There has been a subtle but noticeable shift in the healthcare design industry’s understanding and acceptance of evidence-based design (EBD). EBD is becoming a more mainstream process for designing healthcare facilities, demonstrated by both the growing number of EDAC-certified individuals and the inclusion of EBD in requests for proposals for new projects.

A couple of exciting EBD trends will potentially have a huge impact on the healthcare design industry. One is a growing interest in using and conducting research as a part of the healthcare facility design process, and the second is an increasing focus on healthcare design as part of the curriculum in university design and architecture programs throughout the United States and Canada.

The Center for Health Design’s (CHD) Research Coalition is actively fostering and supporting both these developments through different programs.

The Research Coalition nurtures, supports, and produces EBD research that contributes to therapeutic, safe, efficient, and effective healthcare settings. Comprised of research professionals, design practitioners, and healthcare administrators, the coalition steers CHD’s funding for healthcare EBD research, guides these projects to success, and provides information and tools for implementing EBD in existing and new facilities.

The group has identified three key challenges faced by today’s facility design teams that are using and conducting research as:

  1. The lack of easily accessible research that demonstrates the relationship between specific design strategies and outcomes;
  2. The lack of accepted definitions for the built environment and healthcare outcome terms; and
  3.  The lack of tools for translating and conducting research.

A lack of common definitions, tools, measures, and metrics poses a fundamental problem in any research endeavor, let alone research related to the built environment. To address these challenges, the research coalition initiated work on a “Healthcare Environmental Terms and Outcome Measures: An Evidence-Based Glossary” in October 2009.

The first phase of this collaborative project, released in November 2011, summarizes and examines the relationships between elements in the built environment and healthcare outcomes in seven high-priority areas: healthcare-associated infections (HAIs), medical errors, patient falls, patient satisfaction, patient waiting, staff efficiency, and staff satisfaction.

The EBD Glossary provides commonly accepted definitions for built environment variables and outcomes measures; a model and matrix that depict the environmental design and outcome terms evaluated; and a detailed analysis table that summarizes the research used to develop the glossary. It is an invaluable resource for healthcare facility design teams who are:

  • Examining, understanding, and translating research;
  • Exploring one of the topics to identify the environmental features that have been studied with regard to their impact on organizations’ goals (e.g. reducing falls);
  • Defining terms for their own research projects;
  • Identifying the metrics and measures that have been used to evaluate the impact of specific built environment features; and
  • Beginning a review of the literature for an EBD research project.

The first phase of the EBD Glossary (including supporting tables with the analysis of the literature in the seven areas) can be downloaded from CHD’s website at

The second development that will have a positive impact on the future healthcare design industry is the increase of evidence-based healthcare design curricula in architecture programs at universities around the country. The next generation of healthcare design architects and designers will be specifically trained in interdisciplinary programs and will be well-equipped to take on the challenges of designing the evidence-based healthcare facilities of the future.

To recognize and encourage emerging leaders in healthcare facility design research, CHD’s Research Coalition initiated the New Investigator Award in 2011. The award was open to graduate students and other recent research degree recipients who demonstrate potential to conduct and disseminate research that examines the role of environmental design to support therapeutic, safe, efficient, and effective healthcare settings.

The award’s goal is to support new researchers whose future careers are likely to contribute to the continued development of the field of EBD. Entries covered topics such as green building design, nursing unit configuration, and emergency department design. Out of 13 submissions (from 10 different countries) from students who are currently studying or recently graduated from nine different universities, four students received the 2011 New Investigator Award. All of the proposals went through a thorough review process by members of CHD’s Research Coalition.

Rana Sagha Zadeh, LEED AP, EDAC;
Texas A&M University

Project: The Role of the Physical Environment in Nursing Unit Efficiency and Safety: The Impact of Windows and Daylight on Staff Mood, Satisfaction, Alertness, and Medical Errors

Summary: This dissertation research study was designed to investigate the effects of windows and daylight on healthcare employees’ physical and mental states as evidenced by satisfaction, mood, alertness/sleepiness, and medical errors.


Hyun-Bo Seo, PhD;
Georgia Institute of Technology

Project: Role of the Physical Environment in Interruptions during Medication Administration

Summary: This study investigates how the physical environment helps manage interruptions to critical tasks, by observing the process of medication administration by nurses in hospital units.


Chia-Hui Wang, MArch, LLM;
Hwa-Hsia Institute of Technology

University of Illinois at Urbana-Champaign

Project: Impact of Nursing Unit Configurations on Teamwork and Collaboration—An Example of Centralized Versus Hybrid Nurses’ Stations

Summary: This study will document teamwork and collaboration differences observed between two hospitals: one with a conventional nurses’ station and the other with an innovatively designed decentralized nurses’ station.


Sonali Kumar, MS;
Pennsylvania State University

Project: Experience-Based Design Review of Healthcare Facilities Using Interactive Virtual Prototypes

Summary: This research study will examine how interactive virtual prototypes can be effective design communication tools that help extract the tacit knowledge of end users’ experiences during hospital stays, as well as caregivers’ experiences.


More information on the 2011 New Investigator Award can be found here:

Evidence-based design has the potential to add significant value to the healthcare facility design process and to spur innovation in design. The New Investigator Award and the EBD Glossary provide both an incentive and a standard, add
ing to the crucial foundation that will lead to a stronger, more vibrant healthcare design community in the years to come. HCD


Anjali Joseph, PhD, EDAC, is Director of Research and Carolyn Quist, MA, EDAC, is a Senior Project Manager at The Center for Health Design. For more information, please visit