in decision making. The prevalence of the transformational leadership style among the organization's administrators exceeded the U.S. mean.

Book Review: Evidence-Based Healthcare Design

Evidence-Based Healthcare Design by Rosalyn Cama. Hoboken, New Jersey: John Wiley & Sons, Inc., 2009, 256 pages, $75.00. ISBN 978-0- 470-14942-3Informing design decisions through the use of evidence rather than relying on intuitive ideas or preferences represents a change in the healthcare design process. The integration of research does not change the structure of the design process; it elevates the level of inquiry and the assessment of information used to improve healthcare environments and the quality of healthcare. According to a news release from the American College of Healthcare Executives (January 5, 2009), the top concerns confronting hospitals are financial challenges, patient safety, and quality of care. Hospitals are living laboratories, full of qualitative and quantitative evidence to justify or call into question the physical environment, the work processes that define the quality of care, and outcomes for the occupants-patients, families, and staff.The concept of evidence-based design is not new; for more than 25 years, a growing group of researchers and practitioners has studied the relationships between humans and the highly stressful hospital setting. The acceptance of evidence to inform practice and design has been slow, though momentum has been building over the past few years. We are now on the edge; healthcare architecture and design are preparing to make that leap. We expect much from integrating the science of inquiry into our beloved design process, and much will be expected of us. Design is not just about aesthetics, comfort, and productivity. Design can contribute to the quality of care, experience, and health outcomes in hospitals and other healthcare facilities.Using evidence to inform design requires new skills and new specialties for consultants; measuring outcomes to provide new for the next generation of healthcare architects requires rigor, integrity, and critical thinking. Evidence- Based Healthcare Design promotes a cross-disciplinary methodology that uses intelligence, relevant best evidence from research and practice, to inform the design process. The completed projects discussed in the text, such as Dublin Methodist Hospital, Weill Cornell Medical Center, and Riley Hospital for Children, attest to the commitment and investment of these healthcare organizations and design teams and to the success of evidence-based design. Are we at the tipping point? If so, there is still much work to be done.Rosalyn Cama is a professional interior designer who has focused her career on designing places that improve the quality of the human experience. Her dedication to healthcare design is confirmed by her leadership on The Center for Health Design board of directors and her award-winning designs. The description of evidence-based design from Cama's practitioner perspective offers a compelling approach to integrating informed design decision making into the design process. Using examples of work products and checklists that illustrate the steps and procedures of the decision- making process, this text facilitates sharing the gained by measuring outcomes. The book is organized into three parts. Part 1 is an introductory chapter that discusses the timeliness and importance of the book by exploring the shift toward evidence-based design in healthcare, the process of conducting an evidence-based design project, and the levels of evidence-based practice. Part 2 details the author's recommended process, four steps that may be loosely defined as: (1) gathering data; (2) predesign planning; (3) best practice and/or innovation in design; and (4) measuring outcomes and sharing results. Part 3 addresses the use of evidence-based design in practice and the need for environmental design research; it also offers a glimpse of the future of evidence-based design. The book as a whole draws on a knowledge bank of experts whose essays illustrate the process. For the novice, there are key words, terms, and idea boxes that help develop vocabulary and provide conceptual and practical ways to engage in evidence-based design practice. …