Evidence-Based Practice Touches Everyone

Posted on February 21, 2011

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I think most architects would admit evidence-based design is just starting to build some serious momentum. Sometime in the future, hopefully the near future, healthcare design will be based primarily on evidence-based research—and not just by the large, international practices who have their own R&D departments. This notion was reinforced when I blogged about an excellent Kirk Hamilton piece calling for more rigor in healthcare design.

The powerful aspect about evidence-based practice is that is is not a design-only phenomenon. I think many designers feel it is something that has grown out of designers’ and practitioners’ desire to know more about how design decisions affect treatment. This is only part true. Yes, the evidence-focus currently en vogue in healthcare design is based on the desire to learn, but is the result of evidence-based practice in medicine infiltrating healthcare design and construction.

Evidence-based practice means a focus on accessing, understanding and implementing research into practice.

Evidence-based practice is so important, schools of medicine, nursing, physical therapy, etc. develop curricula around it. For instance, the Doctor of Nursing Practice degree was developed primarily so that nurses could “utilize clinical scholarship and analystical methods for evidence-based practice” as described in the University of Virginia’s School of Nursing program objectives.

Healthcare professionals need to know not only that this research exists, but how to acquire it, analyze it and built it into clinical action in healthcare facilities. This is the equivalent of a CEO learning about new business concepts in an MBA program and implementing them in her company. The ugly truth of work or “practice”, a.k.a. the ‘real world’, is people get too busy with day-to-day tasks to keep up with what is new in research / theory, or to sythesize it and put it into practice in their firms for the betterment of their operations.

I can say that this is definitely not happening in architectural design schools, first because healthcare is not often taught as a design specialty, and second because design is often not taught empirically. Yet, just as healthcare professuionals can acquire degrees strong in this subject matter, so should design professionals. Evidence-based healthcare design should match its evidence-based healthcare practice brothers and sisters.

As I noted above in the CEO example, work in many industries is too caught up in day-to-day practice to neither note new research being done, nor take those lessons and build them into daily routine for better work products (that’s why conferences are so popular). Only truly innovative individuals are keen to such info. Let’s face it:  if it is not about the core product, it is put off for another day. Much research is often dismissed by practitioners anyhow as “theory”, especially if it has impractical scholarship backing up its findings.

However in medicine, journals perform this vetting process, and provide fodder for evidence-based practice. Still, who has time to attend conferences every month, and read disserations and white papers? Evidence-based practice is the bridge between the research (testing done in a clinical way) and how that can be applied to healthcare “in the field”.

Evidence-based design for architects should mean two things:  1) the same relationship as noted above, namely, a bridge between academic design scholarship and how it can be used in real world projects; and 2) more specifically in healthcare design, using clinical output to better inform and improve the design and performance of healthcare environments.

And for me, evidence-based design does not need to be so stodgy and formal. It can be based on traditional means:  pebble projects, academic or medical school research or clinical trials. However, it can also be done the way other non-architectural design firms learn:  anthropology, i.e. watching people use something in their natural environment, or first-hand accounts through actual use by the designer.

However it is done, evidence-based design is here to stay I feel, at least in healthcare. It is logical, defensible and economically practical.  Designers need to get comfortable seeking out the information, having open discussions with administrators and users about the research, and coming to a consensus on how to best use the evidence.  When this happens theory and practicality will merge as caregiving and design for caregiving will merge—and the results will hopefully be revolutionary for designer, caregiver and patient.

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