An Exploration of Military Health Facility Developers’ Perceptions of Evidence-Based Design, Choosing by Advantages, and Lean Culture

The requirement to implement Evidence-Based Design in all military hospital development was enacted in 2007. For almost a decade now, health facility developers have been formally educated on what EBD is, and how to apply it in the Military Health System. Many tools, such as the MHS EBD Checklist developed by The Center for Health Design, have been developed to assist facility planners in programming the right design interventions into the healing space. However, the trend of military medical facilities being delivered consistently behind schedule and over budget suggests that military planners are still struggling with EBD implementation, and its associated design decisions. This qualitative study examined some of the causal factors that result in scheduling delays and cost overruns to assess how paramount a role decision-making plays in the lack of delivery performance. In it, three facets of achieving an EBD healing environment were investigated: cultural transformation, adapting clinical operations, and the EBD built environment, which requires that decisions be made relative to how, and why, design interventions are selected to achieve World class healthcare. The purpose of this research was to investigate how inconsistent decision-making is a contributor to the degraded performance in military hospital construction, and determine whether Choosing by Advantages, a Lean Construction programming methodology, could be applied to improve Evidence-Based Design decision-making