HEALTHCARE DESIGN.08 will be held in Washington, D.C., November 8-11. Ten out of the 49 educational sessions to be presented at the conference will come from the Pebble Project, a research program created by The Center for Health Design to implement evidence-based healthcare design through the joint efforts of forward-thinking healthcare providers and manufacturers. Over the past eight years, the Pebble Project has grown to a community of more than 50 Pebble Partners sharing healthcare construction experience, design innovations, and new evidence-based design research findings.

The 10 Pebble presentations at HCD.08 will be an excellent snapshot of the various aspects of the Pebble Project and its accomplishments. The 10 presentations are listed in chronological order in the table to the right. They generally fall into four tracks or topic areas: evidence-based design research study reports, case studies of evidence-based design implementation process, design challenges and solutions, and technology innovations (each track or topic area is represented by a different color in the table to the right). Altogether, the presentations will cover the full spectrum of healthcare design issues from patient safety, staff efficiency, and quality of care, to financial outcomes. At the same time, the speakers will provide perspectives about the Pebble Project from different professionals—healthcare administrators, architects, interior designers, researchers, industry experts, and university professors.

Evidence-based design research studies and reports

The emphasis of the Pebble Project on research is reflected in the fact that half of the Pebble presentations on HCD.08 are focusing on evidence-based design research studies and results.

The Bridge to ER One (Session E3) is a 10-bed addition to the existing emergency department of Washington Hospital Center. Completed and opened in January 2008, it operates as a test ground for new design concepts and materials that will be used in the ER One Project—an everyday emergency care facility with the ability to accommodate patient surge in unusual situations, such as terrorism and natural disasters. Research is being conducted to compare two types of rooms—the standard room, designed as a standard urban emergency room, and the protected room, incorporating a lot of innovative features, such as new experimental finish materials. The presentation by Ella S. Franklin and Barbara Huelat will guide attendees through the research journey of a construction project. Attendees can also take a tour of the actual facility on Saturday, November 8, to get a more direct experience of the project.

Speech privacy (Session E10) is a critical issue in complying with the regulations of the Healthcare Insurance Portability and Accountability Act (HIPAA). How is speech privacy being measured? How do various construction finish materials contribute to speech privacy? How do you design the open and closed spaces in healthcare settings to support speech privacy? People who are interested in the above questions will probably find answers in the presentation by Kenneth Roy and Anita Snader from Armstrong Ceiling Systems. The speakers will also talk about the process and results of a recent study on speech privacy in a new community hospital. Suggestions about building layout, finish materials, and sound systems will be provided.

Private versus semiprivate rooms (Session E17) will be discussed in the presentation by Susan Lorenz from Princeton Healthcare System. With a continuously aging population, there is an urgent need for research to explore the experience of elderly patients and to examine how the physical environment can better serve the needs of this special patient group. In this presentation, Lorenz will report a retrospective study about the effects of hospital room types on elderly hospital patients. Attendees will hear the most current research about the important role of room type in influencing incidence of falls, healthcare associated infection, and social isolation.

The Children’s Hospital at Denver (Session E24; figure 1) is a brand-new, nine-story, 1.44-million-square-foot, 270-bed facility, which incorporates evidence-based design concepts including single-occupancy room, family-centered care, low light and noise levels in the NICU, healing gardens, and color therapy. In this presentation, the designers Robert Packard and Sharron van der Meulen from Zimmer Gunsul Frasca Architects will talk about the research evidence that they utilized to inform the design and a shadowing research technique by which they gained first-hand knowledge about users’ daily activities. Thirteen months after the opening of this replacement hospital, the designers will also re-evaluate the design strategies and decisions by looking at patient outcomes and share with attendees their experience and the lessons learned.

The Children’s Hospital at Denver

User-centered research (Session E45) is a methodology used by design researchers at Steelcase to gain in-depth knowledge about the experiences and needs of various user groups, discover problems, and generate innovative design solutions. The speakers, Joyce Bromberg, Melanie Redman, Caroline Kelly, and Pamela Witting will share Steelcase’s six steps of the user-centered research and the tools (such as observation and assumption-testing techniques) that they use to collect both qualitative and quantitative data from real healthcare settings. In addition, a real-life example will be given to help attendees understand how the six-step process works to generate desirable outcomes.

Case studies

Three prominent Pebble providers will tell their stories of applying evidence-based design concepts to the design of their own facilities.

University of Kentucky Hospital (Session E1) is building a state-of-art, one-million-square-foot, eight-story, 240-bed inpatient care tower to replace its existing hospital built in 1960s. The speakers Daniel Miesle and Jeff Norton from the U.K. hospital, and John Waughand and Jim Mischnick from the design firm Ellerbe Becket will talk about how they establish evidence-based design guide principles based upon the Institute of Medicine’s Six Quality Aims, and how multiple user groups were involved in decision-making through interdisciplinary processes. The U.K. hospital features a service-based platform that includes ICU and acute care patients on the same floor, large private patient rooms, the flexibility of regular rooms converting to individual intensive care, a patient care team station, and identical patient care rooms and work spaces. The impact of design on healthcare outcomes and operational bottom-line will also be discussed.

Dublin Methodist Hospital (Session E8; figure 2) is a four-story, 320,000-square-foot, 94-bed community hospital, which opened its door in January 2008 in central Ohio. From the beginning, the hospital administrators and designers put much emphasis on improving healthcare outcomes through building design. The new hospital aimed at being the best by incorporating the most recent research and technology from the ground up. Cheryl Herbert, Rosalyn Cama, and Gregory Mare will talk about the design process and will report fresh findings about design innovations, including like-handed patient rooms, headwall orientated bathrooms, decentralized nurses stations, and their impact on clinical, operational, and financial outcomes.

Dublin Methodist Hospital

Weill Greenberg Center (Session E22; figure 3) is a world-class, 15-story, 330,000-square-foot ambulatory care and medical education facility at Weill Cornell Medical College in Manhattan. Opened in 2006, the new building features a spa-like healing environment providing views of pools, images of still-water, and sounds of moving water; ample natural light coming though large picture windows; a wayfinding system utilizing floor layout, materials, and signage; and exam rooms with rubber-vinyl flooring and cabinetry concealing medical equipment. The presenters Louis Meilink, Nancy Farrell, Franklin Becker, and Richard Thomas will talk about the challenges they faced in choosing design elements and present the research results concerning the effects of physical environment on the patient perception of medical care quality.

Weill Greenberg Center

Design Challenges and Solutions

The Art Program at Sacred Heart RiverBend (Session E37; figure 4) is a special example of evidence-based design—evidence-based art selection. The speaker, Kathy Hathorn from American Art Resources, will talk about the process of using research evidence in the selection of local artwork for Sacred Heart Medical Center at RiverBend in Springfield, Oregon, a new one-million-square-foot, 386-bed inpatient hospital opened in August 2008. The selected artwork includes sculptures, paintings, photography, textiles, colored glass panels, handcrafted iron and bronze stair rails, and limestone wall carvings. Attendees will have the chance to learn about setting up an evidence-based art program that caters to the diverse needs of key user groups.

Sacred Heart RiverBend

Technology and Innovations in Facility Planning

Research-driven innovation (Session E39) is an approach used by Philips Design to marry high-tech with high-touch in the development and design of its new healthcare products. In this presentation, Sachin Behere and Stefanie Un will introduce their unique perspective of industrial design research and discuss how their research creates deep and qualitative knowledge about the experiences of patients, families, and staff while inspiring design. To help attendees to learn the value of research-driven approach in humanizing technology, the speakers will show examples of research-based design innovation that enhance the personal experiences of patients by meeting their specific needs.

Carrying cutting-edge information from the Pebble Project, the much-anticipated presentations are likely to further extend the ripples created by the individual healthcare providers and manufacturers to make an even bigger contribution to evidence-based design. HD


The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at

Healthcare Design 2008 November;8(11):12-18