Ene of the themes of this month's issue is evidence-based design (EBD), which has become a widely discussed topic, and often strong opinions fall on one side or another of what may seem to be a fairly straightforward concept. Indeed, words have strength and power in them, and when strung together, these three words often elicit strong emotions from a number of people.

For some, the word “evidence” is of concern. They rightfully point out that there is not yet a large or deep body of evidence regarding the relationship between the built environment and outcomes in healthcare. For many, “research-based” is a more comfortable way to talk about the growing conversation that starts to link outcomes to specific design interventions in the built environment. After more than 20 years developing programs and tools to help move the industry forward, I have found that being aspirational in your vision is the best way to quickly bring that vision into reality. So, although we are not there yet, by being bold in our choice of terminology, we will get there sooner rather than later.

Terminology aside, most are on the same page when it comes to the conviction that the built environment impacts patient stress, patient and staff safety, staff effectiveness, and the quality of care provided in healthcare settings. Just as the medical community has increasingly moved toward “evidence-based medicine,” where clinical choices are informed by research, the healthcare facility design process is increasingly guided by rigorous research linking the built environment of healthcare facilities to patient and staff outcomes, which has come to be known as “evidence-based design.” As an industry, we may not have progressed as far along the continuum as the evidence-based medicine field, but we are on the path and each year the number of credible studies has grown exponentially.

In addition to the growing body of credible research, we have a growing network of universities educating the next generation of healthcare architects and designers. In the past, there were just a handful of programs for this specialized area of study. Now, more than a dozen quality programs are available, with many more in development at every level of education-from bachelor's degrees to doctorates. This is one of the most encouraging factors that should inspire us to be optimistic about our future. It is heartening to hear the passion, excitement, and commitment in the voices of students who reach out with questions to The Center for Health Design throughout the year or who are in need of connections to assist them in their studies.

For The Center, evidence-based design has never been prescriptive; it has always been about process. With the assistance of a team of industry experts who helped develop the Evidence-Based Design Accreditation and Certification Program, we outlined an eight-step process around evidence-based design. The process is broken into five distinct stages and consists of eight specific steps as outlined in Figure 1. It's important to note that the EBD process is fluid. The steps are an integral part of the project, from inception though initial occupancy and even through the facility's entire lifecycle.

For The Center, evidence-based design has never been prescriptive; it has always been about process.

Though there is still discourse on the terminology and concern that we don't over-promise, we should be optimistic about the future of our industry and our ability to apply research and generate new data to support our decisions. I am proud of the seed that has been planted and is growing rapidly, and look forward to continued dialogue with you as we mature this body of knowledge and steer it in the direction of creating safe healthcare facilities that encourage the best possible clinical and economic outcomes for patients, families, and staff. As Rosalyn Cama, a Connecticut-based interior designer and board chair of The Center for Health Design, says, “Using an evidence-based design process forces important discussions earlier in the process and sets a team on measurable goals.”

Your thoughts about the role of an evidence-based design process in our industry are welcomed. We'd like to hear what you think the challenges and barriers are as well as the opportunities moving forward. Feel free to contact me at dlevin@healthdesign.org.

For more information, visit www.healthdesign.org. HCD

Debra J. Levin is president and CEO of The Center for Health Design in Concord, California. Follow her on Twitter@CHD_DebraLevin Healthcare Design 2011 April;11(4):8-9