Have you ever had another driver cut you off, closing in on the reasonable gap you purposely kept between your car and the car in front of you? It might make you question the quality of that person’s driving education.

This same question can be asked about what we are teaching our young professionals about the quality of design, when the pace for our design delivery has exceeded all reasonable caution. In the last 10 years, a flurry of work caused the industry to speed up the pace—but at what cost?

The expectation to research and develop designs as we simultaneously produce construction documents seemed reasonable while we juggled much on our plates. But that expectation has not gone away. In a car, you can back off the gas pedal to maintain a safe distance. But in the design world, although the economy has slowed down, the pace of projects that do get the green light are based on expectations that a final product will be delivered at a breakneck speed.

So what can we do to avert disaster?

First, we must recognize that the shifts in delivery expectations require the rules for design to change. Some of us have heeded the warnings and are prepared to make the necessary shifts, but know that taking our foot off the gas is no longer an option. We are compelled to discover a new project delivery methodology that safeguards the risk of error and delivers a better solution than the last similar project.

This has to become a professional goal. Recommended steps to achieve this might include asking if your project team has assessed the following:
Team selection

Design teams are complex today and often need to augment traditional players with additional expertise. Insisting upon using an evidence-based design process allows the team to do all necessary assessments and clear visioning exercises long before the project hits the design boards. This ensures that once projects begin, they can speed through what was once a longer, traditional design sequence into a fast-track methodology.

It is vital that the team reviews the evidence-based design process with all consultants and ensures all are in agreement with the steps. A misstep here causes speed bumps later. (See “Evidence-Based Healthcare Design,” Cama, R., John Wiley and Sons, 2009.)
Baseline data

In order to deliver the best solutions in short periods of time, design teams will not be able to conduct customized research. It will be expected that all on the team, owners included, are (1) making a personal commitment to owning the industry’s most current knowledge; and (2) tracking a new project’s tenacity to deliver at a minimum, what the current state of the industry expects from a building that has a 40-year life span.

One sure way to do so is to be certain all team members have the EDAC (Evidence-based Design Accreditation and Certification) credential and are keeping up with their continuing education credits.
New vocabulary

As we shift the way we deliver projects, so will we shift the way we design buildings. There are movements that will redirect our thinking in short order as our baseline knowledge rises and becomes readily accessible. Currently, building materials are being reassessed through the influences of the sustainability movement, and the systems that will improve our human condition will be derived from the Biophilia movement.

The best way to be ready for all these changes will be through an evidence-based design process. The Center for Health Design has recently released the “Healthcare Environmental Terms and Outcome Measures: An Evidence-Based Glossary.” This free glossary is the first to provide a standard glossary of terms, definitions, metrics, and measurement tools. It provides the results of using an evidence-based design process, including accepted variable and outcome measure definitions, and a model and matrix of the evaluation process.


Innovation expectations

Not all projects need to innovate, but all projects should deliver baseline design interventions that produce outcomes that match a project’s vision. In my more than 30 years in this profession, I have never met a project team that did not want their project to innovate at some level; however, when their vision and budget are not properly aligned, the slash and burn of value engineering begins, resulting in a project’s important baseline details to often be stripped away.

To avoid this, start the project by clearly stating the project’s expectation, assign a vision keeper, and then determine if baseline interventions are innovative enough. If you then decide that the project can withstand to push the industry forward, then do so with a safety net. Join a group of colleagues blazing the same new trails, sharing information, and providing outcomes.

The Pebble Project, The Center for Health Design’s main research initiative, has shepherded many a project team that has deliberately sought to innovate. The Pebble Project provides peer support to its members, as well as a strong research arm to help guide the innovations toward success.


Project generosity

Every project likes to share its successes, but failures should also be shared. Our industry is so interconnected that all our learning needs to be communicated and explored. We can only create change in the healthcare industry by providing researched and documented examples of healthcare facilities whose designs have made a difference in improving patient and staff outcomes, as well as operating efficiency.

There are many tools available through this publication and its many venues: Speak at the HEALTHCARE DESIGN Conference and its resulting webinars, submit research for peer review through the Health Environments & Research Design Journal, or connect with the staff at The Center for Health Design and learn about the projects where you may have opportunities to volunteer or share examples of your project’s evidence-based design features.


So take caution, the rules of the road have changed. Through The Center for Health Design, we can continue to create an allegiance among all in the industry to share experiences and the resulting knowledge so that there is universal access to lessons learned. It provides a way to navigate changes in the road with opportunities for all in our industry to participate and share in the evidence-based design community in many ways.

Don’t know where to start? One of the easiest ways to prepare for change is to become an affiliate member of The Center. It will provide better navigation without tailgating. HCD


Rosalyn Cama, FASID, EDAC, is President and Principal Interior Designer of Cama, Inc., in New Haven, Connecticut. Her blog post on this topic can be found at blog.healthdesign.org. For more information on The Center for Health Design, please visit www.healthdesign.org.