In the last five years many important healthcare building projects have been completed using evidence-based design. This transition in practice methodology has created a baseline of knowledge that no longer needs debate, and as a result, has fostered groundbreaking design concepts to emerge more rapidly on the foundation of solid evidence. In this period, the majority of evidence-based thinking has seemed to specifically focus on the patient room. I attribute this to the strong emphasis interdisciplinary design teams have placed on patient-centered care. A much more important emphasis than 15 years ago when we thought healthcare needed to be more hospitable and our designs focused primarily on lobbies to set the interior design tone of a healthcare experience. I have been known to say that we have only taken small evidence-based bites out of a large complex building type, but the ability to solve the patient room is the most natural place to start. To that end, some of our evidence-based critical thinking has led to advances, as well as controversies. The beauty of our outcome-driven process is that it won't take long anymore to sort their differences.

The Center for Health Design is working diligently to capture the evidence-based body of knowledge and create tools and products that will assist every design team to come to the next most important “a-ha” moment backed by a base of knowledge that will provide a foundation that is proven. Simply go to our Web site to see the latest tools and publications that will explain the methodology and provide links to documents that will create a road map for your literature search of best practices, which have been peer reviewed.

This issue of HEALTHCARE DESIGN will feature current evidence-based design patient room advances like the single-patient room that took years to prove. This proven design concept spawned several innovations like the same-handed room and the variable acuity room that have sparked controversy. These controversies will dissipate as soon as the evidence-based projects that embraced these design interventions produce the data to support or refute their hypothesized outcomes and then the industry will move on.

In the name of advancement, each one of these innovations, once proven, allows the next evidence-based design team to see future possibilities. Embracing the evidence-based practice methodology will shorten the innovation learning curve in healthcare design that is created by the time it takes to acquire supporting evidence. Instead of failing fast we have typically let failed design concepts die a slow death and develop bad press, often times fostering fear of innovation. Instead, an evidence-based design approach has pushed teams to look at new geometries. This has caused such wonderful interventions as the placement of bathrooms on headwalls for prevention of falls and the canting of the headwall for greater visibility toward nature and family. The next frontier is likely the configuration of the nursing core. Once the distributed nursing concept is supported by an advanced IT system and an automated materials management system, care plans will be redefined and the work flow and healing process will improve greatly. This is my hypothesis.
Rosalyn Cama, FASID

Rosalyn Cama, FASID

The Center for Health Design and practicing advocates like me are here to support you in adopting an evidence-based design process. Take it slowly but embrace the amazing ability this practice methodology gives your team to innovate. There will be great advances but there will also be controversies. It is my opinion that as we push with a greater base of knowledge, our controversies will not be that extreme. The interim measurement that is common in the evidence-based process will more quickly reveal tweaks that may be required, and we will discover a better way to deliver healthcare far sooner than the traditional design methodology has allowed.

In a very short period, you will be able to take the EDAC (Evidence-Based Design Accreditation and Certification) exam. To learn more about the exam, the program, and to order your free copy of the first study guide, visit the EDAC website at Use this opportunity to study and embrace this new practice methodology. It is the right thing to do. Send me your thoughts. HD

Rosalyn Cama, FASID, is Board Chair for The Center for Health Design. Her book, Evidence-Based Healthcare Design is available through John Wiley & Sons. The Center for Health Design is located in Concord, California.

For more information, visit

Healthcare Design 2009 March;9(3):8