Evidence-Based Design and the Pebble Project: 12 Years Later

September 6, 2012
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The University Medical Center of Princeton at Plainsboro (HOK Architects). The Ann & Robert H. Lurie Children’s Hospital of Chicago (ZGF Architects). Photo credit: Nick Merrick © Hedrich Blessing. Susquehanna Health: The Willamsport Hospital and Medical Center (Stantec Architecture, formerly Granary Associates). Evidence-Based Design and the Pebble Project: 12 Years Later
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The goal of the Pebble Project, a research initiative launched by The Center for Health Design (CHD) in 2000, is to create a ripple effect in the healthcare community by providing documented examples of healthcare facilities that have used an evidence-based design (EBD) process to document outcomes.

Twelve years in, it’s interesting to note how the Pebble Project has evolved and may be an option to support your own EBD initiatives, whether it’s a new facility or a renovated space.

Since the inception of the Pebble Project, EBD has become an integral part of the healthcare design vocabulary—nearly three-quarters of respondents to a 2010 survey indicate using EBD (Taylor, 2011). In addition, CHD’s evidence-based design accreditation and certification (EDAC) program was launched to establish a structured framework around the process of EBD, while providing certification surrounding core competency understanding.

The Health Environments Research and Design (HERD) Journal was founded to provide a venue for peer-reviewed dissemination of healthcare-related built environment theory and studies, and many large architectural firms engage their own PhD researchers to conduct research and support and guide teams through the wealth of knowledge being generated throughout the industry.

When the Pebble Project was introduced, it was more of an open and undefined landscape; it was up to a few forward-thinking organizations to establish how they might better understand the implications of the built environment on healthcare outcomes.

The early work of the Pebble Project led to important discussions surrounding medication errors (Barbara Ann Karmanos Cancer Institute, Methodist Hospital-Clarian Health Partners); acuity-adaptable rooms (Methodist Hospital-Clarian Health Partners); and single-bed patient rooms (Bronson Methodist Hospital).

Many of these projects considered the financial implications of the outcomes, resulting in the 1994 Frontiers article about the Fable Hospital. This “hypothetical” facility was based upon many of the outcomes that had been documented by the early Pebble projects (Berry et al., 2004).

More recently, discussions have focused on the aesthetics of space and its impact on the waiting experience and quality of care (Weill Cornell Physician Organization – Weill Greenberg Center); acoustics in healthcare environments (Affinity Health, Jersey Shore University Medical Center, Palomar Pomerado Health); safety issues, such as the use of ceiling-mounted lifts in patient rooms (PeaceHealth); green cleaning (Healthy Hospitals Initiative); and taking the use of mock-ups to a new level with a live room in an existing facility (University Medical Center of Princeton at Plainsboro).

In the past few months, several Pebble Partners have opened their projects, including Susquehanna Health’s Williamsport Hospital and Medical Center, the University Medical Center of Princeton at Plainsboro, and the new Ann & Robert H. Lurie Children’s Hospital of Chicago. More Pebble Projects are scheduled to open later this year.

So how has the prevalence of EBD changed the Pebble Project?

Just as the industry has become more sophisticated with new project delivery processes and considerations of adaptability and flexibility in design solutions, CHD has been working to create additional support structures and flexibility within the Pebble Project. These have been in response to the growing use of EBD as a process and the expanding body of EDAC-certified individuals and organizations interested in more effectively using an EBD process.

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