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.

This thesis concerns Patient Experience (PX), in hospital maternity care in Sweden. The focus lies in the development of a measure to describe the current state of PX. The thesis uses a semi-sequential mixed-methods study design; exploration of the patient journey, through qualitative methods, informs the adaptation of an existing maternity care experience survey instrument. The resulting survey instrument is tried in a pilot study and renders a composite measure of PX. Part of the analysis is dedicated to understanding the e!ect of information and communication in PX; Exploratory Factor Analysis is used to test the model and attempt an answer. The results show that it is possible to describe PX using the proposed survey instrument. The composite measure preserves di!erences in perceptions better than an arithmetic average of two discrete VAS-1 type measurements, and is more appropriate when measuring attitudes, and opinions using Likert-type measures. A three component solution describes 65.44% of the total sample variance. Determining to what degree PX is influenced by information and communication remains di"cult to quantify, but these initial results indicate that the manner of the attending sta! during aftercare and the respondent’s mastery of information during discharge are important dimensions of patients’ total PX (ANOVA R .695, R Square .483). The model’s three components are almost entirely built from items that address interpersonal skills and information assimilation. These correspond to two of the three Service Quality Dimensions, namely Interaction Quality and Outcome Quality. Most important of the three is the component “Chemistry in aftercare”. The predictive strength of the model shows merit under the context of the study and could advise further e!orts to develop measurements for PX in maternity care in a Swedish hospital setting. Lastly, this study contextualises Service Design in hospital maternity healthcare; the study therefore o!ers ample opportunity for innovation. / Arbetet handlar om Patientupplevelse (PU), i förlossningsvården i Sverige. Fokus ligger på utvecklingen av ett mätvärde att beskriva den nuvarande patientupplevelsen. Arbetet använder kvalitativa och kvantitativa metoder (mixed-methods), i en semi-sekventiell design; utforskning av patientresan ligger till grund för anpassningen av ett existerande mätinstrument. Det nya mätinstrumentet testas i en pilotstudie och ger ett kompositmätvärde av PU. En del av analysen ägnas åt att förstå vilken e!ekt information och kommunikation har på PU; Explorativ faktoranalys används för ändamålet. Resultaten visar att det är möjligt att beskriva PU genom det föreslagna mätinstrumentet. Det resulterande kompositvärdet är bättre på att beskriva skillnader i uppfattning än ett medelvärde av två diskreta variabler av VAS-1 typen, och är också lämpligare när attityder och åsikter mäts med hjälp av Likert-skalor. En trekomponentslösning beskriver 65.44% av den totala stickprovsvariansen. Att avgöra hur mycket PU påverkas av information och kommunikation förblir svårt att kvantifiera, men dessa inledande resultat visar att patientbemötande under eftervårdstiden och patientens förmåga att bemästra information under utskrivningen är viktiga dimensioner av patienters totala PU (ANOVA R .695, R Square .483). Modellens tre komponenter är nästan uteslutande uppbyggda av variabler som fångar upp personliga relationer och assimilering av information. Dessa motsvarar två av de tre dimensionerna i Servicekvalitetsmodellen, nämligen Interaktionskvalitet och Utfallskvalitet. Viktigaste komponenten är Personlig kemi under eftervården. Modellens förutsägningsstyrka visar förtjänst under studiens kontext och kunde informera framtida ansträngningar att utveckla mätvärden för förlossningsvården inom svensk sjukhusmiljö. Till sist kan nämnas att studien kontextualiserar Service Design inom förlossningsvården; studien erbjuder därför omfattande möjligheter för innovation.