Creating Standardization for Post-occupancy Evaluations

Post-occupancy evaluation (POE) is one of the most common types of research used to inform evidence-based design (EBD). However, while POEs have been part of the design discourse for many years, there are some significant concerns regarding assimilation and implementation in practice.

In the Third Annual Survey of Research Design in Healthcare Environments (see more on the results here), many organizations state they conduct a POE to measure results (73%), yet this is still a less-used way to gather evidence about design strategies for a project (12.5%). This gap between conducting a POE and using a POE may be aligned with gaps identified in a recent report to the U.S. Military Health System, which include: 

• A lack of standardized POE methods and metrics;
• Findings/conclusions that are not widely accessible;
• A focus for technical performance and not outcomes related to patient-centered care; and
• Lessons learned not tied to institutional processes. 

With a large number of healthcare facilities undergoing replacement or renovation, a knowledge base of post-occupancy evaluations that examine not only user satisfaction but also healthcare outcomes could be an invaluable asset.

POE initiatives at The Center for Health Design
The RIPPLE database. The Center for Health Design (CHD) has been involved in a major research effort over the past few years aimed at developing such a framework and database for linking healthcare facility design with key user outcomes. This database (RIPPLE) aims to create a ripple effect in healthcare design to support not only facility evaluations but also decision making for future projects.

It’s expected to provide a robust framework that enables all constituents involved in healthcare facility design to optimize design decision-making based on POE and other research evidence, benchmark the design strategies used at individual facilities against other similar ones, and assess the effects of design on healthcare outcomes.

When fully developed, this database will include four key focus areas: environmental sustainability, patient safety, worker safety, and effectiveness and quality of care. The initial development focus, environmental sustainability, was supported by funding from the U.S. Green Building Council and was developed through research conducted in 2008-2010.

As a result of this first phase and ongoing development, the RIPPLE database provides user-friendly, online, self-administrated standardized tools for collecting data about implemented design strategies, user feedback, and healthcare outcomes. It provides organizations a way to compare their outcomes against other similar organizations, and it will generate more rigorous research when a large number of facilities participate in the database.

In addition, there’s an option for a more in-depth, on-site audit and evaluation of inpatient facilities that can be conducted for CHD’s Pebble Project partners by CHD staff who will visit the participating facilities. Integrating an on-site environmental audit for healthcare POEs with standardized metric collection provides additional insight about facility performance through interviews, focus groups, and systematic observations during walk-throughs.

Clinic (outpatient) POE. Despite the recent growth in clinic renovation and construction, there’s very little empirical information specific to clinic design that can be used to inform decision-making. Further, the lack of standardized evaluation tools and platforms for sharing the results of design evaluation has limited the generalizability and usability of the existing post-occupancy evaluations conducted in clinics.