This is an exciting time to be a researcher at The Center for Health Design (CHD). As research becomes increasingly incorporated into the practice of healthcare design, CHD is playing an active role to provide the bridge between research and practice. What is particularly exciting is that evidence-based design (EBD) provides the process and approach for making research come alive and become useful for practitioners.

Research underpins much of CHD’s work and helps shape educational offerings we provide, such as the EDAC program, conferences, and advocacy efforts for informed changes to facility guidelines. Our goal with research projects is to develop knowledge and resources that support and strengthen the growing field of evidence-based design.

As such, we aim to bridge the gap between research and design through resources that facilitate the translation and application of research knowledge into design. CHD also develops partnerships with national organizations to conduct research projects that will likely have the maximum impact on the healthcare design industry.

Those of you who regularly read this column may have a sense of the type of research projects that CHD undertakes and supports. These projects fall into three main categories.


Translating research
CHD pulls together information from peer-reviewed articles and industry best practices to create papers and presentations on topics of high interest for the healthcare design community.

In the past, this work has been supported by grants from national organizations such as The Robert Wood Johnson Foundation, the National Association of Children’s Hospitals and Related Institutions, the California HealthCare Foundation (CHCF), as well as industry sponsors.

CHD’s website is being developed as the go-to place for all research related to the design of healthcare environments. Several years ago, CHD began the development of RIPPLE, an open-source database built on information used by Kaiser Permanente to develop its building standards. This was updated with data on environmental safety gathered during a project funded by the U.S. Green Building Council.

The site is currently under further development with support funding from the AIA Academy of Architecture for Health (AIA/AAH), CHCF, and The Kresge Foundation. The upgraded database will provide access to the most current research in healthcare design and enable benchmarking between facilities.

Users will be able to better understand design strategies implemented by healthcare organizations and search the healthcare outcomes related to design. The case studies and repository of research abstracts included will support healthcare design teams using an EBD process in their facility design projects.


Promoting and conducting research
One of the primary ways CHD promotes research that supports the development of the EBD field is through the Pebble Project. This research initiative engages forward-thinking healthcare organizations to utilize an EBD process during their building projects, conduct research to evaluate their designs, and share their findings with the healthcare design community.

CHD supports Pebble Project partners in accessing evidence, defining research objectives, developing collaborations with researchers, and disseminating their findings. Pebble Project partners are also engaged as participants in multisite grant-funded research projects. CHD’s September column will feature additional details about the Pebble Project.

CHD also supports original research through the Research Coalition, which is comprised of volunteers from academia and industry. Through a rigorous evaluation process, the Research Coalition identifies studies for funding in high-priority areas through a structured request for proposals (RFP).

By partnering with the Facility Guidelines Institute (FGI) on this RFP process, CHD has been able to leverage the resources of both organizations to support studies that have a high impact on the field.

Focus areas for funding have included patient falls, healthcare-associated infections, and the impact of noise on sleep quality. This relationship with FGI has facilitated a stronger connection between research and translation of findings into the Guidelines for the Design and Construction of Health Care Facilities.

Last fall, Upali Nanda, PhD, completed the study “The Impact of Visual Art on Waiting Behavior in Emergency Departments.” Later this summer, a “Falls Environmental Evaluation Tool” (FEET) and study report developed by Maggie Calkins, PhD, will be completed and posted for free download on the CHD website (

Projects under way include the study “Role of Design on Psychological Trauma in Hospitalized Children,” being led by Jenifer Cartland at Children’s Memorial Hospital of Chicago, and a study on hand hygiene and healthcare-associated infections being led by Dr. James Stahl of Massachusetts General Hospital, Institute for Technology Assessment.

CHD’s research team also conducts primary research on topics of high importance for the EBD field. Government and industry sponsors provide support for these projects, such as the “Designing for Patient Safety” seminar funded by the Agency for Healthcare Research and Quality and Facility Guidelines Institute; and a study on positive distractions in imaging areas funded by Philips Healthcare.


Developing tools
While all three categories of research described here are critical to healthcare design, there is now a strong focus and need to develop tools that provide support for evidence-based decisions made during the design process.

CHD is engaged in developing a range of tools that can measure and evaluate the effectiveness of design interventions to support the EBD process. These include:

  • “Healthcare Environments Terms and Outcome Measures: An Evidence-Based Glossary”—This document, published in 2011, compiles research in seven key outcome areas to develop a standard baseline of terms, definitions, metrics, and measurement tools used in EBD research and practice. It also begins to identify the areas where standard terms and definitions do not exist and where tools need to be developed to support research and practice.
  • Clinic post-occupancy evaluation (POE) tool—CHD is developing a post-occupancy evaluation tool that can be used by safety net clinics and community health centers to conduct design audits and evaluate the effectiveness of their designs in meeting key organizational and strategic goals. The tool will have an online format, and the data will be directly incorporated into CHD’s Clinic Design website. This tool may be suited for other outpatient environments, as well.
  • Pebble Partner inpatient POE—This tool will be used to collect post-occupancy data from Pebble Partners and will include a design audit, focus groups, and interviews. Eventually, this tool will be used along with the surveys that are being developed to collect data.
  • Patient room checklist and POE—The American Society of Interior Designers has provid
    ed funding to develop a patient room interior design checklist and evaluation tool. The purpose of this project is to develop a standard evidence-based tool that interior designers (and others) can use for applying research evidence and conducting post-occupancy evaluation of patient rooms. Specific checklists will be developed for medical/surgical rooms, intensive care unit rooms, and maternity care rooms over a period of three years. This tool will also have an online format and will be connected to other building-level data.
  • Research repository—CHD is developing a research repository with funds from AIA/AAH that will make our existing database of more than 2,500 references and associated abstracts widely available through the CHD website. This existing database of healthcare design-specific references covers research conducted in acute care, long-term care, and ambulatory care settings. This repository will be a key resource for the healthcare design industry and can be used extensively for identifying relevant research studies throughout the EBD process.

While CHD will continue to focus on research in all three categories described above, the development of tools has been identified as a high priority. The evidence-based design field is still in its early stages, and there is a growing need for tools and resources that can help serve as a foundation, providing support for healthcare design research. The standard tools that are being developed will help to strengthen Pebble Project initiatives as well as support the efforts of EDAC-certified practitioners.

CHD is also developing a list of research priorities that will guide its work internally and provide direction for Pebble Project research. A list of high-priority research topics has been developed based on gaps identified in the 2008 literature review led by Craig Zimring and Roger Ulrich, and are organized into five main areas: patient safety, patient experience/quality, workforce outcomes, organizational impacts, and EBD science.

The Pebble Project partners as well as the Research Coalition members are reviewing these topics. CHD’s top 10 high-priority topics will be shared with the healthcare design community at the 2012 HEALTHCARE DESIGN Conference, November 3-6, 2012, in Phoenix.

The evidence-based design field is evolving with more teams turning to research to help make design decisions. Architecture and design firms, and healthcare organizations are also actively pursuing research projects and sharing their findings. Further, key organizations in the field such as FGI, AIA/AAH, CHD, and others are looking for ways to work together and leverage resources to benefit healthcare design stakeholders. We look forward to working with all of our partners to maintain and continue to build the momentum for built environment research.

Anjali Joseph, PhD, EDAC, is the Director of Research for The Center for Health Design. If you are interested in learning more about The Center for Health Design’s research projects or contributing to the development of the research priorities, please contact her at ajoseph@health​