“Run until apprehended” is the mantra of a new hospital project I am involved with. The CEO is not reckless—just the contrary, actually. He is a thoughtful, provocative, and inspiring leader. The goal behind this slogan is to not have the team fall prey to the inhibitions of current thinking in healthcare delivery. Instead, the client wants to push the envelope by asking questions differently about the cultural shifts needed to improve outcomes and then using design elements to support those behaviors. The caveat, though, is to do so in an informed way by using evidence-based design. This method is known to mitigate risks; hence the unlikelihood of being “apprehended.”

What is evidence-based design? It is a process in which safe conventional wisdom about design for an improved outcome is challenged, which in turn forces the study of organizational, cultural, and operational behaviors, and the development of new design solutions that can be scientifically measured. Predictions about organizational, cultural, and operational changes lead to hypotheses for research projects. Healthcare design research projects are growing because some pioneers in the healthcare industry are willing to measure and admit their successes and failures. These pioneers, who are participating in The Center for Health Design's Pebble Project research initiative, will fuel the revolution needed to redesign the old model of care. It will be slow, but as the evidence builds, newer models of care will create positive outcomes in the areas of health and healing, organizational management, and economic returns.

Are you willing to push the status quo and ask your team to look differently at the delivery of care? At press time, there are 27 healthcare organizations participating in the Pebble Project that are asking their operational managers and design teams to think outside the box—not by designing according to a new published trend, but with the measured knowledge of their colleagues' efforts. Some will pioneer new ground, but many are tackling the same hard questions that often have been difficult to ask without a researcher on the team, such as, “Are we really ready for like-handed, single- occupancy, variable-acuity rooms that are safe, productive, and healing?” “Are we willing to pay the premium to bring that room to fruition?” “Do we know the real return in patient safety, staff satisfaction, and economic gain?” This is precisely what is at the heart of the Pebble Project.

If you answer yes to these questions, then your path is simple. Join an illustrious group of “pebbles” and make a difference. Those who apply and are accepted into the project commit to a minimum of three years and pay an annual fee. In turn, they receive exclusive access to research methodologies and high-level expertise, industry visibility, and more. They agree to conduct research and share their results with others. It takes a unique organization with an extraordinary commitment to excellence—and vision—to be a Pebble partner. Ideal candidates have:

  1. A relatively stable patient population;

  2. Stable and interested senior management who are committed to doing research in this area;

  3. Stable and interested clinical and support staff;

  4. Project staging that permits collection of baseline clinical, organizational, patient, family, employee satisfaction, and financial effectiveness data;

  5. Financial resources to carry out the project's estimated cost;

  6. A high level of enthusiasm and commitment to the project and the sharing of information during and after the process; and

  7. Willingness to participate in Pebble presentation and brainstorming sessions at the annual Symposium on Healthcare Design, as well as periodic roundtable discussions with other Pebble partners.

Healthcare organizations have joined the Pebble Project at various stages of project planning, designing, and building. The Center outlines the following phases for a Pebble that is begun from “scratch”:

The Design Phase. This entails establishing project objectives; creating the project program and design; establishing tools for measurement and evaluation; and creating baseline medical, economic, satisfaction, and/or organizational data for benchmarking and subsequent evaluation.

The Construction and Initial Occupancy Phase. Additional organizational work may, and probably will, be done during this phase.

The Evaluation Phase. This takes place approximately six months after initial occupancy of the new facility. Research parameters for which baseline data have been established are remeasured to begin the process of documenting and evaluating the impact of the design.

Research Hypotheses, Methodology, and Measurements. The overarching hypothesis is that changes in the physical environment of the new facility will affect operations in such a way as to enhance both health and organizational outcomes. Subsidiary or complementary hypotheses, methodologies, and measurements have been discussed extensively. These hypotheses are then shared with other Pebbles and the industry at large.

Those who don't become Pebbles can stay informed by reading this magazine, looking for updates on The Center's Web site (http://www.healthdesign.org/research/pebble), attending Center-sponsored conferences, subscribing to The Center's e-newsletter, and searching the literature for other published articles.

“Run until apprehended” may be too strong for your team, but stay close behind us, because we are about to shift more than one paradigm. HD