Evidence-based design for healthcare buildings in England and Wales

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