Despite widespread belief that healthcare design should be evidence-based, clarity regarding the concept of evidence is still elusive. Rosenberg, Muir Gray, Haynes, and Richardson's (1996) classic definition of evidencebased medicine is one of the most widely quoted:Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence from systematic (p. 71).This definition of evidence-based medicine has become the foundation for nearly all disciplines, each making slight modifications to the wording to individualize it to their specific discipline and practice. Evidence-based design in healthcare is no exception. What is less recognized is that Sackett, Straus, Richardson, Rosenberg, and Haynes (2000) modified the original definition to add that evidence-based practice must consider patient values. With this new consideration, evidencebased practice in any discipline includes the interplay of three essential elements: (1) individual expertise; (2) best available evidence; and (3) the customer's values. In this context, customer could be defined as the patient in medicine or nursing, but it could also be other stakeholders in different disciplines, such as the owner, the healthcare executive team, or the board of directors in a healthcare design project.Although randomized controlled trials (RCTs), systematic reviews, and meta-analyses are the gold standards of research evidence in design practice, the use of these audacious gold standards is difficult to accomplish without years of rigorous research. Of course, when we do have such evidence, we can translate these findings into standards, protocols, practice guidelines, and other such policy to guide the practice of healthcare design. Evidence-based design is an emerging science that is constantly building new evidence through the documentation of findings from each new project; but there is more evidence to consider than research evidence.Best EvidenceSeveral articles in HERD have addressed how to search for the best evidence (Edelstein, 2008; Martin, 2009), and HERD continues to publish research studies that can be considered for application in specific projects or to guide design decisions. Yet there are some who propose that the emphasis on research evidence is too restrictive, especially if the gold standard is the RCT, the systematic review, or meta-analysis, because they neglect to recognize other sources of evidence that may also bring validity to a project (Stankos & Schwartz, 2007). The strictest definition of evidence seems to devalue knowledge other than research evidence and prioritizes the RCT and meta-analysis because they sit at the top of the evidence hierarchy. The RCT is clearly the research study design of choice when studying the effectiveness of specific treatments, interventions, or designs, but there are many design issues and questions that are not amenable to an RCT.In this context, if we are to use evidence as a basis for healthcare design, how does one justify innovation, which may not have evidence to support specific design solutions? If the best evidence answers a design question for a project but has limited generalizability because the study was conducted only at one site, how should we prioritize the research evidence in comparison to the weight of individual experience or the customer's values or preferences? In evidence-based design practice, we must hold all three elements in balance. All-research evidence, individual experience, and customer values-constitute evidence.Individual ExperienceIn the nursing world, Dr. Patricia Benner is noted for her work describing the continuum of how nurses develop knowledge and skill from novice to expert based on the Dreyfus model of skill acquisition. …
Read full abstract