Implementing Evidence-based Design in Hospital Architecture and Changing Design Process: A Pilot Case Study

Presented by: Suining Ding

As a new paradigm in healthcare design in the 21st century, evidence-based design (EBD) has played a critical role in changing hospital architectural design process and shaping new images of hospital architecture. Evidence-based design is research-informed and its results not only affect patient clinical outcomes, but also medical facility operational efficiency and its staff retention and satisfaction. The design process traditionally consists of four phases: programming/conceptual design, schematic design, design development, and construction documents. Joseph et al. (2008) outlines a cyclical framework for the evidence-based design process that is presented as: 1) Identifying available research evidence-literature, existing knowledge, original data collection; 2) Critically analyzing research evidence; 3) Design Innovations; and 4) Conducting research studies to assess the effect of design innovations (Joseph & Kirk Hamilton, 2008). What remains unknown, however, is how these EBD steps are incorporated in traditional design process. It has been a promising path forward in healthcare design that design decisions should be made based on evaluation of creditable evidence (Hamilton & Watkins, 2008). Yet, as in any field, execution typically lags behind theory and research (Ulrich, Berry, Quan, & Turner Parish, 2010). Thus, little information has been found regarding how credible research is implemented in healthcare design practice in order to achieve the best possible outcomes. The purpose of this pilot project is to understand how evidence-based design has been implemented in hospital architectural design process through a case study in Grandriver Hospital in the United States. Grandriver Hospital is a successful project that is designed by implementing research evidence. This study takes a qualitative approach with grounded theory methodology. The methods used for this research are multiple sources of data collection through document reviews, observations and interviews. Total seven participants were interviewed including architects, designers and contractors. As part of the grounded theory methodology, a three-stage coding paradigm is used to organize and analyze the data. The research findings indicate that value of evidence-based design for healthcare settings is indisputable, and its benefits to patients, staff, and hospital administrators are undeniable. Architects and designers have used credible research evidence to support their design decisions. Comparing with traditional design process, there are two major differences in this project’s process. One difference is using Integrated Project Delivery (IPD) approach even though it is not contractual. IPD means all stakeholders were brought on board at the very beginning by participating in several design charrettes. Another major difference in the design process is to build “mock-ups” for patient rooms and nurse stations. It ensured that the users’ needs and expectations were met. Regarding the implementation of research evidence, the common theme running through the interviews is that clear research evidence linking positive outcomes is needed. Sometimes, it is frustrating for designers to read research articles that state future research is needed regarding the research findings. Given the nature of the design activities that are creative and intuitive, architectural theories should propose solutions in the form of analytic-normative complexes of theoretical ideas (Hillier, 1996). The normative statements in the form of prescriptions for particular environment attributes need to be supported by better understanding and explanation (Rapoport, 1987). Since the subject matter of Evidence-based Design is complex and multifaceted, implementing Evidence-based Design in healthcare architecture and mastering the knowledge for the application of research findings in healthcare settings require sensitivity and creativity.


  • Hamilton, D Kirk, & Watkins, David H. (2008). Evidence-based design for multiple building types: Wiley. com.
  • Hillier, Bill. (1996). Space is the machine: a configurational theory of architecture.
  • Joseph, Anjali, & Kirk Hamilton, D. (2008). The Pebble Projects: coordinated evidence-based case studies. Building Research & Information, 36(2), 129-145.
  • Rapoport, Amos. (1987). On the cultural responsiveness of architecture. Journal of architectural education, 41(1), 10-15.
  • Ulrich, Roger S, Berry, Leonard, Quan, Xiaobo, & Turner Parish, Janet. (2010). A conceptual framework for the domain of evidence-based design. Health Environments Research & Design Journal, 2012-2069.
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