A Rigorous Approach to Evidence-Based Design

In recent years, military health facilities across the nation are increasingly embracing the concept of evidence-based design (EBD). Military hospitals are incorporating elements of EBD in new construction, expansions, and remodeling to ensure all military medicine beneficiaries receive a high quality of care, regardless of where they seek care.

The new Irwin Army Community Hospital taking shape at Fort Riley, Kansas, is a perfect example of how EBD has greatly influenced the development of a military medical facility’s healing environment. 

The U.S. Army Corps of Engineers-Kansas City District contracted with the LEO A DALY/RLF joint venture to provide a world-class medical facility that is not only designed to the latest military and private sector standards but also incorporates cutting-edge EBD principles. As such, the Irwin Army Community Hospital replacement project was designed and is being constructed with a highly rigorous and energetic approach toward EBD.

Totaling approximately 522,000 square feet, this healthcare facility will include a 263,000-square-foot inpatient community hospital, a 289,000-square-foot outpatient clinic, a central energy plant, an ambulance garage, and parking for 1,600 vehicles. When the $334 million facility opens in 2014, it will serve the 1st Infantry Division’s military personnel and their families on Fort Riley and in the surrounding areas.  

The Department of Defense’s Military Health System (MHS) stipulates that a healthcare facility should have the following operational characteristics (Source: http://www.tricare.mil/ocfo/docs/AchievingWorldClass.pdf):

• Basic infrastructure;
• Leadership and culture;
• Processes of care;
• Performance;
• Knowledge management; and
• Community and social responsibility.

While the Irwin Army Community Hospital project responded to each of these tenets in different ways, one specific condition under the basic infrastructure tenet stands out—adherence to EBD principles.  
 

Creating checklists

The Department of Defense has a checklist approach to EBD that not only affords design teams a comprehensive process but also allows them to consider logical solutions for a particular facility type. Not all design checklist requirements need be employed, and additional considerations can be entertained specific to the institution or building site.

An example of Irwin Army Community Hospital’s checklist is presented below, indicating some of the principles that were expected in order to create a patient- and family-centered environment in the obstetrics department.  
 

EBD checklist used at Irwin Army Community Hospital.

A Fort-Riley-specific checklist was created by Susan O’Hara, RN, MPH (O’Hara HealthCare Consultants LLC), nurse consultant to the LEO A DALY/RLF team, from the Department of Defense’s master checklist, and also based on her own experience as well as the team’s experience.

“We wanted to create a master list for all of the primary departments of the medical facility so requirements could be analyzed using a systems approach throughout the duration of the submission phases,” O’Hara says.

The checklist identified all the critical principles the project team needed to evaluate in order to make the initial design decisions, even before the charrette stage. These principles extended from the building architectural design into furnishings, equipment, and site planning. This formalized process, however, didn’t stifle innovation and design initiatives.