As I traveled through the Merchandise Mart during NeoCon in June, I was reminded of the special privileges being in the design profession offers. Discreet signs in some showroom windows clearly noted, “To the Trade Only,” meaning access to knowledge about specialty products is privileged.

The Center for Health Design has a similar offering to healthcare and design professionals in the form of a new tool that has grown out of an effort to broaden our research and advocacy role. Just about a year ago, within a project that was funded by the Robert Wood Johnson Foundation, an analysis of all research that linked healthcare environments with improvements in human behavior was completed. Roger Ulrich, PhD, of the Center for Health Systems and Design, College of Architecture, Texas A&M University, and Craig Zimring, PhD, of the College of Architecture, Georgia Institute of Technology, and their graduate students, Xiaobo Quan, Anijali Joseph, and Ruchi Choudhary, conducted a meta-analysis of current data. They found 600 studies relevant to the work that an evidence-based designer would need to successfully complete a literature search in the area of healthcare design.

The findings resulted in a landmark report titled, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity.” What is particularly useful about this report is the researchers' foresight to categorize the database of completed research into four pertinent areas: reduce staff stress and fatigue; improve patient safety; reduce patient stress; and improve overall healthcare quality.

To visually present this work at various conferences around the country, the researchers developed scorecards that provide subsets within each of the above categories, with a rating of one to five stars for each subset (figure). Five stars means that there is enough evidence to make the issue so compelling that a design team need not discuss its merits any further. Anything less than four stars is a cue to The Center for Health Design and its Pebble Project partners (see story on page 32) that more research is needed in these areas.

These scorecards should be a part of the planning process in any healthcare project. For example, because the research documenting the benefits of reduced noise, improved sleep, and reduced nosocomial infections gets four- and five-star ratings, and because these benefits are directly attributable to single-bed rooms, discussing single- versus two-bed rooms would be a waste of precious design time. On the other hand, the one- and two-star ratings for “improve workplace, job satisfaction,” “reduce turnover,” and “reduce fatigue” indicate that more evidence is needed to strengthen the case of the built environment's impact on these factors.

These scorecards provide access to knowledge that is not privileged, but it is sometimes difficult to amass to support a point. Therefore, this first step in the evidence-based process—the literature search—is our gift to you, in the form of these star-rated scorecards. HD

The Center for Health Design is located in Concord, California.