The Evidence on Evidence-Based Design

By Joe Flower

A meta-study has found that quiet, single-patient rooms with ventilation, good lighting and nature images significantly improve outcomes.

Joe Flower

With more than 800 hospital projects currently under construction, it's high time to ask a basic question: Do we really know what we are doing? When we work with architects and space planners and lighting designers to make the thousands of decisions that go into building a new facility or remodeling an old one, how do we make the decisions? What are our criteria? What evidence do we use?

Keep costs down, give the docs the space they need, make it look good to excite contributors--many factors compete for our attention. Yet surely the top question should be how we can design an environment that truly helps patients recover, provides better safety, and helps staff do their jobs better. You've probably heard a hundred presentations, read a thousand articles or been part of a million discussions on this. But how do you pull the real evidence out of all the competing voices?

Ladies and gentlemen, we have an answer.

The Center for Health Design, with funding from the Robert Wood Johnson Foundation, has come up with a meta-study. Every health care executive should read it. Memorizing is optional, but recommended. The research team dug up more than 600 rigorous studies that answered specific questions about how the health care environment affects patients and staff. Then the team analyzed the findings and detailed them in 26 pages, backed up with 41 pages of reference notes.

Clear Advice

Does noise affect patients' recovery time? What about roommates? Plants? Carpeting? What makes a real difference? How much of a difference? Can building design increase your nurse retention rate and patient satisfaction scores? Can it lower your length of stay and cut readmits? Lead investigators Roger Ulrich of the Center for Health Systems and Design at Texas A&M University and Craig Zimring of Georgia Tech have pulled together an impressive set of studies that support clear conclusions.

Among them:

Go for single-bed rooms. Adaptable-acuity single-bed rooms beat multiple-bed rooms hands down in terms of infections, noise, privacy, communication, patient falls and patient satisfaction--even medical errors.
Shhh! Hospitals are far too noisy. Noise is stressful to both patients and staff, and most of it is preventable.
Nature helps. Plants, fountains, gardens, views of trees, videos of fish, even nature paintings have definite positive clinical outcomes.
Getting lost is tough on the immune system and frazzles the staff. Integrated, systemic wayfinding systems involving everything from building layout to signs, maps and kiosks help a lot.
Give them some air. Ventilation and filtration not only make the place feel better and smell better, they prevent the spread of airborne infection.
Goethe's dying words: "More light!" Better lighting, natural lighting, full-spectrum lighting, lighting that is bright enough for good work and dim enough for sleep, is healing--and helps prevent medical errors.
Design the wards and nurses' stations intelligently, and you'll have happier, more productive nurses and better patient care.

The details are as enlightening as the general conclusions. Whether you are just starting a project or are nearly finished, there are findings in this report that you need to know.

Download the report, "The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity," at http://www.healthdesign.org/research/reports/physical_environ.php

Joe Flower is a health care futurist, speaker and founder of the education firm Imagine What If Inc. and its online learning and research environment, the Healthcare Futures Exchange. He is also a regular contributor to H&HN OnLine.

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This article 1st appeared on January 25, 2005 in HHN Magazine online site.

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