History of Healthcare Facility Design Term Paper

Evidence-Based Design in Healthcare Facility Planning

This Letter to Stakeholders aims to help the recipients appreciate the importance of evidence-based design in the planning of Healthcare Facilities.

Dear Sir / Madam

I feel happy to share with you the letter that explains about the upcoming healthcare renovation project. There are a lot of disruptive changes happening in the healthcare landscape and the application of evidence-based design (EBD) is prominent among them. It is essential that we understand the features of the model before taking a final decision. I have put my perspective on why adopting the EBD model for our renovation project is important.

History of Healthcare Facility Design

The original idea that Florence Nightingale had of a hospital was a place that would have abundant fresh air, view of nature and light. This idea sought to substitute deep plan hospitals that rose after World War II which were more concerned about efficiency than the healing of the patients and their comfort. The form of the hospital changed from the style of a pavilion to a totally different style. A configuration of an average hospital turned to a multi-floor block (or platform) that had the patient tower on top of it. This transformation was made possible by building technology that brought the ability to build long span buildings, ventilate the interior spaces through mechanical means, and introduction of elevators to move people between floors. According to estimates, nurses spent 40% of their time in transporting patients when this topology was at its peak (Burpee, 2008).

Current Approaches

Hospitals and Clinics in Canada and many countries in Europe do not offer private rooms to patients. The contrasts between a ward in a hospital and a private room have been described in a rather interesting manner on the website of The British National Health Services (NHS). Evidence shows many patients would prefer a private room. However, this is quite hard unless the patients pay for a private room. There are some obvious advantages of staying in a private room such as privacy, reduced noise, and a lower risk of contracting nosocomial infections. Interestingly, there are some notable disadvantages of a private room for a patient (Gormley, 2010). They include:

• The patient in private room has no social interaction with others;

• It is harder to catch a nurse’s attention and the patient has to use a buzzer; and • There is reduced likelihood of someone noticing if the patient falls while going to the bathroom.

Evidence-based Design in Healthcare Facility Planning

Physical environment, especially when it comes to health care can have a tangible impact on the well-being of human beings. Plausibly, Evidence-based design arises from this realization. According to the founding principal of Houston’s Watkins Hamilton Ross Architects, D. Kirk Hamilton, also an associate professor at the Center for Health Systems and Design in Texas A&M University, a well-designed environment is an important constituent of the patient care system. There is an increasing number of designers, facility executives and architects who are diligently analyzing how the facilities influence the outcome of patients under the concept of evidence-based design. Hamilton states that Evidence-based design is the result of an architect who is thinking critically, working closely with well-informed clients. Such an approach uses concrete evidence from studies to make interpretations on design.

Currently, experts are concentrating on the studies on the effects of the nature of facilities. These include issues such as the location of bathrooms and sinks, decor, as well as overhead pages. Statistical data, such as the rate at which patients acquire illnesses while they are admitted in hospitals, or the number of errors associated with medication, and the duration of patients stay in hospital are used to measure the effects. If these measures are improved, there will be an overall enhancement in the well-being of patients (Kroll, 2005).

Although “evidence-based design” equates with formal research generally, there are many other ways in which “evidence” occurs. These ways include in-house institutional research, professional experience, best practice, and informal benchmarking. The information acquired through the different means is then sieved by different people in different ways. These people are entrusted with the processes of planning, managing, funding, designing, and even those who use the facility: they include the planners, architects, management, government organizations responsible for oversight and regulations, the users, as well as the community that is served by that particular facility. The value of these diverse forms of evidence assists in shaping and testing these means of acquiring information. It also helps facility planners, those involved in designing, the management, and users to combine them into a solution for design that can be used for a particular project. Although the concept that “evidence-based design” will have better outcomes seems simple, the concept is very complex in practice (Becker & Parsons, 2007).

Importance of Evidence-based Design

EBD is mainly concerned about the built environment. However, other major forces guide the design of a hospital. These include the safety of patients, information technology interface, partnering with the family to provide care, and healing environments. The impact of these forces is actually overlapping. For example, there are likely to be fewer patient falls when the family is around. The breaching of patients’ safety is an issue that is independent from how the built environment has been designed, errors that occur in medication, nosocomial infections and other issues. However, it is known that safety can also be categorized as an issue that arises from design. Single occupancy rooms and improvement in the standards of layout enhance the safety of the patients (Malkin, 2008).

The positive effect of daylight and the natural environment on human physiology are some of the major factors that evidence-based design considers. Other factors include improving the movement of people on the built environment while emphasizing on hygiene, efficiency, safety, and ergonomics. Architect Douglas Elting states that these factors are very important for health facilities, such as the wellness center in Butler County. The major design objectives, especially for the new wellness center included improving a view of the outdoor environment and creating as much daylight exposure as possible. According to research, patients allowed to view the natural world reduces how much they need pain medication, reduces the amount of time they stay in the hospital, and has a positive effect on the circadian rhythm, sleep, and alertness. These benefits also occur when patients get exposed to a lot of natural daylight.

The wellness center offers a wonderful view where patients can see a park and other natural environment. This is through a unique curved glass curtain wall that is more than 3000 square feet and extends to a height of 22 feet. Building information management (BIM) was used by Elting to design the building in 3D. To create a healing environment that was more comfortable and make the patients and all the other people in it feel more connected to the outdoors, sun tracking analysis software was used. Elting further adds that the design of the facility was supported with evidence from scientists who have studied the effect of the natural environment. They had found that the reaction of human beings is affected positively when they are provided with a view of the natural environment such as trees, fields, and water from a higher position. This affects humans both physically and mentally. It can be traced back from how our ancestors felt peaceful when they had a good view of where to find food, water and shelter as well as having a good view of where danger would come from while at a safe location. It is with this support from scientific studies that a facility made mostly of glass was designed on the south end of the hospital. (Malmquist, 2014).

Hope my explanation reaches in the right spirit. Looking forward to hear back from you.

Best Regards,


Burpee, Heather (2008). ‘History of Healthcare Architecture’. Integrated Design lab Puget Sound.

Gormley, Tom (2010). ‘The History of Hospitals and Wards’. Healthcare Design. Extracted from http://www.healthcaredesignmagazine.com

Kroll, Karen (2005). ‘Evidence-based design in Healthcare facilities’. Building Operating Management. Extracted from http://www.facilitiesnet.com/

Becker, Franklin and Kelley S. Parsons (2007). ‘Hospital Facilities and the role of evidence-based design’. Journal of Facilities Management Vol. 5 No. 4, 2007 pp. 263-274

Malkin, Jain (2008). ‘A Visual Reference to Evidence-Based Design’. The Center for Health Design (First published — January 2008)

Malmquist, Derek (2014). ‘Improving Patient Outcomes and the Bottom-line with Evidence-Based Design’. Healthcare Facilities Today. Extracted from http://www.healthcarefacilitiestoday.com/

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