This week, Truven Health Analytics, formerly the healthcare business of Thomson Reuters, released its annual study that identifies the 100 top U.S. hospitals based on their overall organizational performance.

Similar to the “Best Hospitals” report published by U.S. News & World Report, this study uses public information, such as Medicare reports and CMS patient satisfaction data, to evaluate performance in 10 clinical and operational areas.

Neither of these studies, I’m sorry to say, looks at the quality of the physical environment in which care is delivered to come up with their rankings. And yet, research has shown that it can be a factor in several of the performance areas on Truven’s list—things like medical complications, patient safety, average patient stay, and patient satisfaction.

What would it take to get the physical environment to be one of the areas of evaluation for the top hospital designation in the U.S.?

Almost 20 years ago, Wayne Ruga, the founding president of The Center for Health Design, and I visited the editors at U.S. News & World report to talk about that very question. They listened to our story about how the design of the physical environment contributes to healthcare outcomes and politely explained that except for a reputational survey of physicians, all the data they use for their rankings is publically available.

“If you can bring us the data on the physical environment, we’d include it,” they told us.

That was truly our “ah-ha” moment, and what started The Center for Health Design down the path of doing its first literature review of research studies that linked the design of the physical environment to outcomes. It was published in 1996. There were 80 credible studies identified in that first report.

As we all know, the field of evidence-based design has grown, and there are now more than 1,400 credible studies that link the design of the physical environment to outcomes. And that’s all well and good, but we still don’t have the aggregate data that we can take to U.S. News & World Report or Truven so they can factor it into their top hospital profile.

Unlike mortality or readmission rates, the quality of the physical environment for each individual hospital may just be too hard to measure. And who could provide an accurate evaluation anyway? Most people—including patients and staff—know when they're in an environment that is or isn’t healing, but they don’t know what makes it that way. They just take good or bad design for granted.

Maybe the healthcare design industry should come up with a list of top hospitals based on what we know are the top 10 evidence-based design features that should be in every facility—sort of our own reputational survey of design professionals. What do you think?