One of my favorite characters in all of literature is Howard Roark, the über-architect protagonist of Ayn Rand's The Fountainhead. As many, if not most, of our readers know, Roark is beholden to no one for inspiration, guidance, or approval in creating his designs. He rejects tradition, social mores, and anything else that stands in the way of his vision. And if you don't like his vision, that's your problem.

I confess, I'm no Rand acolyte, but I think Roark appeals to the “go to hell” individualists buried deeply—sometimes very deeply—inside all of us. Would that we could all create a vision and follow that vision as we see fit, responsible to no one but ourselves. It's commonly believed that Roark is based on the real-life example of Frank Lloyd Wright—although, in all truth, I doubt even Wright was that free. We all have to answer to each other and to the world because, like it or not, our work serves others.

The question is, and I don't think Roark (or Rand) would disagree: How can our work make a contribution?

We'll answer using an old word with a very modern connotation: “evidence,” as in evidence-based design. We have to look around us to find evidence of (1) a need of some kind, (2) the feasibility of meeting that need, and (3) our ability to be involved in doing so. That's the meaning behind the term “evidence-based design”—an openness to evidence, without which it's just another trendy buzzword.

Several articles in this issue of Healthcare Design point to evidence that can be used to guide lighting installation; ICU, CCU, and ED design; healthcare furniture development; and acoustical planning. Also, as promised in our last issue, there's a look at “operational analysis” and “process mapping,” two more ways of studying the world around us before applying pen to paper.

And, because this is our annual Showcase issue, you will find evidence—a lot of evidence—of these ideas being put to work in projects of every description—178 in all.

There's a big difference between seeking/responding to evidence and indulging in the tradition-worship and social toadying that Howard Roark so loathed. Using evidence-based design really isn't a matter of cravenly “seeking approval” for the safe or popular choice; it's a way to be more useful.

One can feel suffused with admiration for the creations of architectural genius, even if the buildings leak and the chairs cause pain. But one does have to get on with life, after all. Why not make the journey as desirable as possible for the people we serve and who serve us? HD