Healthcare Design - May 2014 - 38

C THE CENTER | 06.14
Evidence-based design origins
After decades of research to shape healthcare design, a look back at
where the evidence-based movement started serves as a reminder of
how far the industry has come
By Debra Levin
It's not always easy to pinpoint a beginning,
and yet it's human nature to seek the answer to
where things began. Humans are curious creatures: From silly curiosities (which came first,
the chicken or the egg?) to cerebral discussions
such as the Big Bang Theory, we continue to
seek answers to questions of genesis, both big
and small.
At The Center for Health Design, our mission
is about transforming healthcare environments
to create better health outcomes, and we
achieve this through design research, education, and advocacy. But the nucleus is always
research. Without new insights, it's challenging
to push the boundaries of innovative new design
concepts. Without new knowledge, it's difficult
to create educational content with much value
or depth. And without either proving or debunking standard practice and common theories
that may or may not add value to a healthcare
building, it's impossible to change the codes
and standards we use to create them.
The Environmental Design Research Association recently named The Center for Health
Design as the recipient of its 2014 Organization
Award for Excellence in Environmental Design
Research, Application, or Education. The award
serves as recognition of progress that's been
made in earning acceptance of evidence-based
design, which started me thinking about the
journey. What was the origin of the researchbased healthcare design industry? When did
the evidence-based design movement begin to
find its footing?
It likely all began in earnest with a brick
wall and Dr. Roger Ulrich. There were many
earlier studies and observations linking the built
environment to health, starting with Florence
Nightingale's "Environmental Theory," that led
to an infusion of natural light and ventilation in
hospital design in the mid-1800s. But to this
day, no study has been more referenced and
quoted than Ulrich's 1984 article published in
the journal Science, "View Through a Window
May Influence Recovery from Surgery."
In this study, Ulrich found that post-surgery
gall bladder patients had shorter post-operative
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HCDmagazine.com 06.14

stays, needed fewer pain killers, had fewer postsurgical complications, and made fewer negative
comments when the views through their hospital
window overlooked a grove of trees versus a
brick wall.
This landmark study opened the door for the
next generation of research professionals to
focus on elements of the built environment and
isolate their impact on healing, productivity, and
safety issues in healthcare environments. Since
then, the research-based healthcare design field
has continued to grow-slowly at first-and is
now starting to see a groundswell as more and
more universities offer graduate-level programs
in healthcare design that use an evidence-based
approach.
In 1998, The Center commissioned the first
systematic literature review of studies connecting
the built environment to better health outcomes,
with 84 relevant studies identified. That same
search was commissioned in 2004, and 600
studies were found. In 2008, a review yielded
more than 1,200 studies. If we were to do the
search again today, I have no doubt that that
number would surpass 2,000.
It's interesting to ask the question, "Where did
it all start?" But what's even more fascinating is to
watch the birth of an idea grow into adolescence
and to be excited about its potential in adulthood.
We have all done so much to move this industry
forward using a research-based approach to
design. Looking forward 25 more years, I believe
we will see extraordinary things.
I leave you with a Florence Nightingale quote
from 1860: "People say the effect is only on the
mind. It is no such thing. The effect is on the
body, too. Little as we know about the way in
which we are affected by form, by color, and light,
we do know this, that they have an actual physical effect. Variety of form and brilliancy of color
in the objects presented to patients are actual
means of recovery." HCD
Debra Levin is president and CEO of The Center
for Health Design. She can be reached at dlevin@
healthdesign.org.

Debra Levin

http://www.HCDmagazine.com

Healthcare Design - May 2014

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