What is Evidence-Based Design?

An architect I know called Evidence-Based Design just another buzzword term, like Integrated Design (ID). While Integrated Design is not such a term, the architect believed ID was good practice, and a good architect always involves consultants right from the start of design. He believed ID was a buzzword because it’s a term used to sell software to architects, and projects to clients.

Unlike that architect, I believe Evidence-Based Design (or EBD) is what building commissioning is to engineers: testing the building both before and after to create a base point for the design, and to make sure the what is designed and built actually provides improvements.

EBD Background: In the US in the late 1990’s hospital owners documented both patient turnover and hospital staff job efficiency to determine ways to help improve their bottom lines. Faster patient turnover meant more patients, and in a non-public healthcare system such as theirs, this meant more profit. The results of these studies indicated a number of ways design could improve not only staff members efficiency (for example, how much time nurses took to walk from a nursing station to a patient room) but how design could improve the healing of patients.

As Roger Ulrich (et al.) point out in the document The Role of the Physical Environment in the 21st Century Hospital: A Once-In-a Lifetime Opportunity:

EBD is not about hospitals that are simply nicer or fancier than traditional hospitals. Rather, the focus of evidence-based design is to create hospitals that actually help patients recover and be safer, and help staff do their jobs better. EBD is a process for creating health care buildings informed by the best available evidence concerning how the physical environment can interfere with or support activities by patients, families, and staff, and how the setting provides experiences that provide a caring, effective, safe, patient-centered environment. Many of the improvements suggested by EBD are only slightly more expensive than traditional solutions, if they are more expensive at all.

Many of the items Roger Ulrich, (et al.) suggest in the study consist of items dealt with on a regular basis in hospitals: ways of minimizing airborne contagions, reducing noise transfer for patients, access to nature and connections to the outdoors, providing social support to patients, installing handwash sinks in every patient room, etc. His research inspired a multitude of other research in that area, creating a renewed look at hospital design.

EBD is best utilized when comparing two conditions, or a previous condition to a new one. For example, a person is hired to measure how long it takes staff to do a task, such as walking to hospital rooms, washing hands, filling out forms, etc. Two scenarios are compared, to see which are more efficient, for example a long wing of rooms vs. a central nursing station with a circle of rooms. Or, the patient benefits of an eastern facing room vs. a south-facing one. Time is usually the measuring tool, so a designer would notice if patients recuperate more quickly in eastern or south-facing rooms and orient the building accordingly. A designer might also look at which hospital wing typology is best for the hospital nursing staff. As the design progresses, they might compare ideas like central recording at a nursing station vs. documenting stations outside of each patient area (where they write notes in view of the patient in question). The air handling system would be developed at the same time to deal with airborne issues: is a combined air-heat system better or worse than separate air handling and heat equipment?

EBD is a technique that should be used in conjunction with ID, so the design is the most efficient and appropriate for the clients and users. EBD is one of many topics I will explore on this site in further detail as I get more information from both architectural and health-related sources.