As architects, our goal is to be a trusted partner to our clients. In addition to their vision for the project, we want to understand their broader objectives so we can craft the project as part of a holistic approach to attain them. Good healthcare design isn’t innovation for innovation’s sake, hoping for the best and never looking back. Similarly, a design solution that was successful for one project will not necessarily be effective for another, because each client has unique drivers and definitions of success. In order to create a project that reflects and supports those needs, I believe there is incalculable value in an evidence-based design process.
Evidence-based design captures essential insights to establish goals and inform design solutions; it is a key component throughout the design process and ultimately shapes the project’s trajectory. Incorporating this philosophy, three key practices I use to set the stage for a successful project and guide innovation are: understanding the current state, collecting external evidence and envisioning the ideal state.
Understanding the Current State
Before we can identify where we want to go, we must first understand where we’re starting. In the client’s current processes, what’s working and what opportunities are there for improvement? Are their facilities supporting or hindering their ability to create an optimal experience? Observations of existing facilities, surveys, and focus groups with users (clinicians, staff and patients) provide an imperative baseline of what should be maintained and what could be improved.
Collecting External Evidence
This practice gathers and distills evidence about healthcare trends, benchmarks and design strategies through literature reviews and case studies. This provides the project team with valuable information they can use to inform and guide their creativity and innovation.
Envisioning the Ideal State
With an objective understanding of current state and what’s working for others, we can together craft a vision of the ideal state. Visioning and project goal-setting sessions establish the client’s objectives and specific needs. Design workshops with users allow the team to work through design strategies, perform process walk throughs, build mock-ups and put them to the test prior to construction.
I saw first-hand the benefits of evidence-based design while working on an inpatient behavioral health facility. The design team conducted observations, focus groups, surveys and literature reviews, along with a two-day design workshop with clinicians. When discussing safety, a nurse made a comment that really stuck with me: “It’s not if I’ll get attacked, it’s when.” This stressed the criticality of safety for both staff and patients in the caregiving setting. In a focus group with individuals who had experienced other inpatient settings, one shared: “I was in a facility for six months and went outside only three times,” emphasizing the importance of a connection with nature for well-being. Hearing these first-hand experiences heavily influenced the team’s shared vision: to create a human-centered environment with top priorities of safety, comfort and dignity. The result of a safe healing environment that focuses on overall well-being will ultimately influence the success of the patients, the program and the investment in the project.
This process also demonstrated the importance of user involvement in design. Not only did their participation shape the vision, the clinicians became champions for the project with a sense of ownership and pride in the design, spreading their excitement for the new building to other staff. There’s no more effective way for your users to embrace necessary change than by showing them that their feedback and experience matters. In my experience, investing in an evidence-based design process early is well worth the effort, expediting decision-making later in the design process and ultimately leading to a more successful project.
When excellence is the goal (and of course, when isn’t it?), then evidence-based design is essential; it provokes an evolution in design thinking to be more conscientious and informed, helps avoid the pitfall of “doing what we’ve always done” and encourages continuous learning and improvement. The best architects are not only talented designers, they are facilitators, knowledge seekers, problem solvers and visionaries. They know the value of evidence-based design in understanding a client’s broader vision and helping them achieve their definition of success, growing beyond consultant architect to trusted partner.
Sarah Moser, RA, NCARB, EDAC