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Why evidence-based design (EBD) is health care architecture’s next big thing

When HMC Architects designed Henderson Hospital in Nevada, the California-based architectural firm drew on a wealth of data, anecdotal evidence, and peer-reviewed research to drive the facility’s concepts and features.

Because more visibility and interactions between hospital staff and patients have been found to improve health outcomes, HMC Architects installed glass walls around the hospital’s nursing stations (as opposed to solid walls). Nurses there can now observe patients from virtually any angle, while patients have better access to staff – providing a higher level of comfort and better experiences.

Other research has shown patients with minimal stress heal up to 40 percent faster, so HMC Architects also installed a wireless, silent nurse-call system (as opposed to a loudspeaker-based system, which can be disruptive to patient tranquility).

These unique, research-based design features are just two examples of the growing momentum of evidence-based design (EBD) in healthcare and hospital design and construction.

But what exactly is EBD in healthcare design all about – and how can it benefit both facility operators and patients?

Evidence-based design in healthcare: A primer

The Center for Health Design (CHD) is widely credited with defining 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.”

While EBD methodologies can be applied to any kind of building, Alfonsi et al. say it’s used most often to design and evaluate healthcare facilities.

Indeed, EBD is a scientific analysis methodology that aims to influence healthcare facility design based on both quantitative and qualitative data. It measures both the “physical and psychological effects of the built environment on its users” through a number of data sources and scientific processes, including hypothesis formulation, testing, and outcome measurement.

While hospital design has always relied on several inputs, including the designer’s experience and creativity, client input, and hospital building standards, it was in the early 2000s that researchers such as the CHD’s Roger Ulrich began bringing scientific discipline and rigor to the hospital design process.

Nearly 20 years later, EBD is everywhere – so much so that many architectural firms that play in the healthcare space now have multiple EDAC-certified healthcare designers on staff.

What’s the ‘evidence’ in evidence-based design?

We’ve established that EBD uses an evidence-based model to make design decisions, but the question remains: What evidence are we talking about?

This report says architects can draw from more than 1,000 relevant, peer-reviewed studies on topics such as safety, stress reduction, and ecological health. Other data around organizational and financial performance, patient safety, and clinical outcomes is also very valuable, along with research from neuroscience, evolutionary biology, psychoneuroimmunology, and environmental psychology.

“The most effective and impressive healthcare facilities are created using design plans that balance evidenced-based research results with experiential results,” explains a blog post by HMC Architects, the firm we mentioned earlier. It outlines a number of best practices for gathering and assessing data during the EBD process, including:

  • Scrutinize the study parameters: Long-term studies involving a large sample size are always preferable to shorter ones based on small groups
  • Take a hybrid data gathering approach: Involve peer-reviewed studies, analyze your health outcome data, and gather information directly from staff and patients through interviews and surveys
  • Don’t trust “Peer reviewed” sources blindly: Analyze any peer-reviewed studies yourself and consider their credibility and repeatability, and talk to the authors if you can

    The pillars of EBD in healthcare

    The Center for Health Design says an overall EBD design strategy to create an ideal healing environment can consist of several different elements and tactical decisions, including:

    Connection to nature
    We all know how good we feel when we’re out in nature, or at least have views of trees or water. The research supports that feeling: According to Ulrich et al., views of nature scenery result in less anxiety and pain intensity among many patients.

    Control and choice
    Studies have also shown that patients who feel some element of control also have less stress. Designing hospital rooms with privacy and noise reduction in mind, along with options to view natural scenery and order food via room service, can help patients feel more in control and speed the healing process.

    Social support
    Easily accessed support from family or friends contributes positively to patient emotional and psychological well-being: According to Ulrich, recovery rates improve in myocardial infarction patients with better social support. Another study by Choi and Bosch determined that a “family zone area as part of a patient-centered unit” can improve patient interaction.

    Positive distraction
    The CHD also says that research from neurosciences shows that sensory experiences can also be therapeutic and even boost the immune system: music, aquariums or water features, and guided imagery can all help in this regard.

    Elimination of noise and other stressors
    Noise (a common feature of most hospitals), glare from direct light sources, and poor air quality are also cited as environmental stressors that EBD (and various building products used in hospital design) have helped to minimize or eliminate.

    “If the hospital environment is properly designed, it enables care providers to do their work more effectively, and it has the potential to enhance patient safety,” the CHD says, while HMC Architects add that increased natural light and improving caregiver-patient interactions also play a role in EBD.

    Why EBD in healthcare design is so popular

    Many studies have demonstrated the positive effects of EBD on healthcare outcomes, including reduced pain and stress, faster healing times, lower intake of medication, and even reduced mortality.

    But there are other reasons for EBD, especially in the U.S., where hospitals and health-care systems compete with one another for market share. Viewed in this light, patient experience is key to every hospital’s bottom line – and EBD design helps improve patient experience.

    One only has to look up the Google Reviews of any U.S. hospital to see the importance of making a positive impression.

    “The patient’s perception of comfort is the most critical part of that experience throughout the entire journey,” says this report. “Healthcare designers need to acknowledge that the core need for comfort is the critical path on the patient journey, and need to provide the environment that makes the patient feel that they have privacy, a sense of security, safety, and personal space.”

    Unicel Architectural can help your next EBD project

    When specifying building materials for your next EBD healthcare project, keep in mind that Unicel Architectural’s highly engineered glass, timber, and aluminum building products support cutting-edge EBD design elements.

    Vision Control® advanced louvered glazing technology provides unprecedented comfort and control of vision, light, temperature and sound on interior or exterior windows and doors. Vision Control’s insulating glass units provide the most effective sound control in the industry through a polyisobutylene primary seal and silicone secondary seal, while also guarding against unwanted heat, UV rays, moisture, and vapors.

    And Vision Control’s ligature-resistant operators mean patients can have access to views of nature while being able to control their environment to some degree, but with little risk to themselves or others.

    Want to learn more about how Vision Control integrated louvers help meet these and other challenges head-on in institutional and mental and behavioral health facility design? Contact us today to learn more.