Progressive efforts within the healthcare design community have led to a call for architects to use relevant scientific research in design decision making in order to provide facilities that are safe, efficient, and flexible enough to accommodate evolving care processes. Interdisciplinary design project teams comprising architects, interior designers, engineers, and a variety of consultants struggle to find ways to deal with the challenge of incorporating the evidence base into the projects at hand. To date there has been little research into how these interdisciplinary teams operate in the real world and especially how they communicate and attempt to integrate evidence coming from different sources into the architectural design that is delivered. This study presents an investigation of a healthcare design project in situ by using methods of ethnographic inquiry, with the aim of developing an enhanced understanding of actual collaborative healthcare design practices. A major finding is that ‘evidence’, as used in practice is a richly textured notion extending beyond just the scientific research base. The description and analysis of the observed practices is presented around two core chapters involving the design process of 1) the emergency department and 2) the inpatient unit. Each design episode, which depicts the complex socio-cognitive landscape of architectural practice, introduces how evidence, with its various types and representational forms, was generated, represented, evaluated, and translated within the interdisciplinary design team. Strategically utilizing various design media, including layout drawings and mock-ups, the architects represented and negotiated a set of physical design attributes which were supported by differing levels of scientific research findings, anecdotes, successful precedents, in-house experimental findings, and intuition, each having different affordances and constraints in solving design problems over time. Individually, or combined into larger “stories” which were collectively generated, the set of relevant evidence provided a basis for decision making at various scales, ranging from minor details within rooms to broader principles to guide design work over the course of the project. Emphasizing the role of the architects in translation of evidence, the design episodes provide vivid examples of how various forms of evidence shape the design of healthcare environments. The case observed in this research demonstrated that the participants formulated and explained their design ideas in terms of mechanistic arguments where scientific research, best practices, and anecdotal evidence were integrated into segments that formed causal links. These mechanistic models, as repositories of trans-disciplinary knowledge involving design, medicine, epidemiology, nursing, and engineering, expand the scope of traditional understanding of evidence in healthcare design. In facilitating design processes architects are required not only to become knowledgeable about the available evidence on healthcare, but also to use their meta-expertise to interpret, translate (re-present), and produce evidence in order to meaningfully engage in interdisciplinary exchanges. In re-presenting causal models through layouts or mock-ups, architects play a critical role in evidence-based design processes through creating a platform that displays shortcomings of available evidence and shows where evidence needs to be created in situ.

Healthcare facilities are dynamic, long-term investments that must be able to respond to change in order to avoid obsolescence. Flexibility is a response used in healthcare facility design and construction to counter uncertainties, such as changing medical technologies, medical science and regulations. Flexible infrastructure design offers healthcare facilities the opportunity to combat obsolescence stemming from uncertainties. Interstitial Building Space (IBS) is one of many flexible infrastructure design options that assists with both mid-range and long-term flexibility. IBS is an unfinished and unoccupied horizontal space between a building's floors, fully accessible to people for the purpose of service and maintenance. The advent of Evidence Based Design (EBD) introduced a new dimension to the already dynamic healthcare facility. "EBD represents a body of science that links elements of the built environment with patient, staff and resource outcomes" (Malone et al. 2007 p.5). The incorporation of EBD increases the complexity for the design and construction of healthcare facilities. A framework was developed that articulates the dependent relationships between flexibility, IBS and EBD. The framework is comprised of three key elements: 1) a comprehensive "IBS Spectrum of Benefits" matrix resulting from a systematic literature review 2) a "Flexibility-EBD Conceptual Model" illustrating the relationship between flexibility and EBD, while identifying a continuum of flexibility enabled by this relationship; and 3) a "IBS-EBD Component Mapping Framework" articulating direct matches between the "IBS Spectrum of Benefits" and EBD components. The framework and the key elements within provide a foundational resource for stakeholders and researchers alike, navigating the interrelated intricacies associated with flexibility, EBD and IBS. / Master of Science / Healthcare facilities are dynamic, long-term investments that must be able to respond to change in order to avoid obsolescence. Flexibility is one response which enables facilities to combat changes and/ or uncertainties. This thesis explores the relationships between flexibility, Interstitial Building Space and Evidence Based Design, documents each relationship, and depicts their interrelated nature with the establishment of an overarching framework.

Urban designers do not typically include research or evidence in practice, though the need for an evidence-based approach is becoming increasingly apparent. The way our built environment is constructed affects our health, well-being, and sense of place, as prior research has uncovered. Historically, urban design practice has negatively affected the well-being of urban residents by reinforcing inequitable social and power structures through the design of public space. Some theorists and designers have proposed evidence-based approaches as a response to these concerns. However, the emerging approaches can be disjointed. Tensions arise when deciding between the many types of evidence urban designers can use, and the different ethics they represent. In this thesis, I analyze three existing approaches to evidence-based urban design, including their benefits and their concerns, and ultimately argue that a convergent method is necessary. The conceptual framework I develop is one that responds to concerns of equity and accountability in the built environment, while also maintaining the significance of good design and acknowledging the inevitable integration of technology into society today. / Master of Urban and Regional Planning / Urban design is typically an artistic profession, and conducting or referencing research is not necessarily part of an urban designer's day-to-day. However, the need for a research-backed, or evidence-based, approach to public space design is becoming increasingly apparent. Prior researchers have suggested that the way our cities, neighborhoods, parks, roadways and other public spaces are constructed has an effect on our mental and physical health. Historically, these spaces have been designed to reinforce patterns of social inequity, which has negatively affected the well-being of urban residents. Some theorists and designers have proposed evidence-based approaches as a response to these concerns. However, the emerging approaches towards evidence-based urban design sometimes have conflicting physical and social goals. In this thesis, I analyze three existing approaches to evidence-based urban design, including their benefits and their concerns. I ultimately argue that a new method, which converges the existing methods, is necessary. The conceptual framework I develop is one that responds to concerns of equity and accountability in urban space, maintains the significance of artistry and good design, and acknowledges the inevitable integration of technology into society today.

The objective of this research is to review the degree of United States Army compliance in the implementation of evidence-based design practices within the Military Health System construction cycle. This research looks at the impact of the 2007 Assistant Secretary of Defense for Health Affairs memorandum directing the use of evidence-based design within the Military Healthcare System construction process. The memorandum impacted the military medical construction process that includes over 6.2 billion dollars in government programmed military medical construction covering 9.2 million beneficiaries. An analysis of federal construction documents, interviews, and an online survey was conducted with 85 government and civilian healthcare facility planners to measure general evidence-based design knowledge, direct knowledge of medical construction policy requirements, and the level to which the Military Health System Evidence-based Design Principles matrix has been implemented within four selected military medical construction projects. Results of the review of construction publications show minimal evidence of evidence-based design incorporation with key federal regulatory documents. The results of an online survey conducted during the research had a 65.8% response rate (39 government personnel, 17 civilian personnel). The survey showed that basic knowledge of evidence-based design was present, but revealed severe deficiencies in specific knowledge and application of construction policies. Review of selected medical facilities demonstrated non-standardized incorporation of evidence-based design features. This research concludes that evidence-based design has achieved minimal integration into the Military Health System general knowledge base and project execution. Achieving compliance with the 2007 directive memorandum requires that significant efforts be made in personnel training and reconciliation with federal military medical construction documents.

Thesis (M.Sc.)--York University, 2007. Graduate Programme in Computer Science. / Typescript. Includes bibliographical references (leaves 112-117). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38843

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Dans un contexte mondial de vieillissement de la population, de nombreuses recherches sont menées pour améliorer la qualité de vie des personnes âgées résidant en institution, mais peu de ces travaux développent une approche architecturale. Cette recherche a pour but de proposer de nouvelles manières d’aménager ces lieux de vie, en rupture avec les paradigmes dominants du soin et de l’hôtellerie. L’hypothèse générale est qu’un environnement architectural de type domestique (-homelike) permettra aux résidents de se sentir habitants, ce qui devrait favoriser leur bien-être, leur autonomie et le développement d’interactions sociales. Notre procédure s’est basée sur le concept de l’Evidence-Based Psychology (-psychologie fondée sur la preuve), avec un essai randomisé contrôlé. Elle a consisté à réaménager de manière domestique l’espace d’entrée de plusieurs établissements dits « standards », puis à évaluer selon les méthodes de comparaison avant vs après ; établissement réaménagé vs non réaménagé. L’étude a été multidimensionnelle et exploratoire dans ses outils de recherche ; échelles de qualité de vie, cartographie comportementale, entretiens qualitatifs. Ce travail s’inscrit dans le contexte d’un développement récent du doctorat en architecture en France et contribue de fait à la réflexion épistémologique qui l’accompagne. Il permet également pour de faire prendre conscience de l’importance du cadre bâti pour la qualité de vie et met en avant le rôle social de l’architecte. / In a global context of population ageing, many research are conducted to improve the quality of life of older people living in assisted living facilities, but few of these works develop an architectural approach. This research aims to propose new ways to design these places of life, breaking with the dominant hospital and/or hotel models. The general assumption is that an architectural environment with homelike characteristics will allow residents to feel inhabitants, which should promote their welfare, autonomy and the development of social interactions. Our procedure is based on the concept of Evidence Based Psychology, with a randomized controlled trial. The entrance hall of several facilities corresponding to standards were refurbished in a homelike way, and then we evaluated comparing before vs after; refurbished nursing home vs non refurbished. The study was multidimensional and exploratory in its research tools; quality of life scales, behavioral mapping, qualitative interviews. This work take place in the French context of recent emergence of PhD in architecture and contributes de facto to the epistemological reflection that goes with it. It also helps to raise awareness of the importance of the built environment to the quality of life and highlights the social role of architectes.

A substantial amount of credible evidence shows that properly designed healthcare built environments can positively impact upon the health outcomes of the building users. This offers an opportunity to improve the quality of healthcare through appropriately designed healthcare built environments. Evidence-based design (EBD) emerged within healthcare building design practice to enhance the process of designing with credible evidence. This research explored improvement opportunities for EBD in the UK which would subsequently improve the quality of healthcare through built environment interventions. Specifically, three key research gaps were addressed during this research. Firstly, this research explored current practices of evidence use during healthcare designing and opportunities to increase the direct use of research-based evidence and alternative ways of conveying research-based evidence into the design process through other source of generic evidence for design. Secondly, this research explored how evidence could be effectively expressed within healthcare design standards, guidance and tools (SGaTs) in the forms of performance and prescriptive specifications. Finally, considering the unique nature of built environment design, this research explored how project unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances. These challenges were then transformed into six objectives. Following a comprehensive literature review, this research was divided into four phases. First, a model of the sources and flows of evidence (SaFE) was developed to represent evidence for EBD within generic evidence for design. The initial conceptual model was developed through desk study, based on the literature review, self-experience and the experience. This model was then verified with the comments from five un-structured interviews conducted with lecturers and senior lecturers of the School of Civil and Building Engineering. Finally, the model was validated using 12 semi-structured interviews conducted with design practitioners from the industry. In addition to the validating the sources and flows of evidence these interviews revealed rationales behind design practitioners use of evidence from four types of evidence sources. These results revealed improvement opportunities to increase the intake of research-based evidence use during healthcare built environments designing. The main data collection method for this research was case studies. Eight exemplar design elements within three case studies were investigated to explore details of evidence use practices; practices of using performance and prescriptive specifications; and impact of project unique contextual circumstances for EBD process and how design practitioners reflect on these circumstances. Results of this research revealed that EBD needs to be supported by both externally published research evidence and through internally generated evidence. It was also identified that EBD could be significantly facilitated through research- evidence informed other generic design evidence sources. Healthcare design SGaTs provides a promising prospect to facilitate EBD. Performance specification driven healthcare design SGaTs supplemented by prescriptive specifications to define design outputs and design inputs could improve effective use of evidence-informed SGaTs. These results were incorporated into a framework to guide development of healthcare design SGaTs. Finally, by exploring how projects unique contextual circumstances impact EBD processes and how practitioners reflect on these circumstances, this research identified the need for procedural guidance for designers to guide evidence acquisition, evidence application and new evidence generation.

Despite significant technological and scientific advances in healthcare provision and treatment in past decades, economies are struggling to address increasing costs while enhancing accessibility to quality health and care services. Globally, around 8.4% of gross domestic product (GDP) is spent on healthcare, with United States spending 17.4% of its GDP. There is, therefore, a growing interest in reducing healthcare costs and improving quality of care in terms of patients outcomes and their perception. Research has found strong association between physical environments and patient outcomes and staff and patient wellbeing. The acknowledgement of this link has led to the postulation of the idea of evidence based design (EBD) of healthcare facilities, in which design decisions are based on the evidence of the impact of environment on healthcare indicators. The key challenges for integrating EBD in healthcare design are the difficulty in disaggregating past research findings (i.e. evidence) from the context and the use of these findings, often hidden behind several behavioural and demographic variables or of the form of multi-dimensional indices, in design decision-making. Another recent development in healthcare is the patient-centred approach of care, in which patients perceptions and needs take the centre-stage in the planning and delivery of their care. Local and regional healthcare authorities are, therefore, interested in incorporating patients views in all aspects of care, including the design and operation of health and care facilities. Considering the gaps in knowledge, this research was aimed at investigating: users perception of physical environment indicators that had the potential for influencing their wellbeing and care outcomes, and the integration of their perception in the design of healthcare facilities through automated space layout planning. Perceptions of physical environment indicators were investigated using structured questionnaires among three user groups: inpatients, outpatients and healthcare providers. Resulting perception indicators were then used in a prototype automated space layout planning system, developed as part of this research, to aid the optimization process. The research has identified significant differences in perception between different user groups, in particular between males and females. Analyses of scaled responses indicate that environmental design (e.g. lighting and thermal comfort) and maintenance (e.g. cleanliness) related factors are more important to users than abstract architectural design factors (e.g. aesthetics). Accommodating the variation in perception would require individual approaches for the design of constituent spaces in a healthcare facility. With regard to the integration of user perception in design, the research demonstrates that qualitative indicators such as perception can be integrated in automated design frameworks and, therefore, design decisions can be based on a mix of quantitative and qualitative evidence. The application of automated layout planning system in the design of healthcare space layouts also demonstrates that computer-mediated systems and frameworks are a promising alternative to traditional manual design, if increasing number of design factors and objectives are to be reconciled for decision making.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Jessica Canfield / Landscape architecture is embarking on a new design frontier, one where its practitioners are increasingly being asked by clients to design using credible evidence and to ensure design performance. As design disciplines follow in the footsteps of other evidence-based practices, like medicine and engineering, landscape architecture is poised to become a more scholarly profession – a profession of evidence-based landscape architecture. Evidence-based landscape architecture was first coined and defined in 2011 by Brown and Corry as “the deliberate and explicit use of scholarly evidence in making decisions about the use and shaping of land” (Brown and Corry 2011, 328). Current literature explains the benefits of practicing evidence-based design (EBD). These include ensuring design performance, justifying client investment, quantifying the value of design, systematically managing complex projects, marketing the firm to clients, attracting the most innovative designers to the firm, and adding to the knowledge base of the landscape architecture field. However, little is known about how landscape architecture firms are engaging evidence-based design in daily practice. This thesis examines how four leading landscape architecture firms (Design Workshop, Mithun, Sasaki Associates, and OLIN) have developed unique EBD approaches to integrate, apply, and propagate evidence-based design in professional practice. In order to study and analyze the four firms’ EBD approaches, individual comprehensive case studies were conducted. Qualitative data was collected through: focused interviews with directors and leaders of evidence-based design at each firm; casual observations made during office visits; and, a review of firm literature. A case study framework for EBD approaches in professional practice was developed based on discussion topics that consistently emerged from the interviews. The framework was used to organize, analyze, and present the findings into four major themes. A cross-case analysis was conducted to compare the development, implementation, and effects of EBD approaches at each firm. Findings reveal that each firm has developed an EBD approach to meet the need for engaging complex problems and meeting increasing client expectations for performance. While each firm’s EBD approach is unique, similarities and characteristics emerged between the case studies. The most consistent factors identified across cases include: having academic founders of the firm; the implementation of EBD- or research-specific roles and responsibilities; the creation of tools to organize and understand data; cultivating design cultures to support the EBD approach vision; the communication and transparency of relationships with clients and consultants; and, the reporting of findings for the advancement of the profession. Although any landscape architecture firm is likely to employ at least one of these concepts, the developed integration, application, and propagation of a majority of these concepts is what makes these firms unique and successful in applying EBD in professional practice. It was also found that the design processes themselves vary dramatically across the firms. EBD in practice is therefore not prescriptive and does not always look the same. The findings and case study framework developed in the study are useful primarily for landscape architecture firms looking to develop, integrate, apply, and propagate their own EBD approach.