Summer is waning and schedules are adjusting. What better time than at the beginning of the academic season to begin to adopt an evidence-based approach to your projects?

Many teams are now evidence-based in the way they approach the design of healthcare facilities, many however, still are not. If it is fear of the unknown, begin slowly and just start by gathering intelligence that will inform and empower design interventions connected to outcomes aligned with your project’s guiding principles. The sooner you begin, the easier it is to adjust a mindset that it is too difficult or too time consuming. There is a learning curve to think differently about data collection. It is in the thinking differently that the uncomfortableness occurs, but it is in the pain that the gain is made.

I have been telling my staff that the effort made today is what will raise our bar in understanding the current intelligence, and in time, it will be our base of common knowledge. This base of knowledge raises the platform from which to develop our best “aha” moments. It is this baseline that will allow you to no longer argue the merit of certain design interventions because you will be armed with the supportive knowledge and peer-reviewed, documented evidence to take the disruptive discussions off of the design review table. It is here that your project will benefit, because innovating will become easier as the evidence the field has to offer will mitigate your level of fear.

How do you get started? There are plenty of tools currently available and many more to launch in the next few months.

I have found that beginning with the Ulrich, Zimring, et al, analysis of current data (found at for the 2004 analysis and the most recent edition of HERD Journal for the 2008 analysis, which captures 1,250 peer-reviewed articles, to be the best way to get a handle on the core of evidence-based knowledge. The reports sort the studies into categories we all struggle with improving through the design interventions we create. These reports will also open a team’s thinking to additional questions where further investigation through assorted search engines will lead to in-depth knowledge on a particular topic.

EDAC training manuals will be available for the first time at the HEALTHCARE DESIGN.08 conference in Washington D.C., November 8-11. They will provide a primer of information about evidence-based design that will prepare all who may participate on an interdisciplinary team for a new exam that will be available to individuals in 2009 for accreditation as an evidence-based design practitioner.

A beta database called Ripple is being tested on The Center for Health Design’s website ( This incredibly interactive tool is the joint effort of The Center for Health Design and The Global Health and Safety Initiative funded by Kaiser Permanente and The Robert Wood Johnson Foundation, and is used to organize and sort valuable data addressing the needs of evidence-based teams to assist them in arriving at the best possible outcomes. The opportunity exists now to critique the development of this tool to best serve you and your team’s needs.

Many books are now, or are about to be, published on the process of evidence-based design, the availability of data, and known design interventions. The Center for Health Design has published A Visual Reference Guide to Evidence-based Design by Jain Malkin available at Many of The Center’s board members have also been busy publishing: Len Berry has recorded his journey to study the Management Lessons from the Mayo Clinic, and Robin Guenther on Sustainable Healthcare Architecture. Blair Sadler along with Anjali Joseph, et al, authored Evidence for Innovation for The Center for Health Design and published by NACHRI. Kirk Hamilton and I have been working independently on books with John Wiley and Sons that document the process of evidence-based design, to be released in 2009. Many more articles and case studies are being published about the many projects that have employed evidence-based design principles and the results of their interim and final studies.

On November 8-11 in Washington D.C., at the new Gaylord property on the Potomac, HEALTHCARE DESIGN.08 will launch with the best educational offerings in healthcare evidence-based design. Aside from the knowledge content being shared, the industry offerings and the high level of collegial and institutional exposure make it a fun and enlightening few days.

There are many opportunities to come along and design with a strong base of shared knowledge. If you and your team just accept this first level of evidence-based design I promise you will become the wiser for the effort. Share with us your joys and struggles with this shift in practice methodology, this change in habits and resulting improved outcomes. HD


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Healthcare Design 2008 October;8(10):8