Despite an existing commitment to contributing to medical research, Parkland Health & Hospital System was new to using design research and evidence-based design (EBD) on building projects. When it set out to replace Parkland Memorial Hospital in Dallas, however, the internal Parkland team recognized the benefit of aligning the approach with its research roots. So in 2009, the provider signed on to The Center for Health Design’s Pebble Project and created a healthcare design research collaborative model, committing to conducting design research throughout the next seven years of the project. The use of EBD on the project wasn’t just about the end product of the building, but the decision-making process behind the design, as well, with all project members having a stake in the initiatives.

Developing the team
At 2.1 million square feet and 862 patient rooms, the sheer size of the project creates multiple opportunities for study. As a result, design research qualifications were addressed in the request for proposals (RFP) process. Design firms and all vendors were encouraged to participate in research studies, either as individual entities or by partnering with one of the other firms or companies working with Parkland.

Parkland recognized the value of involving vendors and suppliers in the research. While there may be a perceived bias in research conducted by such partners, this can be mediated by the type of study conducted as well as by discussion amongst the varied research teams. If the goal is to improve the quality of design, rather than prove the merit of a specific product, the nature of the research question starts to change and there can be “wins” for everyone.

Addressing research in the RFP meant no surprises. The expectations were clearly set and the option for teams to allude to design research, but never do anything, was eliminated. Social facilitation played a role throughout the project, too: No one wants to be part of the team that didn’t step up, and once established as a team “norm,” participation increases.

Getting off the ground
It wasn’t immediately clear how design research could be easily embedded into the regular project process—particularly on a project of this magnitude—and the topics needed to be prioritized according to areas of interest and alignment with Parkland’s strategic goals. There were several initial ideas that weren’t pursued as a result, and the projects eventually rising to the top had a combination of strategic alignment, a design research partner, and an internal Parkland champion. However, all agreed from the beginning it would be important to share all research findings regardless of the outcomes. Transparency was a key to being a research partner with Parkland.

Managing feedback from partners and tracking the projects were also difficults task at first, thanks to the number of design research projects started and the multiple consultants involved. The need to manage the system soon became evident and it was clear that communication with all stakeholders was the key. Working with The Center, Parkland created a tracking document that each design research team completed to outline study details, phases of data collection, and ongoing progress. Monthly calls were established, with early calls identifying any duplication of efforts.

By stating research priorities up front and communicating with all of the stakeholders, it became possible to leverage partnerships and expertise between consultants where pooled resources might create a stronger project. To that end, partnerships were developed between some of the teams whose research was aligned. For example, when it was obvious that two teams were studying different aspects of the waiting experience, it was decided that each could benefit from the other rather than operating in a silo.

As a result of the tracking process, status was recorded monthly and allowed sharing of successes as well as barriers or hiccups. The forum allowed teams the ability to gauge the magnitude of any problems that arose, identifying if it was an issue of timing, resources, or a need to adapt research methods. Flagging any concerns could be more effectively addressed and resolved, with adjustments made to the schedule as needed. Establishing a management system for the multiple projects allowed a much better picture of what was happening and when. When the design research teams saw a potential overlap or synergy, it could be discussed.

To date, Parkland has undertaken six design research projects, all of which can be leveraged into continuing studies once the new building is occupied (see chart for more details).

Researchers weigh in
Parkland set the tone for engaging partners in the process, emphasizing that the research was to aid in design decision-making and be used to document existing conditions so that post-occupancy evaluations could be conducted. Lori McGilberry, associate at Corgan Associates Inc. (Dallas), says “it has been a fantastic opportunity for cross-discipline teaming,” adding that Parkland was particularly adept in facilitating collaboration.

Many of Parkland’s research partners describe the process as a natural extension of their shared interest in topic areas, intent to be data-driven, and desire to be good stewards of the Parkland legacy. All research partners were generous in contributing financially or through “in kind” resources. All recognized the internal business value of the proposition.

When the question of each partner’s impression of return on investment (ROI) was posed, most pointed to nonmonetary aspects, such as the advancement of intellectual capital, shared opportunities to learn, discovery, and shared common interests. Many partners also pointed to the standard of simply “doing the right thing” as a driver for their firm’s involvement.

Sheila Elijah-Barnwell, PhD, director of healthcare research and education at HDR (Omaha, Neb.), says this type of business acumen is needed in the healthcare design industry. Other industries commonly maintain a research and development initiative, she notes, and design and construction firms should consider the value such efforts bring.

Keeping momentum going
With the magnitude of the Parkland project, it can be hard to stay the research course with all of the competing demands that exist. Staffing changes for the hospital project team, and even leadership over the course of a long project, can easily be a distraction. It truly does become a team effort to stay focused, and it’s easy to move on to other things if there’s no regular check-in. The monthly touch-base calls were successful in boosting morale as progress among the groups was shared.

Parkland regularly gives presentations at conferences and events, often with many members of the team on hand to share details of the research findings. As Parkland embarks on its next phase, including a scheduled opening later this year, the team is hopeful for the next rounds of design research and aims to continue engagement with its partners and share the results with the healthcare design industry as a whole.


Gena English, AAHID, EDAC, RAS, is senior program manager NPH FF&E/interior designer for the hospital replacement program at Parkland Hospital in Dallas. She can be reached at gena.english@phhs.org. Kathy Harper, RN, MBA, EDAC, is vice president for clinical coordination of the new Parkland campus. She can be reached at kathy.harper@phhs.org