The design of healthcare facilities has been influenced by a number of trends in recent years that share a key element in common: a focus on patients. Whether it’s creating single-patient rooms with residential touches to make them feel more inviting or providing access to daylight and views to nature and beautiful artwork, it’s clear that patient comfort, satisfaction, and outcomes have taken a front seat in the design of hospitals and outpatient medical centers.
Underlying the patient-centered care model is credible research that links design with improved patient and worker safety, patient outcomes, environmental performance, and operational efficiency.1 Better known as evidence-based design (EBD), this maturing field of practice has made tremendous strides since its adoption in the early 2000s, thanks in large part to the launch of the Center for Health Design’s Pebble Project, a dynamic collective of forward-thinking healthcare organizations, architects, designers, and industry partners that share knowledge and tools to assist in the creation of research-based healthcare design projects.2 Using EBD principles, healthcare facilities today are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive, therapeutic environment.3
Additionally, the move toward patient-centered care has been accelerated recently due to the passage of the Affordable Care Act (ACA) in 2010, the largest reform to the American healthcare system since the establishment of Medicare in 1965.4 Under the ACA, for the first time healthcare providers are being rewarded for improving quality and patient satisfaction—outcomes that have been directly linked to the design of buildings.5 To design practitioners, the positive impact of the built environment on occupants likely comes as no surprise, but quantifying that claim is a bigger challenge.
“Every element of a built environment can have a considerable positive or negative impact on our state of mind and emotional well-being, or so we like to think,” said psychologist Dr. Nicola Davies, author of “Empathy in Architecture.” “But how can we prove it? That’s where evidence-based design comes into play—and, fortunately, as research on the psychological and neurological impact of certain design elements is constantly being enhanced, designers are more equipped than ever with objective facts to back up their seemingly subjective choices.”6
This CEU will examine the growing practice of evidence-based design in the healthcare industry, the role that art programs play in improving patient outcomes in the real world, as well as resilient materials solutions that specifiers can utilize to incorporate artwork and graphics in exciting new ways in hospitals and other medical facilities.
EBD: In Scope And Practice
By now, most architects and design professionals are familiar with the term, but for the uninitiated, let’s begin with a working definition of evidence-based design. The Center for Health Design (CHD) defines EBD as “the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”7 According to Jain Malkin, author of “A Visual Reference for Evidence Based Design,” an evidence-based model can be used for all design decisions on a project, but a great deal of the research published in peer-reviewed journals can be sorted into three broad categories: safety, reduction of stress, and ecological health.8
“In some respects, it can be said that the concept of healing environments has evolved into EBD, but it’s mainly in the area of reduction of stress that this overlap occurs,” Malkin noted. She goes on to explain that the research underpinning the concept of a healing or psychologically supportive environment is drawn from the neurosciences, evolutionary biology, psychoneuroimmunology (the effect of the emotions on the immune system), and environmental psychology.9 However, Malkin also notes that “EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety.”