Creating a Foundation for Evidence-Based Healthcare Design Research and Practice

December 13, 2011
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Creating a Foundation for Evidence-Based Healthcare Design Research and Practice

The design of healthcare facilities is an inherently complicated process involving interdisciplinary teamwork among healthcare administrators, planners, programmers, designers, clinicians, and patient representatives, and others who have different backgrounds and professional languages. Communication between stakeholders during the facility design process, especially while using evidence to inform design and creating evidence by empirically evaluating the built environment, becomes difficult due to a lack of common understanding of terms and measures.

There is a need for a set of standard definitions of key terms and measures used in healthcare design—this base knowledge would make it easier to communicate with team members, interpret and translate research studies to design knowledge, generalize studies to different types of settings, compare data across multiple facilities, and develop a central repository of evidence.

In October 2009, The Center for Health Design (CHD) initiated a project to develop a standard glossary for evidence-based design (EBD) in healthcare. The first phase of the project aimed at: (1) identifying environmental variables and outcome measures in the existing EBD research; and (2) examining how these variables and outcomes were defined and measured in seven high-priority topic areas:

  • Healthcare-associated infections (HAIs)
  • Medical errors
  • Patient falls
  • Patient satisfaction
  • Patient waiting
  • Staff efficiency
  • Staff satisfaction 

A better understanding of key variables, metrics, and measurement tools currently used in EBD research will provide a crucial foundation for future phases of this project by enabling CHD, as well as others, to develop more accurate definitions of terms and variables, to develop more powerful metrics and tools, and eventually to enhance the quality of EBD research and practice.

This paper provides a synopsis of the EBD glossary terms, metrics, and measurement tools extracted from the literature as well as the process of the first phase. Because of space limitation, only a very small sample of the results is presented here. The complete results, including a full research report, literature analysis tables, glossary tables, and conceptual frameworks are available at CHD’s website: For corresponding tables, please see attachments below.



The CHD research team worked together with experts from CHD’s Research Coalition to conduct an extensive literature search and review. The literature review focused on peer-reviewed research articles that empirically demonstrated the effects of environmental variables on healthcare outcomes in each of the seven topic areas. The relevant articles from CHD’s previous literature reviews (for example, two comprehensive literature reviews by Roger Ulrich and colleagues [2004, 2008]) were retrieved.

Publications after CHD’s previous literature reviews were searched in research databases such as PubMed and EBSCO. Additional articles came from the reference lists of existing articles and the recommendations of academic and industry experts.

The articles were sorted and sifted for detailed literature analysis with the goal of creating a comprehensive list of variables as well as metrics and measurement tools. The purpose of the literature review was not to exhaustively review all articles on a particular subject. Rather, the goal was to review a sample of articles in different topic areas that had an empirical focus and clearly defined environmental and outcome variables. Each selected article was analyzed to extract relevant information, including the environmental variable(s) and outcome(s), metrics, measurement tools, sample(s), setting(s), research design, and findings. The results of the literature analysis included a series of tables and a chart for each topic area:

CHD Research Report_Table 1.pdf29.64 KB
CHD Research Report_Table 2.pdf28.6 KB
CHD Research Report_Table 3.pdf20.54 KB
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