An important part of the evidence-based design process includes creating a baseline of knowledge about an institution that should include the wishes and desires of their consumer base. The easiest way to do so is to arrange for visioning sessions with various community sectors, bringing them up to speed on current design practices, and asking them to imagine a better future for their community’s new building program. Such was the case for me last week with five distinct groups for the new University Medical Center at Princeton project, also a Pebble Project.

Each session included 30 to 40 participants, each of whom was first asked to describe the current environment in which he or she receives care and then the ideal environments that would deliver “Wow” experiences.

Many ideas that designers are keenly aware of were reported, but many were articulated in a sincere and inspiring fashion.

Although we conduct these sessions often, the passion participants have for their local facility and the knowledge they have about the best practices throughout the nation never ceases to amaze me. We live in a society of transience and even those laden with disease still venture out to visit family where they find medical support when needed, broadening their perspective of current practices and environments of care.

Many issues arose in these focus groups as top of mind, and when aligned with programmatic requirements, internal user intelligence, and corporate strategic directives, the resulting internal base of knowledge will reveal clues for design interventions that can respond to improvement outcomes stated in the project’s vision. Using this process as a start to help identify exactly what to search for in the literature can send a design team or project into what Kirk Hamilton refers to as a “Level-One Evidence-Based Design.” This level of internal intelligence first suggests some operational and cultural shifts and then informs new designs for the built environment, and in some cases, innovative solutions.

These particular focus groups asked for several basic interventions related to parking, first impressions, wayfinding, registration, personalized care, communications and access to information, comfort and control, pleasant surprises and distractions, convenience, family involvement, discharge, and education and community outreach. Some of their most obvious suggestions have been picked up by other Pebble Projects who are about to measure the design intervention’s effectiveness. One includes a “Wow” experience where a “Greeter” makes an immediate personal connection upon arrival. At the Dublin Methodist Hospital this same consumer observation resulted in a design intervention that eliminated the reception desk and places greeters near the front door at kiosks that makes them more nimble for a personal greeting and assessment of a visitor’s needs. Another suggestion asked for personnel assigned as “Maze Masters” to assist in clear direction to one’s final destination. Confusion is often created by typical hospital construction linking multiple building into a frightening maze. Palomar Pomerado Health, another Pebble Project, is exploring a new wayfinding solution that works with a global positioning system to direct a patient exactly to their location.

Although sometimes there may seem like nothing is new under the sun, there is a movement toward consumer expectations that is being caught faster amongst our Pebble Projects. Using an evidence-based process these ideas and new systems of facility improvements will be tested and perpetuated or dropped faster than what I have typically referred to as the nine-year healthcare innovation curve (the time it has taken for good unmeasured ideas to get noticed and copied by other facilities).

Consult your community; they may in fact be savvier than you on what is important to their well-being and the special design features needed to “Wow” their experience within your healthcare facility. Use an evidence-based process and share your results so that we may move to “Wow” our consumers in the way care is delivered in this new millennium. HD

The Center for Health Design is located in Concord, California. For more information, visit


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