Design Collaborative’s mission is that We Improve People’s Worlds. We do this by designing People-first Places. But, how exactly do we do that? What characteristics of the built environment can actually have a positive effect on the occupants of that environment? And how do we know that what works in one building will have the same effect on occupants in other, similar buildings?
Some basic features of buildings have well-established criteria that are known (and in some cases, scientifically proven) to evoke a specific positive human response. For example, the Illuminating Engineering Society (IES) has developed and published several design guides that provide detailed information on proper lighting levels for the exterior and interior of buildings. With this information, our electrical engineers know that each room or space in a building needs to have a certain number and type of light fixtures, each producing a certain amount of lumens (amount of light emitted), to achieve a level of light that positively supports the human activity planned for that space.
In educational classrooms for example, IES recommends that there be enough light fixtures to produce 40 footcandles (the illuminance on a one square foot surface from a uniform source of light) of light at 30 inches above the finished floor (desktop height). Meeting this recommendation provides the students and the instructor using that classroom with the proper amount of light for reading and other learning activities. This is just one of many basic building features that, over the years, have been researched, tested, and documented to improve the human experience.
Improving Healthcare Facility Design
For healthcare facilities specifically – one of DC’s core markets – there is an organized effort and movement to take the built environment to another level of positive human experience. Known as the Evidence-Based Design (EBD) process, its purpose is to “base the decisions about the built (healthcare) environment on credible research to achieve the best possible outcomes” (Center for Health Design, 2008). EBD is all about applying proven and documented positive design features to a new or renovated healthcare facility as well as developing and adding to the collective body of knowledge through scientific research and publication. Some of the primary goals for EBD are to 1) reduce stress for patients, families, and caregivers, 2) reduce errors in patient care, 3) provide a safe and efficient environment for all occupants, and 4) most importantly, to provide a healing environment for patients.
Implementing a successful EBD process as part of a new healthcare facility project requires buy-in, leadership, and input from all stakeholders, including the hospital administration, caregivers, designers, contractors and research professionals. It is truly a collaborative effort that ultimately must be supported by the hospital’s CEO. The CEO needs to be a champion for the overall EBD process to sustain it through the many obstacles and challenges that will occur. EBD begins at the very inception of a new project with the intent to guide the programming, research, planning, design, construction, and post-occupancy evaluation.
So, why would a hospital want to add EBD to an already lengthy and costly process of designing and building a new healthcare facility? The business case for EBD is compelling as hospitals and healthcare organizations are under increasing pressure to reduce costs and waste while providing a safe, efficient, and healing environment. In fact, in recent years a new concept has gained momentum with payers such as the Centers for Medicare and Medicaid Services (CMS), Medicaid, and other commercial groups called “value-based purchasing” or “pay for performance.” The idea is that hospitals in certain cases are now being required to meet specified performance measures (quality, efficiency, and overall value) with financial incentives/disincentives attached. There has never been a time when healthcare organizations could benefit more from an EBD process than right now.
What Does the EBD Process Look Like?
The eight steps to the EBD process are:
DEFINE EBD goals and objectives
FIND sources for relevant evidence
Critically INTERPRET relevant evidence
CREATE and innovate EBD concepts
Develop a HYPOTHESIS
COLLECT baseline performance measures
MONITOR implementation of design and construction
MEASURE post occupancy performance results
Ellen Taylor, PhD, AIA, MBA, EDAC, vice president for research at The Center for Health Design (CHD), has stated that “the EBD process addresses the key strategic goals and challenges of the health care provider by developing measurable concepts about how design strategies target clinical environmental and safety outcomes”. While not all projects may start or stick to an EBD process, at a minimum, EBD practitioners are encouraged to critically interpret relevant evidence that has been documented from scientific research and apply it where appropriate in their current project.
EBD and EBM
It’s interesting to note that the EBD process draws a close parallel to the earlier established evidenced-based medicine (EBM) process. EBM is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” It is intentional that the high level of rigor associated with EBM is also demanded in EBD. It’s important for EBD practitioners to share this correlation with those who may be skeptical of the value of EBD.
Evidence can mean many things to many people. What’s important to know is that not all evidence has been verified through rigorous scientific research. Often times, building owners and designers will look to articles in trade journals or other publications to learn about how certain design solutions may have had a positive result. However, this needs to be done with caution as the results that are published may not have been vetted through a scientific study. One reliable resource for the latest research is the CHD Knowledge Repository. This is a great starting point for finding sources of relevant evidence that may be able to be applied successfully to a new project.
Evidence-Based Design Accreditation and Certification
The CHD has created an international program called “Evidence-Based Design Accreditation and Certification” (EDAC) which “awards credentials to individuals demonstrating the ability to apply an evidence-based process to facility design, including measuring and reporting results.” Individuals eligible to take the EDAC exam include healthcare planners, architects, interior designers, engineers, contractors, clinicians, and healthcare organization managers.
While this blog mainly focuses on EBD for healthcare facilities, EBD is also getting traction with other building types, including schools, office spaces, hotels, restaurants, museums, prisons, and even residences. The scientific research for these other building types may not be as readily available, but there is growing evidence on how the built environment can have positive outcomes or experiences for the people that use them. At DC, we believe our unique approach to making People-first Places is firmly rooted on using the best available evidence and to encourage the collaborative process of finding new ways that We Improve People’s Worlds.
Bill Ledger AIA, ACHA, NCARB, EDAC, LEED AP
Associate, Healthcare Architect