11. Evidence-Based Design Matters

Evidence-based medicine.  Evidence-based management.  Evidence-based design.

The thinking makes a lot of sense: do today with what you (and others!) learned yesterday.

The Center for Health Design is the ultimate source on this subject and they provide a much more comprehensive definition:

Evidence-based healthcare designs are used to create environments that are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress.

An evidence-based designer, together with an informed client, makes decisions based on the best information available from research and project evaluations. Critical thinking is required to develop an appropriate solution to the design problem; the pool of information will rarely offer a precise fit with a client’s unique situation.

In the last analysis, though, an evidence-based healthcare design should result in demonstrated improvements in the organization’s clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures.

As we plan and build our virtual hospital, our own system is committed to constructing a healing environment through evidence-based design.  The Center even provides a toolkit that will help us:

  • Understand what patients want from the built environment
  • Enhance the design process through consumer involvement
  • Build patient-centered environments
  • Improve design quality and consumer satisfaction

Ulrich and Zimring published a comprehensive literature review/report on hospital evidence-based design in 2004.  The Robert Wood Johnson Foundation has a nice overview/summary of the research.  We can take explicit recommendations from this research and turn them into action:

The Single Room that does it all. “This change alone will help improve patient safety by reducing patient transfers, cut the risk of nosocomial infections, enhance patient privacy, lower stress for patients and their families, and improve staff communication with patients.”

Ventilation Systems and Air Filters. “Several studies have demonstrated that identifying and fixing air-quality problems, in combination with single rooms and scrupulous hand-washing, can substantially lower infection rates at hospitals.”

Noise Reduction. Elements like carpeting and sound-reducing ceiling tiles can lower noise levels.  “Research shows that noise is a major source of stress at hospitals. At hospitals that took steps to cut noise levels, patients were more satisfied with their care, slept better, had lower blood pressure, and were less likely to be re-hospitalized.”

Natural Light. “Looking out at bright light can improve health outcomes, including depression, agitation, sleep, and circadian rest-activity rhythms.”

The “Little Stuff.” “Small changes to room layouts, color scheme, furniture choice and arrangement, floor coverings, and curtains, as well as providing informational material and displays, can improve people’s moods and physiological states.”

Easy Navigation. “It’s easy to get lost or confused trying to find one’s way in a hospital. Not only is this confusion stressful for visitors, but it also incurs a cost to hospitals.”

Work Environments that help staff do their work. “Nursing stations are hectic and stressful places where too many errors occur while updating charts, filling medication orders, and communicating between shifts.”

One more thing: the Pebble Project.  “The purpose of the work (Pebble Project) is to create a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities whose design has made a difference in the quality of care and financial performance of the institution.”  Just take a look at some of the benefits of great design: staff turnover reduced, occupancy rates increased, patient satisfaction up, etc.  And if you have an extra minute or two, enjoy the great images of proven evidence-based design.

Principle #11: Evidence-based design is beyond important, it’s item number one on the things to do list at our own system. The Center for Health Design will help us get there.

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