The pebble project in 2010.
The Pebble Project in 2010.

With the impact of healthcare reform on the industry at-large looming over the United States, The Center for Health Design's Pebble Project remains on track with fulfilling its mission to drive change in healthcare design. In 2010, five partners joined the initiative, bringing the total to 39 active partners and 35 alumni. These partners continue to share their work with the healthcare design community through research studies presented at conferences and meetings, as well as through the significant media attention they've received throughout 2010.

The status of Pebble Projects

As a group, the Pebbles are in varied stages of design and construction, as well as research design and collection. More than 40% of the active Pebbles are occupying their facilities, with more than one-third under construction. This bodes well for the availability of research data in the near future. Currently, 20% of Pebbles have collected and analyzed data and are in the process of disseminating their findings, while another 23% are in the data-collection phase.

Topics of the research being conducted include acoustics, such as the effect of carpet and ceiling tile (Palomar Pomerado Hospital with Armstrong and Tandus, and Jersey Shore University Medical Center with Armstrong), as well as wall coverings (Affinity Health with Johns Mansville); the effects of materials and surfaces (The Bridge to ER One); decentralized nursing (Jersey Shore University Medical Center); outpatient pharmacy satisfaction and efficiency (VA New Jersey East Orange); a postoccupancy evaluation of the impacts of a new environment on family and staff (The Children's Hospital); building performance evaluation methodology using Alberta's balanced scorecard approach (Peter Lougheed Centre); emergency department satisfaction and throughput efficiency through a chair-centric approach (University of Kentucky); and the development of valid and reliable psychometric tools to understand the role of hospital design on the psychological trauma of hospitalization for children (Ann & Robert H. Lurie Children's Hospital of Chicago).

New Pebbles and overall representation

Joined in 2010:

  • VA New Jersey Health Care System, East Orange Campus (East Orange, New Jersey)
  • The Children's Hospital at Legacy Emanuel (Portland, Oregon)
  • The Mohawk Group (Marietta, Georgia)
  • Healthier Hospitals Initiative (Jamaica Plain, Massachusetts)

Opened in 2010:

  • University of Kentucky Chandler Hospital Emergency Department (Lexington, Kentucky)
  • Laguna Honda Replacement Hospital & Rehabilitation Center (San Francisco)

Scheduled to Open in 2011:

  • University of Kentucky Albert B. Chandler Hospital (Lexington, Kentucky)
  • Vancouver Island Health Authority, Royal Jubilee Hospital Patient Care Center (Victoria, British Columbia, Canada)
  • Virtua Health Inc. (Voorhees, New Jersey)
  • Spectrum Health Helen DeVos Children's Hospital (Grand Rapids, Michigan)
2010 status of pebble projects.
2010 Status of Pebble Projects.

Additional topics being considered for study include family presence and engagement, elder-friendly environments, and the effect of communication technology on building design.

Pebble Colloquiums

University of kentucky chandler hospital will host the pebble project colloquium in the fall.
University of Kentucky


University of Kentucky Chandler Hospital will host the Pebble Project Colloquium in the fall.


Royal jubilee hospital patient care center will host the spring pebble project colloquium may 2-4.
Rendering courtesy of Cannon Design for Royal Jubilee


Royal Jubilee Hospital Patient Care Center will host the Spring Pebble Project Colloquium May 2-4.

Pebble Partner Paoli Hospital in Paoli, Pennsylvania, which opened in July 2009, hosted the spring 2010 Colloquium. Interestingly, Paoli has come full circle, as the facility was the site of the seminal 1984 Roger Ulrich study that associated views of nature from patient rooms with reduced length of stay and reduced pain medication. More than 100 participants from 24 Pebble Projects toured Paoli's new pavilion, a 259,000-square-foot addition with 126 new single-bed rooms that incorporate large windows to enhance patient views. Currently, Paoli's postoccupancy data collection and evaluation is underway to understand the “bundle” impact on its new environment measured through staff satisfaction, patient satisfaction, HAIs, falls, medication errors, LOS, patient transfers, reduced staff injuries, and perceptions of art.

While Roger Ulrich had been scheduled to celebrate the 25th anniversary of his study as the keynote speaker in Paoli, his presentation had to be rescheduled to the fall meeting, which was hosted by Laguna Honda Hospital and Rehabilitation Center in San Francisco. Laguna Honda had just completed 500,000 square feet of new construction and 150,000 square feet of remodeling, and moved residents into the new spaces in December 2010.

During this fall presentation, Ulrich discussed the origins of the study and its influence as both evidence-based design and green design have taken hold. He also spoke about the future direction of healthcare design to address the ever-increasing issue of “super bugs,” infections that are resistant to traditional medical treatments and raise high levels of concern related to transmission and containment.

Other presentations included: Affinity Health System (sound study); Cincinnati Children's Hospital Liberty Campus Project (the effects of a new emergency department on utilization, market share, and satisfaction); VA New Jersey Health Care System (pharmacy redesign); Louisiana State University (Implementing evidence-based design in a financially challenged organization); and Ann & Robert H. Lurie Children's Hospital of Chicago (engaging the community in design.)

Pebbles also toured the new Laguna Honda Hospital, which includes acute general medical facilities with 30 beds; a 750-bed skilled nursing facility; and a central esplanade that houses a wellness and community center, aviary, library, barber shop, beauty salon, art studios, general store, gift shop, and cafeteria. In addition to the tour, Pebble Partners were able to learn about a variety of topics, including study design for the proposed built environment research, culture change, artwork, and environmentally friendly design and construction.

Turning ripples into waves

In the spirit of causing more ripple effects of change in the healthcare design industry, Pebble Project partners also found time to contribute to other research and educational programs associated with The Center for Health Design.

Representatives from five active Pebbles participated in a project funded by the U.S. Green Building Council to add healthcare outcome and building performance outcome data to the RIPPLE Web site ( By developing a comprehensive open-source online database of information on sustainable design strategies and performance outcomes in healthcare settings that will be tracked over time, the goal is to offer a benchmarking tool for site visitors to compare against their own data.

In addition, to further enhance their projects' regard in the industry, two Pebbles each dedicated an interdisciplinary project team to successfully complete the Evidence-based Design Accreditation and Certification (EDAC) exam and document their evidence-based design processes as “Pebble Pioneers.”

Lastly, in late 2010, the initiative opened its doors to the larger healthcare design audience by offering a spin-off program named “PASSPORT.” Membership into the program promises a glance into the larger initiative through networking opportunities, tours allowing benchmarking of facilities, and insights into how Pebbles are conducting evidence-based design research.

Publicized Pebbles

In 2010, the Pebble Project appeared about 30 times in the media via magazines and journals online and offline, and featured in more than 20 presentations that were conducted by Pebble Partners or The Center for Health Design representatives. The topics ranged from the unique features that were chosen for each individual project to the depth of research conducted by project teams during their design processes.

The Pebble Project moving ahead in 2011

Four more Pebble Projects are scheduled to open in 2011. Two of these organizations are hosting the spring and fall Pebble Colloquiums-the first of which will take place outside of the U.S. in Victoria, British Columbia. The Vancouver Island Health Authority will be the first international organization to share its updates, goals, and lessons learned at its Royal Jubilee Hospital Patient Care Center with this U.S.-based research initiative. In the fall, the Colloquium will return to the United States at the University of Kentucky Chandler Hospital in Lexington, Kentucky. HCD

Visit for more information. For complete information on the PASSPORT program, contact Mark Goodman at

Ellen Taylor, AIA, MBA, EDAC, is a Research Consultant with The Center for Health Design, and Pamela Cheng, EDAC, is The Center's Senior Marketing and Communications Manager. Healthcare Design 2011 February;11(2):14-17

The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at