Designers often use storytelling as a way to communicate with clients. And a strong narrative becomes even more crucial in an evidence-based design (EBD) project, opening the doors for more innovation. It shows the client and user what’s important beyond the functions of the space and how the two are interwoven. 

Avoiding fairy tales and horror stories
Innovation is critical to success in healthcare design, but it can be tricky to balance innovative ideas with the realities of an organization’s culture and the population it serves. No one wants to feel that they’re being sold on an idea that has only fleeting relevance, or, worse, build something that becomes an operational or maintenance disaster.

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The EBD process takes clients on a journey that addresses problems to be solved and goals to be attained while exploring the best possible route to get there. Risk is mitigated when design solutions are based on tested results. And incorporating the parameters of EBD creates a structure that can be used to reinforce our hypothesis and benchmark our proposed solutions.

Further evolving these parameters into a “plot line” creates a vehicle through which we engage a client in the layers of the process, going deeper than just resolving a floor plan and developing design language. When we define the problems to be solved, we not only set a baseline for success but establish solutions for conflict (read: value engineering, or revised client thinking) that might arise in our narrative structure.


Getting the story straight
In healthcare, it’s critical to solve the right problem (which may or may not be the one originally identified by the client). We rely on the EDB process to establish the exposition and rising action. Our key characters—the client, user group, and the space in question—have been introduced. We now move on to the plot: for example, balancing the number of exam rooms needed against changes to the way that patients are processed in a new clinic design.

In order to answer all of the questions, we turn our attention to sources of relevant evidence and further engage our client with tools such as a “moderated” mock-up, utilizing a skeletal structure early in the design process. This allows clients to fully engage based on their knowledge of the existing space, and for us to share stories from space observations along with findings from research and case studies.

We often find that this process not only enhances everyone’s understanding of the project goals but uncovers origins of problems or highlights specific challenges.

Involving the user group and client in the evidence gathering and interpreting phases ensures that everyone is invested in creating and evaluating the concepts as we move into the design development phase. Representative of rising action, this process helps the client see clearly how potential solutions tie directly back to the research.

This is a critical link in encouraging the client to commit to innovative design solutions. Each element of the story has contributed to the framework for solutions that respond to the design criteria as well as each problem that has been defined or discovered along the way.


Bringing observation to life
More than a series of steps applied behind the scenes at the design level, EBD is a highly interactive process that relies on user input augmented by institutional goals and metrics. However, it’s critical to have the proper process in place in order to make sure that you’re getting the right information from the right stakeholders at the right time.

We do several things in pre-design to gather evidence, including walking existing spaces with the users to gain insight into what works, what doesn’t work, and why. We supplement this information with observations of their workspace, allowing us to map flows and spatial relationships as well as to separate needs from wants in design. Because an entire department team isn’t able to attend design meetings, we also look for other ways to get input and insights from everyone.

One effective tool is a staff survey targeted to a specific room or rooms (referred to as key rooms) critical to the design. Key rooms are divided into zones and questions are asked about how space within that zone is utilized on a daily basis.

Survey results are combined with the other research we’ve gathered to create a “thought diagram” for the key room in the new project. A rudimentary mock-up of that diagram is constructed for staff of all levels in the department to review. This is done very early in the process in order to allow thorough exploration of critical issues.

The mock-up in a facilitated environment allows a focused discussion, which leads to better data collection. The specific design issues that our walk-through, observation, and survey process uncovers are then tested within the mock-up, through a discussion that moves from zone to zone within the space, inviting comments on specific issues under study.

In large group settings, one voice can dominate the discussion, or even raise issues that are off-topic. To allow everyone’s voice to be heard and to prioritize the comments raised, we lead the discussion on each design element, listing suggestions on a chart with a Likert scale.

Then, we invite participants to rank the issues in order of importance by placing a sticker in the appropriate place on the scale. This has proved to be an eye-opening process, fostering better resolution about the way the space should be used.


A meaningful conclusion
Because the success of any EBD effort lies in user buy-in and participation, it can’t be imposed on the project, but must instead arise from a collaborative and inclusive process of information gathering, interpretation, and feedback. Strategy for a successful process is focused on s
torytelling—sharing knowledge in a manner that clients understand and tying it to quantifiable metrics.

Effective storytelling results in meaningful implementation of goals and evidence in ways that don’t typically happen otherwise.  

Erin Schmidt, IIDA, NCIDQ, LEED AP ID+C, is an interior designer at GBBN Architects. Angela Mazzi, AIA, ACHA, EDAC, is a medical planner at GBBN Architects. For more information, please visit