Evidence-Based Design (EBD) is defined by the Center for Health Design as “the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”
Traditionally, hospital designs were based on a designer’s past experiences with similar projects, input from the user occupants, and standards such as CSA Z8000 Canadian Health Care Facilities – Planning, Design and Construction and Facilities Guideline Institute 2018 – Guidelines for design and construction of Healthcare Facility.
What was lacking was evidence that such past experience was necessarily transferrable, especially when locales, patient populations, and equipment all varied. In addition, staff experiences were often based solely on current processes and procedures, providing scant opportunity to introduce new concepts or to truly understand the impact of specific design interventions. What was needed was specific evidence of the positive and negative impacts of these interventions on patients and staff.
Early research into evidence-based design was controversial, as the ‘gold’ standard of study design was randomized, double-blind, placebo-controlled studies, which are very difficult to conduct within the built environment. Patient populations in hospitals are very different in age, diagnosis, culture, experience, etc. There is also a continuous interplay among the design and layout of a hospital, care-delivery processes, and patient reactions; however, researchers Roger Ulrich, Craig Zimring, Archibald Cochrane and others brought scientific rigour to these early studies and essentially created an entirely new way to design healthcare facilities. Leveraging existing knowledge, and new research on how people interact within a complex environment, now inform planning and design decisions. The result is a new tool for achieving the best-possible patient, staff and operational outcomes. This is the heart of evidence-based design.
As an Evidence-based Design Accredited and Certification (EDAC) firm, staffed with EDAC-certified healthcare designers, we are committed to the “process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” We regularly attend training sessions or webinars and contribute to knowledge bases. More importantly, in conjunction with our clients, we have established several EBD Research Studies of specific impacts on the healing process resulting from our project designs.
Our designers regularly participate in the Center for Health Design’s webinars such as Meeting Patient Expectations during Hospitalization: A Grounded Theoretical Analysis of Patient-Centered Room Elements. This webinar provided useful reference and case-study material with respect to patient-room design, specifically with regard to control and independence. The study designers generated a theoretical design framework for their construct and mocked-up five different patient bedrooms. These were toured by patients and families, who answered a fairly detailed questionnaire. The study demonstrated that patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient’s personal effects, and offers the patient suitable levels of independent control, throughout the hospital stay.
As part of our commitment to research and betterment of healthcare delivery, we have undertaken internal Post Occupancy evaluation studies as well as larger studies with research experts, to inform the design decisions we make on a daily basis. In our infancy as an EDAC accredited firm, we undertook independent POE studies at Southwest Centre for Forensic Mental Health Care, St Thomas, Ontario, and at Parkwood Institute, Mental Health Care Building, London, Ontario. The design goal at these facilities was to challenge the aesthetic typically associated with forensic detention facilities, and to support the client’s healing journey through use of colour. Our positive findings in this study were included in Evidence Based Design in Practice 2014, published by the Center for Health Design. These findings encouraged us to conduct a broader research project in conjunction with Dr. Saleh Kalantari, Post-Occupancy Evaluation of a Mental Healthcare Facility Based on Staff Perceptions of Design Innovations, published in the Health Environment Research & Design Journal 2017.
These positive outcomes informed our design at Providence Care Hospital in Kingston, Ontario. Here we made many decisions in relation to Inpatient Unit layout, use of open Care Stations on mental healthcare units, and application of colour, based on previous research, by ourselves and others. Providence Care Hospital is one of the first in the province to secure funding for an independent Post-Occupancy Evaluation, led by Methologi.ca. Parkin has consulted with Dr. Celeste Alvaro and her team at Methologi.ca and aided in the development of the Pre- and Post-Occupancy study framework for the project. Pre-Construction Data was collected between August and October 2016. Post-Construction Data Collection is scheduled for August to October, 2018.