The growing momentum of evidence-based design

Healthcare Leaders are faced with an increasingly difficult mission. The mission is making their healthcare business plan work. Over the last decade, new challenges have continually surfaced. Studies, such as those by the Institute of Medicine, emphasize the need to increase patient safety. A declining resource pool of nurses and physicians emphasize the need for Staff satisfaction and retention. Imminent changes to reimbursement policies, such as Pay for Performance programs, are political hot topics aimed at reducing healthcare costs. With these challenges and more, healthcare leaders are under increasing pressure to do more with less in order to accomplish their mission. In response to these challenges, the healthcare community is experiencing an evolution in the way its healthcare facilities are designed. A growing body of evidence is being used to document how design can positively impact the challenges of today's healthcare business environment.

For decades, designers have known that the physical environment effected a patient's physical and mental well-being. However, in the mid 90's designers, architects, and researchers began to look at existing scientific studies which actually proved this relationship. In reviewing this data, institutions, like Georgia Tech and The Center for Health Design began collaborating with industry experts to compile and publish these studies. The process of using research to help guide the Project Team's design decisions became known as Evidence-Based Design.

Evidence-Based Design is not a completely new concept. The design of healthcare facilities has historically been based on professional experience, industry best practices, and innovative ideas. The typical flow of design involved defining the problem, proposing a solution, and constructing the result. The Evidence-Based Design process introduces a scientific approach to each phase of the design process. Problem definition now includes expected outcomes. Proposed solutions now incorporate credible research to guide designs. The constructed result is now studied to measure how successfully the outcome goals are achieved. And finally, an additional step in Evidence-Based Design is to document and publish the results of the process.

The Evidence-Based Design process begins with selection of the Team. Team members must be able to champion the process. They must understand the process of establishing goals and achieving buy-in from stakeholders to realize those goals. Determined by the complexity of the project, Team members may include Administration, Staff, Physicians, Design Professionals, Researchers, Community Members and Equipment Venders. The commitment and support of the Hospital Administration is critical to the success of the project. Evidence-Based Design is comprehensive. To adequately impact outcomes, the design process does not focus exclusively on the physical environment. The design process may require changes in operations, culture, procedures or staffing. In fact, the deeper a design solution is integrated into the culture and operations the more impact it can make. A unified Team led by a committed Leader has the greatest chance for successful integration.

As the Team moves into the design process, goals are established. During this first step, it is customary to establish subjective goals. Meeting subjective goals relies on the Team's collective experience and talents. Project Expectations set by the Team such as cutting-edge design, improved flow, flexible departmental layouts are examples of these goals. A project also has objective goals. The Team may establish goals such as decreasing length of stays of patients, decreasing injury rates for staff, or decrease patient falls in the Med/Surg Nursing Unit. These are objective expectations whose success can be measured and quantified.

With the expectations and goals clearly defined, the Team can begin the planning process. Implementing the Evidence-Based Design process in the planning stage is quite simple; find evidence to support a cause and effect relationship. If one of the goals is to reduce patient falls in the Med/Surg unit, the Team should find and analyze research studies that prove the link between design elements and desired outcomes involving patient falls. In the past, finding this type of research study would have been an arduous task. However, organizations like the Center for Health Design are organizing and publishing this research. The pool of information continues to grow as more and more healthcare systems and design professionals complete projects and publish the resulting outcomes.

Evidence to support design decisions does not always come from third party sources. One of the most important laboratories of Evidence-Based Design research is an existing healthcare facility. Surveying existing conditions and reviewing current outcomes can be a very important tool in the process of predicting desired outcomes. Likewise, Evidence-Based design is not only applied to new building construction projects. Improving patient safety issues or improving hospital acquired infection statistics might involve process changes or procedure changes. In other words, Evidence-Based Design can be applied to any size project at anytime during its schedule; even in post occupancy.

Healthcare Leaders have an ever challenging mission to provide quality care to the communities they serve. Today, more and more emphasis is being placed on patient safety and improved medical outcomes. This focus is also coupled by an increasing difficult financial environment. By using the Evidence-Based Design process, a collaborative Team of designers, architects, and owners can deliver building projects proven to positively affect patient and financial outcomes.