[3] Studies have since examined the relationships between design of the physical environment of hospitals with outcomes in health, the results of which show how the physical environment can lower the incidence of nosocomial infections, medical errors, patient falls, and staff injuries;[4][5] and reduce stress of facility users, improve safety and productivity, reduce resource waste, and enhance sustainability.
[6] Evidence in EBD may include a wide range of sources of knowledge, from systematic literature reviews to practice guidelines and expert opinions.
[1] The roots of evidence-based design could go back to 1860 when Florence Nightingale identified fresh air as "the very first canon of nursing," and emphasized the importance of quiet, proper lighting, warmth and clean water.
Perhaps so, but it is not less so upon the body on that account ...."[10] Nightingale’s ideas appear to have been influential on E R Robson, architect to the London School Board, when he wrote: “It is well known that the rays of the sun have a beneficial influence on the air of a room, tending to promote ventilation, and that they are to a young child very much what they are to a flower.” [11] The evidence-based design movement began in the 1970s with Archie Cochranes's book Effectiveness and Efficiency: Random Reflections on Health Services.
A 1984 study by Roger Ulrich[13] seemed to support Nightingale's ideas from more than a century before: he found that surgical patients with a view of nature suffered fewer complications, used less pain medication and were discharged sooner than those who looked out on a brick wall; and laid the foundation for what has now become a discipline known as evidence-based design.
[16] In the 1960s and 1970s numerous studies were carried out using methods drawn from behavioural psychology to examine both people’s behaviour in relation to buildings and their responses to different designs – see for example the book by David Canter and Terence Lee [17] More recently, architectural researchers have conducted post-occupancy evaluations (POE) to provide advice on improving building design and quality.
In an early review of evidence in the healthcare sector, Rubin, Owens & Golden[21] examined the medical literature for research papers on the effect of the physical environment on patient outcomes.
The study categorised the evidence as conclusive, strong, suggestive or anecdotal, and also noted the difficulty of establishing causation since various design elements may be found in combination with other features.
In its 2003 review of the evidence about housing [25] CABE expressed similar concerns about the evidence base when it said: “The most striking finding in a review of the literature relating to the quality of residential design is the almost complete absence of any empirical attempts to measure the implications of high quality on costs, prices or values.” David Halpern’s book [26] brings together and reviews a substantial number of studies covering among other issues: mental ill-health in city centres; social isolation in out of town housing estates; residential satisfaction; and estate layouts, semi-private spaces and a sense of community.
He concludes that there is substantial evidence to show the physical environment has real and significant effects on group and friendship formation, and on patterns of neighbourly behaviour.
[31] It concluded that there was evidence for the effect of basic physical variables (air quality, temperature, noise) on learning but that once minimum standards were achieved, further improvements were less significant.
[34] In the higher education sector, a review by CABE[35] reports on the links between building design and the recruitment, retention and performance of staff and students.
A study in 2000 by Sheffield Hallam University[36] reported that apart from surveys of occupants of individual offices, the evidence base on new workplaces was mainly journalistic and biased towards interviews with successes and failures.
There is a growing awareness among healthcare professionals and medical planners for the need to create patient-centered environments that can help patients and family cope with the stress that accompanies illness.
[38] There is also growing supporting research and evidence through various studies that have shown both the influence of well-designed environments on positive patient health outcomes, and poor design on negative effects including longer hospital stays.
[38] Using biophilic design concepts in interior environments is increasingly argued to have positive impacts on health and well-being through improving direct and indirect experiences of nature.
Contact with nature and daylight[43] has been found to enhance emotional functioning; drawing on research from studies (EBD) on well-being outcomes and building features.
Technical systems, such as heating, ventilation and air-conditioning, have interrelated design choices and related performance requirements (such as energy use, comfort and use cycles) are variable components.
[48] Sackett, Rosenberg, Gray, Haynes and Richardson argue that "evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients".
The Center for Health Design developed the Pebble Project,[51] a joint research effort by CHD and selected healthcare providers on the effect of building environments on patients and staff.
A systematic review process should follow five steps: According to Hamilton,[8] architects have a responsibility in translation of research in the field, and its application in informing designs.