On July 31st, the American Society for Healthcare Engineering of the American Hospital Association (ASHE) released a Guidance Statement to Membership in which they caution “potential misrepresentations of the [evidence based design] concept and the apparently widespread application of the new design methodology.” Titled “Considering Evidence-Based Design?” the Guidance Statement supports “the idea of conducting experiments, adopting guidelines to support design decisions, and undertaking other measures intended to promote quality and safety… We urge caution, however, when statements are made that promise results based on little or poor-quality research.”

This thoughtful (and thought-provoking) document should serve as a wake-up call that Evidence-Based Design is not just the heading of a sub-folder in our marketing files, filled with anecdotal “evidence” to which we turn when asked to respond to a Request for Proposal. In fact, over the last few years it seems that this folder may likely have already been moved further back and supplanted by sub-folders named “Sustainability” and, more currently, “Lean”.

The challenge of developing new facilities in an era of rapidly increasing expectations and greater resource constraints is daunting. I read this Guidance Statement as a reminder that our clients are looking for optimistic leadership from their consulting architects through a broad variety of very complex issues with which they must contend to optimize their investment. We must consider that healthcare organizations are comprised of complex multiple constituencies, each having varied perspectives. Whereas the medical staff may be trying to optimize clinical practice and workflow efficiencies and the administration may be concerned with strategic fit and competitive position, our colleagues within the facilities group are likely concerned with cost, schedule and information flow. An oversimplification, yes.
But we must have available a variety of tools with which to offer holistic solutions and guidance given our opportunities at hand. These tools may likely include aspects of EBD, sustainability and lean: they are not, however, our latest and greatest design ideas, published in a journal and repackaged as proof of a cause and an effect.

The Guidance Statement recommends that healthcare executives ask the following of their design professionals:

    • What does the designer understand EBD to be?
    • Has the designer read research study(ies) related to proposed design decisions that are said to be based on evidence?
    • What books or articles related to EBD or EBM has the designer read?
    • How certain is the designer that the desired outcomes of an EBD decision will be attained?

These are not easy questions to answer.