The Center for Health Design Blog

Evidence-Based Design Issues

The American Society for Hospital Engineering (ASHE) of the American Hospital Association (AHA) recently published a guidance statement on evidence-based design (EBD).

This statement reflects concerns among ASHE board members and staff about potential misrepresentation of EBD and is meant to provide guidance to its members who are involved in the project development process.

While many of the points brought up in this statement are valid, there are others that need some clarification and further discussion. I’d like to start a discussion about it on this blog so we can all come to a better understanding of how we can, in our different roles, contribute to the design of safer and better hospitals.

EBD is an evolving concept and as more projects following an EBD process near completion, we are reaching a better understanding of many different issues. Some of points of concern that have been brought up in the ASHE statement are still being discussed in the field of evidence based medicine (which has been around for a long time). Building on an evidence based medicine tutorial developed by librarians at Duke University and University of North Carolina, I’d like to clarify some of the points raised in the ASHE statement and invite further discussion.

Opponents:
EBD is “old hat.” Architects and designers have been using research to guide their decisions for a long time. The label is new.

Proponents:
The new focus on EBD “formalizes” that “old hat” process and filters the literature so that decisions are made based on “strong” evidence.

Opponents:
EBD is “cook book design.” It suggests that decisions are based solely on the evidence, downplaying experience and imagination.

Proponents:
EBD should be one part of the process. Design decisions must be based on many different things — the individual architect/firm’s experience, site specific and organization specific issues, and, when available, good evidence.

Opponents:
EBD is the mindless application of general studies conducted in different types of healthcare settings and different populations to a specific building design project.

Proponents:
A key step in the EBD process is to critically analyze the evidence and decide whether or not the information and results are applicable to your project.

Opponents:
Often there is no randomized controlled trial or “gold standard” in the literature to address a particular design problem

Proponents:
The design team might consider the “evidence pyramid” and look for the next best level of evidence. Architects and designers need to understand that there may be no good evidence to support every design decision.

Opponents:
There is often great difficulty in getting access to the evidence and in conducting effective searches to identify the best evidence.

Proponents:
Resource librarians can help identify the best resources and teach design professionals effective searching skills.

What do you think? Let us know!

Notes from EDRA Conference

Last week Amy Keller and I attended the Environmental Design Research Association (EDRA) conference in Sacramento. The focus of this year’s session was on ‘Building Sustainable Communities’.

It’s a great group – usually there are environmental psychologists, architects, researchers, students and academicians represented. I have been active at EDRA since my student days at Georgia Tech where I organized workshops as well as presented posters and papers. One of the most remarkable things about EDRA is that it is incredibly welcoming of students and provides a wonderful venue to present their ideas and to get feedback from those established in the field. I have gotten to know a lot of wonderful people through EDRA.

This year’s EDRA was no exception. There were several really interesting sessions on healthcare related topics starting with the healthcare intensive on Nursing Floor design organized by Dr. Craig Zimring and his students from Georgia Tech. Amy Keller and I presented the research on the impact of the work environment on the healthcare team. Other presenters included Dr. Eve Edelstein, from San Diego State University, John Kouletsis from Kaiser Permanente, Joyce Bromberg from Steelcase, John Pressler, Ageneta Morelli and Terri Zborowsky, Diane Drexler from Banner Estrella and Georgia Tech students Michelle Ossman and Bo Seo. Other students presented their research ideas through poster presentations during the break. Speakers presented new research pertaining to nursing unit floor design.

The session was well attended with active audience participation. Several new ideas were put forth for growing this new field including ways in which students can be more actively involved in research. The Pebble Project provides a wonderful venue for linking research interests of the Pebbles with those of students interesting in doing research. I hope to be able to facilitate these linkages in the days to come!!

There were many other interesting sessions on healthcare research presented by speakers from academia as well as architecture firms. Dr. Maggie Calkins and Dr. Gowri Betrabet presented the CHER study on Falls. I presented the four RWJF issue papers as a bundle. These presentations were all well received. Clearly, there was a lot of excitement around healthcare at this EDRA.

Craig Zimring summed it up nicely – according to him – over the many years he has been involved in this field of environmental psychology, this time is the most exciting since he sees a huge opportunity for us as environmental psychologists, researchers and designers to work together to really impact the design of the physical environment such that it changes the way we live and act. The massive healthcare construction boom provides us this opportunity to impact change in a big way. At the time same time, he expressed some concern over the over use of the term ‘evidence based design’ as a solution to all our problems. He and others cautioned that we need to broaden our definition of ‘evidence’ from simply empirical evidence to that obtained from project evaluations and other sorts of evaluations to really help inform design.