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‘Rigor and Research in Healthcare Design: A Decade of Advocacy’: Ten Suggestions for Increasing Rigor in Architecture and Design

The McMorrow Reports is excited to bring you the third of four bi-monthly excerpts from the industry-acclaimed Evidence-Based Design resource book Rigor and Research in Healthcare Design: A Decade of Advocacy.

Kirk Hamilton

Kirk Hamilton

The book was written by Kirk Hamilton, FAIA, FACHA. Hamilton is a Professor of Architecture, Texas A&M University, a Founding Principal of WHR Architects and a board member of The Center for Health Design. He is also an editor of Health Environments Research & Design Journal. Hamilton has published more than 30 articles, many of which are featured in the book, on Evidence-Based Design (EBD) in HERD and Healthcare Design magazine.

Herman Miller Healthcare, working in collaboration with Hamilton and Vendome Group compiled many of the architect’s writings into this single, printed publication.

Coming in the next few weeks will be the final chapter: “Differential Obsolescence, and Measurement.”

Excerpted from Chapter 9: Ten Suggestions for Increasing Rigor in Architecture and Design

“1. Use consistent language and clear definitions. There is a tendency for people to use the same words to mean different things, the effects of which can be exaggerated when communicating with someone from another discipline or organization. Commonly understood definitions of key words and phrases that are accepted by consensus within the field—or at least within a design team—are needed. …

2. Base key decisions on the best current evidence. …I have written elsewhere about the evidence-based design process (Hamilton & Watkins, 2010), so here I will mention only that critical thinking is required to interpret the implications of possible findings on the design of the current unique project. Decisions that have been informed by the best available credible scientific research and observations from completed projects stand a better chance of producing the desired results.

3. Make more decisions on the basis of recognized best practice. Many design decisions—in fact most of them—do not rise to the level of requiring a serious search for evidence. A high percentage of such decisions, however, can be based on what is described as best practice. If competent design professionals and experts in the field have identified successfully implemented design strategies, concepts, and details that can be studied in built examples, then designers can emulate these examples or rely on them to modify their own projects.

4. Make more objective and fewer subjective design decisions. If key decisions are made on the basis of a search for the best current evidence, and many other decisions can be attributed to best practice, it may be possible to reduce the number of arbitrary and subjective decisions. …

5. Document design intention. Design professionals must document the intent of their most important design concepts, perhaps in the form of design hypotheses, before a project is implemented. The ability to trace the record of design intent is especially useful in the evaluation and analysis of results. Knowing what outcomes are expected provides insight regarding the measurements that must be taken to see whether these results have been achieved. …

6. Document the process for making key decisions. When a key issue has been addressed, a good habit for the design team is to document the decision and its rationale. The reasoning behind key decisions should be documented in a way that permits one to go back and review how major decisions were made. Knowing what was considered, accepted, or rejected, and why, can be useful for later projects. …

7. Measure the design outcomes.  It comes as no surprise that rigor cannot be increased unless the measurement of outcomes is aggressively pursued. …The outcomes that should be measured explicitly include any associated with the key design issues for which an evidence-based process was utilized. …

8. Commit to search for answers with consistent and appropriate methods.  Evidence-based practitioners must be committed to discovering useful information as a result of their projects. The healthcare design field needs a set of understandable and repeatable methods for performing environmental research and project evaluations. The replication of studies that use the same validated methodologies and instruments will help build a body of evidence upon which the field can rely. …

9. Objectively assess new and innovative designs. Evidence-based design is a process, not a product. There should not be an expectation that reference to the best evidence will always result in the same answer, and in many cases, deliberate and purposeful innovation is needed and expected. When a design involves something new and untried, there is an opportunity for measurement and evaluation. Objective, unbiased, open-minded evaluation is desirable. The results of the evaluation of a new concept can then contribute to the constantly evolving body of knowledge and improve the field’s understanding of what constitutes best practice.

10. Be accountable for design decisions. Perhaps the most important suggestion is that designers transparently and openly assume accountability for all the results associated with their designs. … In the same way that architects must accept certain liability for the quality of the contract documents and compliance with codes, there should be a comparable responsibility for the intentional and purposeful design decisions intended to deliver specific outcomes as stated in advance. This has the potential to make a truly significant difference in the way clients view design professionals.”