Healthcare Design - October 2015 - 38


beyond that. A new comprehensive review could survey
hundreds of studies, including many that have appeared
since the last review. And when a skilled, talented team
carefully does a systematic review, it can identify patterns
across findings and draw broader conclusions. This can
enable new insights and sometimes identify new design
approaches. A review would also show where there are
major gaps in knowledge. A good review evaluates the
strengths, or the scientific quality, of individual studies-so
the reader can know which studies and findings to take
more seriously. Right now, that's rarely done.
What will it take for that to happen?
It would take a sizable grant and a team of well-qualified
and dedicated researchers. It's a big, sprawling, fastevolving topic. I think some of the newer studies are like
rough diamonds that are widely scattered through different fields. It takes a team to go out and find them.
Here's a small example that illustrates why a new literature review is needed: There was a study in 2011 called
"Infection Acquisition Following Intensive Care Unit Room
Privatization" [by Teltsch et al.] that appeared in Archives
of Internal Medicine. This journal is selective, influential,
quoted by major media, and has a higher readership
impact than any design-related journal in the world. This
study was no rough gem hidden away in an obscure journal. It was a glittering nugget right there in plain sight.
The research took place at a university medical center
in Canada, where rates of different types of drug-resistant
infections were studied in two ICUs with multibed rooms.
Some rooms held up to 12 patients. One ICU was closed
and renovated to single rooms, while the other ICU continued unchanged with multibed rooms.
The researchers compared infection acquisition in the
two ICUs. Infection rates continued to be high in the ICU
that was not renovated. But importantly, infection rates
immediately plummeted in the newly renovated ICU with
single rooms-acquisition of serious infections (C. difficile,
MRSA) went down 54 percent soon after it opened. Infections declined so much that the overall length of stay (all
patients) in the renovated ICU was shortened by 10 percent. This suggests the renovation saved a lot of money in
care costs (not to mention saving lives), and the renovation expense was repaid fairly quickly by cost savings.
Unfortunately, I detected little or no awareness at
conferences or among practitioners of this ICU study,
or for that matter of several other design/safety studies
that have appeared since 2008. I've attended healthcare design presentations where architects, facility
managers, and even some clinicians recite the same
EBD guidelines from the 2008 survey, and then go on
to criticize what they see as a lack of new research.
This shows these professionals have not taken the
trouble to spend a few afternoons using Google
38

HCDmagazine.com 10.15

Scholar or other research databases to
find new studies. Sometimes one hears
this complaint from design firms that,
in the same breath, are emphasizing to
clients that they have expertise in EBD. It
is disappointing. It makes the firm's claim
of EBD expertise ring hollow, because
it shows they're not really trying to stay
current.
What do you say to those who suggest
that EBD can actually get in the way of
innovation?
I take the issue seriously. Going back to
the late 1990s, I heard criticism from some
architects in the U.S. that EBD was going
to constrain creativity and get in the way
of innovation. Creativity would be put in
handcuffs by EBD guidelines. Some worried Top: Ulrich received the President George H. W.
that it would have the effect of marginalizing
Bush Award for Excellence and Pre-eminence in
International Research in 2007 at the George H.
the role of the architect compared to other
W. Bush Presidential Library in College Station,
stakeholders. A few university-based architects (with little practice experience) equated Texas. Above: During a 2006 personal meeting
with Prince Charles in London, Ulrich discussed
EBD with the Forces of Darkness.
hospital architecture and the role of evidenceAt the time, I was on the faculty of the
based design.
College of Architecture at Texas A&M University and met regularly with architects from several firms
that were major players in healthcare design. By the early
2000s, these leading practitioners were saying that EBD
promoted innovation rather than hindered it. One effect of
EBD was to raise the quality bar in the design specifications
for new projects and possibly increase budgets. They indicated that clients were placing more and more priority on
design research and that expertise in EBD was an advantage in winning projects. It was becoming a requirement to
bid for a growing number of projects.
Concerning creativity versus guidelines, the premise
that design should be performance-oriented is basic to the
guidelines' rationale. The effects of the project design on
outcomes should be measured. I endorse a performancebased approach to EBD guidelines that leaves it to the
design team to find a creative and effective way to build the
solution.
This certainly should not be a checkbox-based approach
to design. Research findings can help designers find new
solutions that perform well, and point them away from directions that are likely to fail.
There are many examples of design innovations that
might never have occurred if the designers had not been
informed by research and performance thinking. Here's
one example that has turned out to be influential. A few
years ago I was a consultant to RTKL for a consortium bid
for a PFI [private finance initiative] hospital in England. The
specifications required single patient rooms with several


http://www.HCDmagazine.com

Table of Contents for the Digital Edition of Healthcare Design - October 2015

Healthcare Design - October 2015
Contents
hcdmagazine.com
Editorial
Show Talk
Monitor
Interiors
The Center
Adapt and Overcome
Seeds of Change
Site Seeing
State of Mind
Research
Special Advertising Section: 2015 Landscape Design Portfolio
First Look
Healthcare Design - October 2015 - Healthcare Design - October 2015
Healthcare Design - October 2015 - Cover2
Healthcare Design - October 2015 - 1
Healthcare Design - October 2015 - Contents
Healthcare Design - October 2015 - 3
Healthcare Design - October 2015 - hcdmagazine.com
Healthcare Design - October 2015 - 5
Healthcare Design - October 2015 - Editorial
Healthcare Design - October 2015 - 7
Healthcare Design - October 2015 - Show Talk
Healthcare Design - October 2015 - 9
Healthcare Design - October 2015 - Monitor
Healthcare Design - October 2015 - 11
Healthcare Design - October 2015 - 12
Healthcare Design - October 2015 - 13
Healthcare Design - October 2015 - 14
Healthcare Design - October 2015 - 15
Healthcare Design - October 2015 - 16
Healthcare Design - October 2015 - 17
Healthcare Design - October 2015 - 18
Healthcare Design - October 2015 - 19
Healthcare Design - October 2015 - Interiors
Healthcare Design - October 2015 - 21
Healthcare Design - October 2015 - 22
Healthcare Design - October 2015 - 23
Healthcare Design - October 2015 - 24
Healthcare Design - October 2015 - 25
Healthcare Design - October 2015 - The Center
Healthcare Design - October 2015 - 27
Healthcare Design - October 2015 - Adapt and Overcome
Healthcare Design - October 2015 - 29
Healthcare Design - October 2015 - 30
Healthcare Design - October 2015 - 31
Healthcare Design - October 2015 - 32
Healthcare Design - October 2015 - 33
Healthcare Design - October 2015 - 34
Healthcare Design - October 2015 - 35
Healthcare Design - October 2015 - Seeds of Change
Healthcare Design - October 2015 - 37
Healthcare Design - October 2015 - 38
Healthcare Design - October 2015 - 39
Healthcare Design - October 2015 - 40
Healthcare Design - October 2015 - 41
Healthcare Design - October 2015 - Site Seeing
Healthcare Design - October 2015 - 43
Healthcare Design - October 2015 - State of Mind
Healthcare Design - October 2015 - 45
Healthcare Design - October 2015 - 46
Healthcare Design - October 2015 - 47
Healthcare Design - October 2015 - 48
Healthcare Design - October 2015 - 49
Healthcare Design - October 2015 - 50
Healthcare Design - October 2015 - 51
Healthcare Design - October 2015 - 52
Healthcare Design - October 2015 - 53
Healthcare Design - October 2015 - Research
Healthcare Design - October 2015 - 55
Healthcare Design - October 2015 - 56
Healthcare Design - October 2015 - 57
Healthcare Design - October 2015 - Special Advertising Section: 2015 Landscape Design Portfolio
Healthcare Design - October 2015 - 59
Healthcare Design - October 2015 - 60
Healthcare Design - October 2015 - 61
Healthcare Design - October 2015 - 62
Healthcare Design - October 2015 - 63
Healthcare Design - October 2015 - First Look
Healthcare Design - October 2015 - Cover3
Healthcare Design - October 2015 - Cover4
Healthcare Design - October 2015 - SCover1
Healthcare Design - October 2015 - S1
Healthcare Design - October 2015 - S2
Healthcare Design - October 2015 - S3
Healthcare Design - October 2015 - S4
Healthcare Design - October 2015 - S5
Healthcare Design - October 2015 - S6
Healthcare Design - October 2015 - S7
Healthcare Design - October 2015 - S8
Healthcare Design - October 2015 - S9
Healthcare Design - October 2015 - SCover3
Healthcare Design - October 2015 - SCover4
https://www.nxtbook.com/nxtbooks/healthcaredesign/202010
https://www.nxtbook.com/nxtbooks/healthcaredesign/202009
https://www.nxtbook.com/nxtbooks/healthcaredesign/202008
https://www.nxtbook.com/nxtbooks/healthcaredesign/20200607
https://www.nxtbook.com/nxtbooks/healthcaredesign/202005
https://www.nxtbook.com/nxtbooks/healthcaredesign/202004
https://www.nxtbook.com/nxtbooks/healthcaredesign/202003
https://www.nxtbook.com/nxtbooks/healthcaredesign/20200102
https://www.nxtbook.com/nxtbooks/healthcaredesign/201912
https://www.nxtbook.com/nxtbooks/healthcaredesign/201911
https://www.nxtbook.com/nxtbooks/healthcaredesign/201910
https://www.nxtbook.com/nxtbooks/healthcaredesign/201909
https://www.nxtbook.com/nxtbooks/healthcaredesign/201908
https://www.nxtbook.com/nxtbooks/healthcaredesign/20190607
https://www.nxtbook.com/nxtbooks/healthcaredesign/201905
https://www.nxtbook.com/nxtbooks/healthcaredesign/201904
https://www.nxtbook.com/nxtbooks/healthcaredesign/201903
https://www.nxtbook.com/nxtbooks/healthcaredesign/201902
https://www.nxtbook.com/nxtbooks/healthcaredesign/201901
https://www.nxtbook.com/nxtbooks/healthcaredesign/201812
https://www.nxtbook.com/nxtbooks/healthcaredesign/201811
https://www.nxtbook.com/nxtbooks/healthcaredesign/201810
https://www.nxtbook.com/nxtbooks/healthcaredesign/201809
https://www.nxtbook.com/nxtbooks/healthcaredesign/201808
https://www.nxtbook.com/nxtbooks/healthcaredesign/20180607
https://www.nxtbook.com/nxtbooks/healthcaredesign/201805
https://www.nxtbook.com/nxtbooks/healthcaredesign/201804
https://www.nxtbook.com/nxtbooks/healthcaredesign/201803
https://www.nxtbook.com/nxtbooks/healthcaredesign/201802
https://www.nxtbook.com/nxtbooks/healthcaredesign/201801
https://www.nxtbook.com/nxtbooks/healthcaredesign/201712
https://www.nxtbook.com/nxtbooks/healthcaredesign/201711
https://www.nxtbook.com/nxtbooks/healthcaredesign/201710
https://www.nxtbook.com/nxtbooks/healthcaredesign/201709
https://www.nxtbook.com/nxtbooks/healthcaredesign/201708
https://www.nxtbook.com/nxtbooks/healthcaredesign/201706
https://www.nxtbook.com/nxtbooks/healthcaredesign/201705
https://www.nxtbook.com/nxtbooks/healthcaredesign/201704
https://www.nxtbook.com/nxtbooks/healthcaredesign/201703
https://www.nxtbook.com/nxtbooks/healthcaredesign/201702
https://www.nxtbook.com/nxtbooks/healthcaredesign/201701
https://www.nxtbook.com/nxtbooks/healthcaredesign/201612
https://www.nxtbook.com/nxtbooks/healthcaredesign/201611
https://www.nxtbook.com/nxtbooks/healthcaredesign/201610
https://www.nxtbook.com/nxtbooks/healthcaredesign/201609
https://www.nxtbook.com/nxtbooks/healthcaredesign/201608
https://www.nxtbook.com/nxtbooks/healthcaredesign/20160607
https://www.nxtbook.com/nxtbooks/healthcaredesign/201605
https://www.nxtbook.com/nxtbooks/healthcaredesign/201604
https://www.nxtbook.com/nxtbooks/healthcaredesign/201603
https://www.nxtbook.com/nxtbooks/healthcaredesign/20160102
https://www.nxtbook.com/nxtbooks/healthcaredesign/201512
https://www.nxtbook.com/nxtbooks/healthcaredesign/201511
https://www.nxtbook.com/nxtbooks/healthcaredesign/201510
https://www.nxtbook.com/nxtbooks/healthcaredesign/201509
https://www.nxtbook.com/nxtbooks/healthcaredesign/201508
https://www.nxtbook.com/nxtbooks/healthcaredesign/201506
https://www.nxtbook.com/nxtbooks/healthcaredesign/201505
https://www.nxtbook.com/nxtbooks/healthcaredesign/201504
https://www.nxtbook.com/nxtbooks/healthcaredesign/201503
https://www.nxtbook.com/nxtbooks/healthcaredesign/201501
https://www.nxtbook.com/nxtbooks/healthcaredesign/201412
https://www.nxtbook.com/nxtbooks/healthcaredesign/201410
https://www.nxtbook.com/nxtbooks/healthcaredesign/201409
https://www.nxtbook.com/nxtbooks/healthcaredesign/201408
https://www.nxtbook.com/nxtbooks/healthcaredesign/201407
https://www.nxtbook.com/nxtbooks/healthcaredesign/201405
https://www.nxtbook.com/nxtbooks/healthcaredesign/201404
https://www.nxtbook.com/nxtbooks/healthcaredesign/201403
https://www.nxtbook.com/nxtbooks/healthcaredesign/201401
https://www.nxtbook.com/nxtbooks/healthcaredesign/201312
https://www.nxtbook.com/nxtbooks/healthcaredesign/201311
https://www.nxtbook.com/nxtbooks/healthcaredesign/201310
https://www.nxtbook.com/nxtbooks/healthcaredesign/201309
https://www.nxtbook.com/nxtbooks/healthcaredesign/201308
https://www.nxtbookmedia.com