7 Things You Might Not Know about Evidence-Based Design

7 Things About Evidence-Based Design

Evidence-Based Design

Evidence-Based Design…

It has an “official” sounding ring, doesn’t it? And for good reason. In a nutshell, evidence-based design (EBD) relies on credible, quantitative and (sometimes) qualitative data to inform design decisions of physical spaces that measurably affect positive outcomes. These are generally associated with patient outcomes in healthcare settings. Yet EBD is making its way into new fields – spoiler alert – and making a big impact on other industries.

1. Moving on up! Evidence-based design is spreading

We moved this factoid to number one so you didn’t have to wait too long for your spoiler. While EBD started in healthcare settings, it is steadily moving into other areas including education, hospitality, restaurants, museums and even prisons.

Educational Institutions
Some educational installations from Art Force

David Whitemyer tapped into the expanding universe of EBD for the International Design Association (IIDA). He showed that EBD makes sense in the high-risk environment of healthcare, where empirical evidence and due diligence are king.

Yet a common thread of managing risk seems to be weaving in and out of these separate industries. It makes intuitive sense, after all, that sizable investments on construction projects can benefit from user preference data to guide decisions.

Educational institutions mark the biggest growth sector in EBD next to healthcare, according to Whitemyer. Citing a 1999 study on sunlight, test scores for students in classrooms with large windows and skylights scored 7 to 18 percent better on tests than students in rooms with little natural light. Now that’s an empirical insight worth knowing!

2. Evidence-based design has a father(s?)

Dr. Roger Ulrich, professor of architecture at Chalmers University in Gothenburg, Sweden is often credited with planting the seed of EBD. However, other sources point to Professor Archie Cochrane’s book, “Effectiveness and Efficiency: Random Reflections on Health Services” and the patient-centered care movement that began in the US in 1978 as other harbingers of EBD.

For the sake of brevity, Nathan Stall wrote in the Canadian Medical Association Journal about Dr. Ulrich’s groundbreaking work in ‘environmental psychophysiology’ – the investigation of “human transactions with physical environments based on physiological assessments.”

In his “seminal article” in Science (1984), Ulrich determined that surgical patients with windows overlooking natural scenes had shorter hospital stints and took fewer “analgesics” (painkillers) than patients in rooms with windows facing the brick walls of a neighboring building.

3. Evidence-based design has a neighbor

User Centered Design
Thinking like a user is important

Or is it a sibling? Either way, according to, EBD is an “idealized” version “user-centered design” (UCD). UCD seeks to achieve exactly what the name implies. It is the practice of utilizing usability testing and other user research to optimize web sites, products and software.

Perhaps the implied logic in both EBD and UCD help in the adoption-curve of both practices? It’s certainly not a stretch to put yourself in your users’ shoes to improve experiences.

In the information age where knowledge is more than power, making decisions based on empirical data helps business leaders measure success and stick to the scientific method when testing hypothesis and innovative new ideas.

4. Evidence-based design has theoretical foes

Those foes? Half-truths, guesswork and conventional wisdom. Is it true that the days of doing things “how they’ve always been done” are over? If so, we can thank the evidence based movement for this critical paradigm shift in large part.

According to the practice of “evidence based management” detailed in Hard Facts, Dangerous Half-Truths and Total Nonsense from the Harvard Business School Press, “Business decisions are often based on hope or fear, what others seem to be doing, what senior leaders have done and believe has worked in the past and strong ideologies.”

In the article, authors Jeffrey Pfeffer & Robert I Sutton offer a spectacular framework for assessing situations with this mindset:


Source: via Harvard Business School Press

5. Evidence-based design has applications in military hospitals

It’s natural to assume that the positive aspects of EBD in civilian hospitals would also apply to military hospitals.

Evidence-based design and Military
On the road to recovery

According to Americans for the Arts and the National Initiative for Arts & Health in the Military, Congress helped take things a step further.

The 2005 Base Realignment and Closure Act (BRAC) set a “congressional mandate to develop world-class facility design, and additional funding from Congress provided an extraordinary opportunity for military hospital design and construction to apply the principles of patient-centered care and evidence-based design (EBD).”

Following telephone interviews with both active-duty personnel and their spouses, the three most important features reported were rooms for families, environmental control and enhanced communication.

6. Evidence-based design can help with wayfinding

Wayfinding traditionally consists of signage or information used to help people navigate physical spaces. While wayfinding exists outside of the sphere of EBD, both can benefit from the same data.

Wayfinding: Signage, Landmarks and more…

For healthcare patients coping with dementia, hospital corridors can present many challenges. Consider that many patients might also suffer from vision loss or any number of additional ailments that make wayfinding difficult.

An inability to find a destination can cause serious problems for people with dementia. According to Long-Term Living, “Residents who could not identify paths to desired locations exhibited anxiety, confusion, mutism, and even panic.”

While signage often ranks near the top for providing top-notch wayfinding, EBD often incorporates color coding, symbolism, kiosks, cues on ceilings and flooring and even different textures and gradients on handrails to give people multiple points of reference while finding their way.

7. Evidence-based design reduces medical errors and staff injuries

If this one doesn’t demonstrate the impact of EBD on outcomes, what will? Becker’s Hospital Review wrote a great piece on the ways EBD adds value to hospitals. The article points to medication errors due to issues concerning centralization of medicine.

Healthcare design
Design solutions where they matter most

“By placing a small, locked cabinet in patient rooms, medication administration becomes quick, efficient and accurate.” Molly Gamble wrote for Becker’s. “These “decentralized” medication storage areas contain only the prescribed medications for that one individual.”

While at first glance this may seem minor, Clarian Health Partners reported a 70 percent decrease in medication errors with this small change according to the article. Gamble also reported that the leading cause of staff back injuries is caused by lifting and transferring patients. Sacred Heart Medical Center at Riverbend in Springfield, Oregon helped reduce staff injuries with patient lifts. According to a New York Times report, the lifts paid for themselves in two years based on the reduced cost of claims and lost work.

For more information on how Art Force is utilizing this information in this article and much more, please visit our Healthcare page.