Evidence-based design

Evidence-based design, or EBD, is the process of constructing a building or physical environment on based on scientific research to achieve the best possible outcomes. Evidence-based design is especially important in evidence-based medicine, where research has shown that environment design can affect patient outcomes. It is also used in architecture, interior design, landscape design, facilities management, education, and city planning. Evidence-based design is part of the larger movement towards evidence-based practices. Evidence-based design, or EBD, is the process of constructing a building or physical environment on based on scientific research to achieve the best possible outcomes. Evidence-based design is especially important in evidence-based medicine, where research has shown that environment design can affect patient outcomes. It is also used in architecture, interior design, landscape design, facilities management, education, and city planning. Evidence-based design is part of the larger movement towards evidence-based practices. Evidence-based design (EBD) was popularized by the seminal study by Ulrich (1984) that showed the impact of a window view on patient recovery. Studies have since examined the relationships between design of the physical environment of hospitals with outcomes in health, the results of which show how the physical environment can lower the incidence of nosocomial infections, medical errors, patient falls, and staff injuries; and reduce stress of facility users, improve safety and productivity, reduce resource waste, and enhance sustainability. Evidence in EBD may include a wide range of sources of knowledge, from systematic literature reviews to practice guidelines and expert opinions. Evidence-based design was first defined as 'the deliberate attempt to base design decisions on the best available research evidence' and that 'an evidence-based designer, together with an informed client, makes decisions based on the best available information from research and project evaluations'. The Center for Heath Design (CHD), a non-profit organization that supports healthcare and design professionals to improve the understanding and application of design that influence the performance of healthcare, patient satisfaction, staff productivity and safety, base their model on the importance of working in partnership with the client and interdisciplinary team to foster understanding of the client, preferences and resources. The roots of evidence-based design could go back to 1860 when Florence Nightingale identified fresh air as 'the very first canon of nursing,' and emphasized the importance of quiet, proper lighting, warmth and clean water. Nightingale applied statistics to nursing, notably with 'Diagram of the causes of mortality in the army in the East'. This statistical study led to advances in sanitation, although the germ theory of disease was not yet fully accepted. The evidence-based design movement began much later in the 1970s with Archie Cochranes's book 'Effectiveness and Efficiency: Random Reflections on Health Services'. to collect, codify, and disseminate 'evidence' gathered in randomised controlled trials relative to the built environment. A 1984 study by Roger Ulrich found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall; and laid the foundation for what has now become a discipline known as evidence-based design. Studies exist about the psychological effects of lighting, carpeting and noise on critical-care patients, and evidence links physical environment with improvement of patients and staff safety, wellness and satisfaction. Architectural researchers have studied the impact of hospital layout on staff effectiveness, and social scientists studied guidance and wayfinding. Architectural researchers have conducted post-occupancy evaluations (POE) to provide advice on improving building design and quality. While the EDB process is particularly suited to healthcare, it may be also used in other fields for positive health outcomes and provision of healing environments. There is a growing awareness among healthcare professionals and medical planners for the need to create patient-centered environments that can help patients and family cope with the stress that accompanies illness. There is also growing supporting research and evidence through various studies; that have shown both the influence of well designed environments on positive patient health outcomes, and poor design on negative effects including longer hospital stays. Numerous studies have demonstrated improved patient health outcomes through environmental measures; exposing patients to nature has been shown to produce substantial alleviation of pain, and limited research also suggests that patients experience less pain when exposed to higher levels of daylight in their hospital rooms. Patients have an increased need for sleep during illness, but suffer from poor sleep when hospitalised. Approaches such as single-bed rooms and reduced noise have been shown to improve patient sleep. Natural daylight in patient rooms help to maintain circadian rhythms and improve sleep. According to Heerwagen, an environmental psychologist, medical models of health integrate behavioral, social, psychological, and mental processes. Contact with nature and daylight has been found to enhance emotional functioning; drawing on research from studies (EBD) on well-being outcomes and building features. Positive feelings such as calmness increase, while anxiety, anger, or other negative emotions diminish with views of nature. In contrast there is also convincing evidence that stress could be worsened and ineffective in fostering restoration in built environments that lack nature. Few studies have shown the restorative effects of gardens for stressed patients, families and staff. Behavioural observation and interview methods in post occupancy studies of hospital gardens have shown a faster recovery from stress by nearly all garden users. Limited evidence suggest increased benefits when these gardens contain foliage, flowers, water, pleasant nature sounds, such as birds and water. EBD is closely related to performance-based building design (PBBD) practices. As an approach to design, PBBD tries to create clear statistical relationships between design decisions and satisfaction levels demonstrated by the building systems. Like EBD, PBBD uses research evidence to predict performance related to design decisions.