When reliable and practical evidence related to design features and principles is used, facility design decisions can contribute to more effective health services delivery. Recent trends suggest a heightened interest in evidence-based healthcare facility design. However, it is not clear how healthcare organizations engaged in renovation or new construction projects are actually using different types of information during the design process, or the kind of sources of evidence being used.
In order to examine how evidence was being used in design decision-making, interviews and observation sessions were conducted at three Pebble Partner healthcare facilities at different phases of the evidence-based design (EBD) implementation process. The site visit for the predesign phase was conducted at a Midwestern community hospital (Waukesha Memorial Hospital, ProHealth Care); the design phase at a Northeastern academic medical center (Princeton University Medical Center); and the construction phase at a Pacific Coast long-term care safety net facility (Laguna Honda Hospital). Questions addressed during these site visits included:
What sources of information are used by EBD practitioners?
How are these sources of information used to inform the EBD decision-making process?
How is the “value” of evidence weighed by EBD practitioners?
What are additional factors, barriers, or constraints that may facilitate or impede the use of evidence as part of the design decision-making process?
What sources of information are used by EBD practitioners?
Participants at all three sites indicated they used a range of information sources during the design process. This included reading materials, such as peer-reviewed journal articles, trade journal articles, reports, white papers, and opinion pieces, as well as consultants, and design team presentations and talks. They also mentioned accessing Web sites of relevant organizations in the field to get cutting-edge information about different topics.
While these published and unpublished information sources were considered useful, it was evident from the discussions at all sites that “experiential knowledge” trumped all sources of information in terms of usability and relevance to the design process. This included information obtained during site visits to other hospitals, discussions with peers regarding specific issues, day-to-day experience of working in their current hospitals, participation in peer groups, and formal and informal discussions with community leaders and stakeholders.
There was unanimous agreement among participants across all three sites that irrespective of where they were in their design phase, site visits were critical sources of information. Time and again, participants referred to the importance of being able to “touch and feel” design strategies under consideration. Observing something functioning, seeing what worked and what didn't, and being able to critically evaluate whether a certain feature would likely work within the context of their facility and organization was described as very helpful.
While similar sources of information were referred to as being important during all three phases, there appeared to be a greater emphasis during the design phase on using knowledge from day-to-day experiences. At Princeton, as participants described how they made fairly detailed design decisions regarding placement of different types of spaces, it became clear that they relied upon experiences working in their current environment. This was less evident during the pre-design phase, when participants were told to think of ideal scenarios. They referred to this as their “dream phase.”
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